cow’s milk intolerance and constipation in children

COW’S MILK INTOLERANCE AND CONSTIPATION IN

CHILDREN

Rendy Febrian Badri030-05-186

Cow’s Milk Intolerance

Definition

Cow's milk intolerance is an intolerance to either the protein component of milk or to lactose, which is a naturally-occurring sugar found in cow's milk. A lot of confusion exists between the terms cow's milk allergy and intolerance, and they are often used interchangeably

Cause

How and why milk intolerances occur is still not fully understood. One popular theory related to infants' immature digestive systems, which may not produce enough digestive enzymes to break down all the protein in the milk. This allows poorly digested protein to enter the large intestine, where the normal bacteria present in the bowel, ferment the protein creating stomach and bowel symptoms

Symptoms

Symptoms of milk intolerance mostly involve only the stomach and bowel However, symptoms involving the skin, nose, throat or lungs that mimic those of milk allergy, can also occur

Many stomach and bowel symptoms often associated with cow's milk protein intolerance can also be due to other conditions, such as gastro-intestinal infections OR feeding management. Where eliminating milk from the diet does not relieve these symptoms, further exploration may be necessary

Treatment

Once the diagnostic of food hypersensitivity is established, cow’s milk is eliminated from the diet. Symptomatic intolerance of cow’s milk is often improved over time. Thus, clinical studies with food should be repeated at set intervals

For infants, formula based on cow’s milk should be substituted by formula based on soy or cow’s milk hydrolysate formula (casein or lactalbumin). For children whose diet does not depend on milk, it is necessary to emphasize a varied diet.

The best way to prevent intolerance of cow’s milk is by breast-feeding and orients weaning.

Constipation in Children

Constipation is a condition in which bowel movements occur less frequently than usual or stools tend to be hard, dry, and difficult and painful to pass. Constipation occurs commonly in children, affecting up to 10% at any given time

Constipation describes the infrequent passage of stools (bowel movements) or the passage of hard stools. Any definition of constipation depends upon comparison to how often the child normally passes stools and to the normal consistency of his or her stools

Causes

The most common cause in a child older than 18 months is the avoidance of going to the bathroom for various reasons. For example, toddlers are often too involved in their play and lack the time or patience for bathroom breaks

They may have had a prior painful or frightening experience that makes them want to avoid going to the bathroom. Over time, their brain learns to ignore repeated urges by the colon to go to the bathroom. As stool remains in the colon, the colon will absorb water out of the stool, making it hard and dry.

Diet or changes in diet have been thought to have an effect on bowel habits. Infants and children who eat well-balanced meals typically are not constipated.

Breastfed infants will generally have more stools per day. Their stools vary more in their frequency when compared to bottle-fed infants. switching the type of milk or formula a child is taking can also cause constipation.

Symptoms

Generally, if a child has fewer than three bowel movements per week and they are hard and difficult to pass, he or she may have constipation

Children often exhibit characteristic behaviors while trying to keep from having a bowel movement.

Infants having painful bowel movements may extend their legs and squeeze their anal and buttock muscles to prevent passage of stool.

Toddlers often rise up on their toes, rock back and forth, and hold their legs and buttocks stiffly

Treatment

Constipation is treated by changing diet, taking laxatives, and adopting healthy bowel habits. Treatment depends on the child’s age and the severity of the problem. Dietary changes include eating more high-fiber foods, such as whole grains, fruits, and vegetables

Laxatives are frequently used to clear a fecal impaction and sometimes to restore regular bowel movements. A doctor should be consulted before giving a laxative to a child.

Parents should encourage their child to spend time on the toilet after meals and when their child shows signs of withholding stool

THE CORRELATION BETWEENCOW’S MILK INTOLERANCE AND CONSTIPATION IN CHILDREN

Although chronic diarrhea is the most common gastrointestinal symptom of intolerance of cow's milk in children, our current results confirm our earlier observation that chronic constipation can also occur. We found a relation between the intake of cow's milk and constipation in about two thirds of the patients studied.

Immunologic tests showed hypersensitivity in nearly three quarters of the children with constipation related to intolerance of cow's milk, with the most common mechanisms being IgE-mediated; thus, hypersensitivity increases the probability that constipation will be a manifestation of food intolerance

Furthermore, clinical examination of the children in the study showed a very high frequency of severe anal fissures. Because these lesions reappeared after the reintroduction of cow's milk and before the onset of constipation, we hypothesize that they are one of the mechanisms causing constipation. Pain on defecation can cause retention of feces in the rectum, with consequent dehydration and hardening of the stools, thus aggravating constipation

CONCLUSION

It is a challenge to identify precociously children with chronic constipation due to intolerance of cow’s milk. Many clinical and immunologic characteristics have been studied in children with cow’s milk intolerance but the results have been inconsistent. In fact, this may occur with constipation due to intolerance of cow’s milk

The observation that constipation might sometimes be caused by milk intolerance has appeared in the medical literature from time to time, But only recently has there been a well-designed study published showing that this is indeed the case. The results of this study, when widely known, can set many children free to enjoy the exuberance of childhood without pain

Presumably, swelling of the intestinal lining causes the constipation. Whatever the exact mechanism, the problem is likely with the protein in cow's milk, not with the fat or lactose (the sugar). Skim milk or lactose-free milk will not help with this one. Switching to soymilk and other soy products might relieve the symptoms in only a couple of weeks

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