Why does cows milk cause constipation

Center City: Bala Cynwyd: Fishtown: Got Milk? Our providers and nurses field a lot of questions from caregivers about how to introduce whole milk to babies.

Whole milk is traditionally introduced at the first birthday. There is nothing magical that occurs on that very date, but this is a good time to anticipate introducing whole milk. If formula is running low or the mother needs to stop breastfeeding due to supply issues or other factors, whole milk may be introduced a couple of weeks early.

It is also fine to delay the introduction of whole milk by a couple of weeks. Some children have no issue taking whole milk right away. Other children require more of a weaning process. On the basis of a prior open study, we hypothesized that intolerance of cow's milk can also cause severe perianal lesions with pain on defecation and consequent constipation in young children.

Methods: We performed a double-blind, crossover study comparing cow's milk with soy milk in 65 children age range, 11 to 72 months with chronic constipation defined as having one bowel movement every 3 to 15 days. All had been referred to a pediatric gastroenterology clinic and had previously been treated with laxatives without success; 49 had anal fissures and perianal erythema or edema.

In this randomized clinical trial all consecutive patients less than 14 years of age with chronic constipation referred to Pediatric Gastroentero-logy Clinic affiliated with Shiraz University of Medical Sciences between April and April were evaluated.

We used Rome III criteria for definition of functional constipation[ 17 ], i. Criteria fulfilled at least once per week for at least 2 months before diagnosis, and one month of at least two of the following in infants up to 4 years of age:. History of large diameter stools which may obstruct the toilet[ 17 ]. The exclusion criteria were anatomical causes of constipation eg, Hirschsprung's disease, spinal disease , constipation due to other disorders eg, hypothyroidism, psychomotor retardation , prior anal surgery, and use of medications that can cause constipation.

They all fed cow's milk, dairy products, or commercial formulas derived from cow's milk. Previous treatment with different laxatives such as lactulose, Mg OH 2 , paraffin, and PEG for at least three months had been unsuccessful in all patients.

When the patient was first seen, complete physical examination including rectal examination was done and a detailed chart was compiled containing the results of the physical examination and medical history information such as breast feeding during the first months of life, acceptance of formula at weaning, and especially the presence or absence of Rome III criteria.

Next day the patient received Skin Prick Test. Diagnosis of cow's milk allergy induced constipation was based on increased frequency of defecation or decreased number of signs and symptoms after 4 weeks CMFD and coming back to Rome III criteria after 2 weeks of challenge with CMD in comparison to the control group.

We define CMFD as a diet free of any dairy products made of cow's milk. At the first visit, the parents were asked to record the child's signs and symptoms, and all medications were discontinued. Then the patient was assigned to receive PEG solution 0. PEG was prescribed by pediatric gastroenterologist to all patients. The order of dietary treatment was randomly assigned by a computer generated method with the individual patient as the unit of randomization and according to this randomization the patients were recommended to receive CMFD or CMD by a pediatric allergist.

At the end of the treatment, the protocols were evaluated again by pediatric gastroenterologist who was blinded to the type of diet. At baseline and at the end of the first study periods, the children were examined by a researcher. During the study period, the parents recorded the number of bowel movements, as well as the appearance of the stools and the child's difficulty in passing them. To ensure that the children did not receive any other kind of milk or milk-containing foods during the study, the parents were given a list of the most common milk-containing foods to be avoided.

During the study period, they were asked to record the amount and type of food their child had eaten each day. At the end of the study, we analyzed these diaries to evaluate adherence to the diet and the quantity of milk consumed.

The parents were able to contact us whenever necessary, and telephone contacts helped to ensure adherence to the diet. During the two week challenge period, the parents recorded any clinical symptoms, and the patients were reexamined in the hospital for any adverse reaction, and at the end of the challenge period they were evaluated for presence of constipation again.

Informed consent was obtained from the parents of all the patients involved in the study. Frequency analysis was performed with Fisher's exact test. All P -values were two-tailed, and P -values less than 0. Two groups were matched for age, sex, duration of illness, frequency of breast feeding at birth and signs and symptoms of constipation at the time of entry to study.

Table 4 shows the comparison of these criteria between case and control group. All patients in case group underwent a challenge with CMD for two weeks. The comparison of Rome criteria in case group before trial and at the end of trial are shown in Table 5. None of the patients who received CMD had an acute reaction.

After this period 24 out of 56 Comparison of Rome criteria in children with chronic constipation before trial and 4 weeks after cow's milk free diet. Comparison of Rome criteria in children with chronic constipation on cow's milk free diet and cow's milk diet after 4 weeks. Comparison of Rome criteria in children with chronic constipation on cow's milk free diet before trial and 2 weeks after cow's milk diet challenge. At beginning of the study there was a trend towards a high frequency of negative skin prick test among the patients with functional constipation, and in only one child with cow's milk allergy induced constipation it was positive.

Or should we try a lactose-free type of milk or soymilk? Any help would be appreciated greatly!!! Shannon - Woodstock, Nebraska. A cranky, unhappy toddler may well be responding to physical discomfort. Tummy troubles of one type or another can make anyone feel miserable. If a child is intolerant to milk, this can affect how he feels every single day of his life.

Nausea, cramps, and pain can squelch the normal joys of discovery and mastery. But the classic symptoms of milk intolerance are diarrhea , spitting up, or abdominal pain. Many kids with milk intolerance also wheeze, especially when they get a cold.

They can also have the dry, sensitive skin of eczema and their noses always seem to be running. Ear infections are also more common than in other kids. Constipation, however, has not been typically associated with milk intolerance — until now. The observation that constipation might sometimes be caused by milk intolerance has appeared in the medical literature from time to time, dating back as far as But only recently has there been a well-designed study published showing that this is indeed the case.

The results of this study have helped many children to enjoy the exuberance of childhood without pain. Researchers at the University of Palermo in Italy worked with 65 children with chronic constipation. All of these children had been treated with laxatives when dietary measures had failed. Even with the medical treatment, these children were still constipated, having hard, painful stools only every 3 to 15 days.

Forty-nine of their little bottoms had fissures and redness or swelling from the hard plugs of stool. Next, they had a week during which they could eat and drink anything they wanted to wash out the effects of the first 2 weeks. Careful recordings of the bowel habits were made. The redness, swelling, and fissures on their bottoms healed. The results were most dramatic in kids who also had frequent runny noses, eczema, or wheezing.

This has broad implications. The children in this study were those with severe chronic constipation that was unresponsive to medications. I am convinced that they are only the tip of the iceberg. There must be a much larger group of mildly allergic children whose constipation improves with laxatives. Time may prove that it is better for these children to avoid the offending protein by switching milks rather than being treated with laxatives.

Presumably, swelling of the intestinal lining causes the constipation. Skim milk or lactose-free milk will not help with this one.