Dr.dr.

Bernie Endyarni Medise, SpA(K), MPH

• Pekerjaan:
• Ketua Divisi Tumbuh Kembang – Pediatri Sosial, Departemen Ilmu
Kesehatan Anak (IKA) FKUI-RSCM
• Konsultan Tumbuh Kembang Anak Brawijaya Clinic @ Kemang
• Klinik Tumbuh Kembang Lalita, Summarecon Bekasi
• Riwayat pendidikan:
• Doktor Ilmu Kedokteran FKUI-RSCM
• Master of Public Health: University of Nebraska Medical Center, USA
• Sp II Tumbuh Kembang – Pediatri Sosial: Dep IKA FKUI-RSCM
• Dokter Spesialis Anak: Dep IKA FKUI-RSCM
• Dokter Umum: FKUI – RSCM
• Email: bernie.medise@yahoo.com
• Instagram: berniemedise
Optimalisasi tumbuh kembang
anak dengan alergi susu sapi
Bernie Endyarni Medise
4 Januari 2023
Definisi anak
Patterns of
development
• Normal
• Slow but steady
• Plateau
• Regression.

Lissauer T et.al. 2012

Brain architecture
Thompson and Nelson 2001
Normal brain
development
≈ normal
development
Importance of
developmental screening
and assessment
Lissauer T, Clayden G. Illustrated Textbook of Paediatrics. 2012
Lissauer T, Clayden G. Illustrated Textbook of Paediatrics. 2012
Faktor yang memengaruhi
perkembangan

Faktor
genetik

• ASI/PASI
Nutrisi • MP-ASI

• Protektif: Imunisasi, Perawatan

Kesehatan
Lingkungan: • Stimulasi
• Pola Asuh
Apa dampak Alergi
terhadap tumbuh
kembang anak?
Perjalanan bentuk • Bentuk alergi pada bayi hingga dewasa
alergi

Hill DA, 2017

 GI Tract

Alergi susu sapi Dysphagia

Vomitting, Diarrhea

(Cow’s milk allergy) Reflux, Colic

Respiratory Skin
Wheezing
Runny nose CMA Urticaria
Colic Cough Eczema

Runny nose General

Fatigue, Lethargy
Poor sleeping
Anaphylaxis
Risk factors leading to the poor growth
of children suffering from food allergies
▪ Delayed Diagnosis ▪ Elimination from the diet of
▪ Onset of disease in early age foods with high nutritional value
(milk, eggs)
▪ Multiple food allergies
▪ Poor compliance to dietary
▪ Disease in active phase management (unwillingness to
▪ Persistent intestinal expand the diet)
inflammation (subclinical) ▪ Extreme self-limitation of food
▪ Elimination of most foods from ▪ Association with atopic diseases
the diet (asthma, atopic eczema) or with
chronic diseases
Giovannini et al. Italian Journal of Pediatrics 2014
Dampak masalah kesehatan anak alergi

Dampak:
Masalah: Intake makanan kurang:
Gumoh, muntah, sulit selected food
Banyak pantangan
makan, diare berulang, Jenis makanan
makanan
konstipasi berkurang: protein
Picky eater

Cegah alergi pada

Gangguan pertumbuhan bayi dan anak !!
Gangguan
perkembangan

Giovannini et al., 2014

 Luaran tinggi
badan anak tanpa
vs dengan alergi
makanan dan susu

Anak yang mengalami

alergi makanan dan
alergi susu memiliki
tinggi badan lebih
rendah dibandingkan
anak tanpa alergi
makanan.

Mehta et.al. J Pediatr 2014;165:842-8

 Luaran berat badan
anak tanpa vs
dengan alergi
makanan dan susu

Anak yang mengalami

alergi makanan dan
alergi susu memiliki
berat badan lebih rendah
dibandingkan anak tanpa
alergi makanan.

Mehta et.al. J Pediatr 2014;165:842-8

 Tanpa
Tanpa alergi
alergi Alergi
Perbandingan WFL dan Alergi
BMI pada anak alergi
dengan kondisi lain

Berat berdasarkan tinggi

badan (status gizi) dan BMI
atau indeks massa tubuh
anak alergi lebih rendah
dibandingkan anak tanpa
alergi

Hobbs et.al. 2016. J Allergy Clin Immunol Pract.

Persentil pertumbuhan
berdasarkan jumlah
jenis alergi makanan

• Pertumbuhan anak lebih

rendah pada anak dengan
jumlah alergi makanan
lebih banyak

Hobbs et.al. 2016. J Allergy Clin Immunol Pract.

