CoMiSS® Tool: Cow’s Milk-related Symptom Score

• Crying relates to colic. Colic is defined as > 3 hours crying/day for at least 3 days during 1 week for at least 1 week.
• The duration of crying is evaluated. The longer the crying-time, the higher the score.
  Crying should be present at least > 3 days/week for 1 week or more, assessed by parents, without any other obvious cause.
• The score is related to the number of hours the infant cries on a daily basis e.g. up to 3 hours of crying/day will equal a score of 3.
• The age range during which crying (colic) should be considered is between > 2 weeks and < 4 months.

CoMiss Scoring

≤ 1 hour/day = 0

1 to 1.5 hours/day = 1

1.5 to 2 hours/day = 2

2 to 3 hours/day = 3

3 to 4 hours/day = 4

4 to 5 hours/day = 5

≥ 5 hours/day = 6

• The grading of regurgitation defines the score.*
• Each score applies to a specific volume regurgitated and the severity of the regurgitation.
• Regurgitation also includes vomiting.
• Regurgitation should only be considered if it is ≥ to 1 week duration and in the absence of infectious disease.
• The age range during which regurgitation should be considered is between > 2 weeks and < 6 months.

CoMiss Scoring

0 to 2 episodes/day = 0

≥ 3 to ≤ 5 episodes of volume < 5ml = 1

> 5 episodes of > 5ml = 2

> 5 episodes of ± half of the feeds in < half of the feeds = 3

Continuous regurgitations of small volumes > 30 min after each feed = 4

Regurgitation of half to complete volume of a feed in at least half of the feeds = 5

Regurgitation of the complete feed after each feeding = 6

The Brussels Infants and Toddlers Stool Scale (BITSS) is used to evaluate the consistency of stools for Infants less than 1 year.*

CoMisSS Scoring

Type 1, 2 and 3 indicate hard stools = 4

Gastrointestinal symptoms and stool changes should only be considered if they are ≥ to 1 week duration and in the absence of infectious disease.

Atopic eczema

• An easy to apply score based on an estimation of the surface covered by
  the dermatitis, using the surface estimation drawings from burns.
• Atopic eczema should only be considered if it is ≥ to 1 week duration.

CoMiss Scoring based on Estimated Surface
0 = 0
< 1/3rd = 1
1/3-2/3rd = 2
> 2/3rd = 3

(Acute) Urticaria* and/or angioedema*

• If urticaria/angioedema can be directly related to cow’s milk (e.g. drinking
  milk in the absence of other food) this is strongly suggestive of CMA.
• Worsening of eczema might be indicative of CMA.

CoMiss Scoring

there signs of Urticaria or Angioedema?
No = 0
Yes = 6

An easy way to apply score based on an estimation of the surface covered by the dermatitis, using the surface estimation drawings from burns.

Estimated surface
0 = 0
< 1/3rd = 1
1/3-2/3rd = 2
> 2/3rd = 3

Respiratory symptoms are considered in CoMiSS® but do not carry the same weight as other symptoms. This is because respiratory symptoms can be caused by cow’s milk, but most of the time chronic cough, runny nose and even wheezing are caused by viral infections.

Symptoms to be considered are*:

• Chronic cough
• Runny nose
• Wheezing

For a duration of ≥ to 1 week.

CoMiss Scoring

No respiratory symptoms = 0
Slight symptoms = 1
Mild symptoms = 2
Severe symptoms = 3