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Food Protein-Induced Allergic Proctocolitis (FPIAP)
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Eliminate triggers, reintroduce around 1 year.
Decision
Outcome
Decision
Well-appearing infant <6 mo with blood-streaked stools and nonfocal exam. Feeding type?
✓
Breastfeeding → eliminate common triggers from maternal diet (dairy, soy)
✓
Formula → switch to hypoallergenic (extensively hydrolyzed) formula
Decision
Symptom response?
✓
Resolution → FPIAP confirmed; reintroduce around age 1
✓
Persistent → consider alternative dx (flex sig)
Outcome
Reintroduce offending protein around 1 year; most tolerate by 1–3 y
Outcome
Consider infectious colitis, IBD, intussusception — flex sigmoidoscopy if indicated