Pediatr Gastroenterol Hepatol Nutr.  2025 Mar;28(2):124-134. 10.5223/pghn.2025.28.2.124.

Difference in Cow’s Milk-Related Symptom Score (CoMiSS^TM ) Among Presumed Healthy Infants in Indonesia and Brazil

• Knockaert N
• Huysentruyt K
• Hegar B
• Franco JM
• Macedo VRS
• Vieira SCF
• Vandenplas Y

• KMID: 2565864
• DOI: http://doi.org/10.5223/pghn.2025.28.2.124

Abstract

Purpose
The Cow’s Milk-related Symptom Score (CoMiSS) improves the recognition of cow milk allergy (CMA) symptoms. A score of ≥10 should raise awareness of CMA. The median CoMiSS in healthy European infants aged <6 months is 3. This study aimed to determine the impact of different regions on CoMiSS in healthy infants aged <12 months to evaluate regional and age-related differences.
Methods
A prospective cross-sectional study was conducted at one hospital each in Indonesia (Jakarta) and Brazil (Sergipe). CoMiSS was assessed in healthy infants aged –12 months old.
Results
In Jakarta, a total of 286 infants (50.7% boys) were included. The median (interquartile range) CoMiSS was 1.5 (0–4); the 95th percentile was 7. In Sergipe, 101 infants (60.4% boys) were included. The median (interquartile range) CoMiSS was 4 (4–6); the 95th centile was 10.9. Age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94–0.99; p<0.001) and country (OR, 2.40; 95% CI, 2.06–2.79; p<0.001) were significant independent predictors of changes in mean CoMiSS in a linear regression model (r² =0.27).
Conclusion
Median CoMiSS in healthy infants differed between Jakarta and Sergipe (1.5 vs. 4.0). These findings highlight that the perceived normality of parents may be region-dependent.

Keyword

Cow’s Milk-related Symptom Score; Healthy infant; Infant colic; Regurgitation; Stool consistency