Tata laksana alergi susu sapi
Tujuan intervensi nutrisi
• Mencegah reaksi alergi:
• Mencegah paparan alergen
• Nutrisi yang tepat agar tidak menimbulkan gejala alergi
• Memastikan pertumbuhan dan perkembangan anak yang optimal
• Mengidentifikasi dan menangani masalah gangguan gizi

Giovannini et al., 2014

Rekomendasi IDAI
Tata Laksana Alergi
Susu Sapi
pada Bayi dengan
Asi Eksklusif
Bila ada masalah dana dan
ketersediaan susu terhidrolisat
ekstensif, sebagai alternatif dapat
diberikan formula isolat
protein kedelai dengan
disertai edukasi bahwa masih ada
kemungkinan alergi terhadap
formula kedelai
Rekomendasi IDAI
Tata Laksana Alergi
Susu Sapi pada
Bayi dengan Susu
Formula

Bila ada masalah dana dan

ketersediaan susu terhidrolisat
ekstensif, sebagai alternatif dapat
diberikan formula isolat
protein kedelai dengan disertai
edukasi bahwa masih ada
kemungkinan alergi terhadap
formula kedelai
Pengaruh formula isolat protein soya
terhadap pertumbuhan dan
perkembangan anak
Westmark, 2017
• One study was published in 1992 and the other in 2012 allowing for the comparison of
Generation Y (the millennial generation) versus Generation Z (the digital generation) at 6
months of age.
• To determine if there was any change in infant anthropometric measurements between
generations in response to consumption of SIF pre- and post-1994 when GM soybeans were
introduced into farming.
• No statistically significant changes in height, weight, or head circumference at birth or after 6
months with respect to diet

Westmark, 2017
Comparison of soy formula with human milk/cow’s
milk formula

*Exclusively breastfed for a least 2 mo and weaned to cow milk–based formula.

Merrit & Jenk 2018
Andres A et.al. Pediatrics 2012;129:1134–1140
Andres A et.al. Pediatrics 2012;129:1134–1140
Andres A et.al. Pediatrics 2012;129:1134–1140
All scores on developmental testing were within established normal
ranges and that MF and SF groups did not differ
significantly. Furthermore, this study demonstrated a slight
advantage of BF infants on cognitive development
compared with formula-fed infants. Andres A et.al. Pediatrics 2012;129:1134–1140
• Boxplots of breast bud volumes relative
to body weight will be followed until
puberty of girls (A) and boys (B) at 5 y of
age, relative ovarian (C) and uterine (E)
volumes of the girls, and relative testes (D)
and prostate (F) volumes of the boys who
were BF as infants or fed MF or SF.
• P values, adjusted for race, gestational
age, and birth weight, were not significant
(P >0.1).

Andres et al., 2015

Ovarian cysts, uterine, and testes characteristics in 5-y-old children who
were BF or fed MF or SF during infancy

Fifty-one uteri were imaged. No significant group differences were found in uterine volume
(P = 0.64; Figure 1E), uterine length (P = 0.52), the presence of a visible endometrial stripe (P
= 0.45), or uterine shape (heart vs. cylindrical vs. pear; P = 0.57) Andres et al., 2015
• No statistical difference between groups for
PP (OR: 0.51, 95% CI: 0.09 to 2.94, 3 studies,
206 participants, low certainty of evidence).
• No between-group difference was observed
in menarche age (MD 0.14 years, 95% CI -0.16
to 0.45, 3 studies, 605 children, low certainty
of evidence).
• The onset of menarche was marginally
increased in girls who received a soy-based
diet, the reported age was within the normal
age range for menarche.
• There was no association between a soy-
based infant diet and the onset of puberty in
boys or girls.
Metaanalysis
soy formula
and onset of
puberty
No significant difference in
the risk of precocious puberty
between the children who were
exposed or unexposed to soy formula
(OR: 0.51, 95% CI: 0.09–2.93)
Oliveira et.al., 2021
Soy formula
and mean
age of
menarche
Meta-analysis of 3 studies:
No difference between the
groups for the onset of
menarche (MD 0.14 years, 95% CI -
0.16 to 0.45 years, 605 children, low
certainty evidence) Oliveira et.al., 2021
Height in
the final
follow up
No clinically significant difference
between groups was found (MD 0.432
cm, 95% CI -1.03 to 1.9 cm)

Oliveira et.al., 2021

Organ volumes as determined by ultrasound
for 4-month-old infants who were BF (20
boys and 20 girls), MF (18 boys and 23 girls),
or SF (19 boys and 20 girls)

Among girls, there were no significant feeding group

differences in:
• Breast bud or uterine volume; mean breast
volume was slightly lower in SF infants
• Uterine length did not differ by feeding group
• Endometrial stripe or shape (heart vs cylindrical vs
pear) of the uterus
• MF girls had greater (P < .05) mean ovarian
volume than did BF girls, whereas SF infants had a
mean ovarian volume that did not differ from BF.

Gilchrist et. al, 2009

Organ volumes as determined by ultrasound
for 4-month-old infants who were BF (20
boys and 20 girls), MF (18 boys and 23 girls),
or SF (19 boys and 20 girls)

Among boys, there were no feeding group differences

in:
• Breast bud
• Prostate volumes
• Mean testicular volumes did not differ between SF
and MF boys, but both were lower (P < .04) than
BF boys.

Gilchrist et. al, 2009

Strom et.al., 2001
Strom et.al., 2001
 • Anak dengan alergi susu sapi atau makanan
lebih sering mengalami gangguan
pertumbuhan yang berhubungan dengan
gangguan asupan makanan dan
menyebabkan gangguan perkembangan
• Bila dilakukan intervensi nutrisi yang tepat
dan dipantau dengan baik akan membantu
Kesimpulan anak alergi tumbuh dan kembang optimal.
• Susu formula isolate protein soya dapat
menjadi pilihan dalam penanganan kasus
alergi susu sapi pada anak dengan
persyaratan tertentu.
Terima kasih
@berniemedise