Pediatr Gastroenterol Hepatol Nutr.  2020 Mar;23(2):154-162. 10.5223/pghn.2020.23.2.154.

Cow's Milk-Related Symptom Score in Presumed Healthy Polish Infants Aged 0–6 Months

  • 1The Student's Scientific Group of the Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
  • 2Department of Paediatric, St. Hedwig Hospital in Trzebnica, Trzebnica, Poland.
  • 3KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
  • 4Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland.


The Cow's Milk-related Symptom Score (CoMiSS™), which considers crying, regurgitation, stools, skin and respiratory symptoms, was developed as an awareness tool for evaluating cow's milk-related symptoms. The scoring ranges from 0 to 33. A score ≥12 was proposed as being likely cow's milk-related and suggestive of allergy to cow's milk. This study aimed to determine the age-related CoMiSS™ values in presumed healthy infants in Poland.
This was a cross-sectional study conducted in well-child clinics in two locations. Parents of the presumed healthy infants aged ≤6 months were approached during a routine checkup/vaccination visit. The exclusion criteria were as follows: presence of acute or chronic diseases, preterm delivery, treatment with therapeutic formula, and use of any food supplements (except vitamins) or medications.
Data from 226 infants were obtained (median age [Q1-Q3], 4 months [3-4]). The overall median (Q1-Q3) and mean (standard deviation) CoMiSS™ values were 4 (2-7) and 4.7 (3.5), respectively. The 95th percentile was 11. Scores on some, albeit not all, components of the CoMiSS™ significantly differed between age groups (crying, stools) or feeding type groups (stools and skin symptoms). Eleven children (4.9%) scored ≥12.
This study adds to earlier age-related CoMiSSâ„¢ data by providing CoMiSSâ„¢ values in presumed healthy infants in Poland.


Infant; Milk; Food allergy; Food hypersensitivity

MeSH Terms

Chronic Disease
Cross-Sectional Studies
Dietary Supplements
Food Hypersensitivity


  • Fig. 1 Distribution of Cow's Milk-related Symptom Score (CoMiSS™) total scores.

  • Fig. 2 Distribution of Cow's Milk-related Symptom Score (CoMiSS™) individual scores by sex.

  • Fig. 3 Distribution of Cow's Milk-related Symptom Score (CoMiSS™) individual scores by age.

  • Fig. 4 Distribution of Cow's Milk-related Symptom Score (CoMiSS™) individual scores by the type of feeding.


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