Chronic Constipation? Hold the Milk!

Chronic Constipation? Hold the Milk!

One third of children with chronic constipation improved after cow's milk was removed from their diet.

Cow's milk has been linked with chronic constipation in children, and an immune response to cow's-milk protein has been proposed as a possible mechanism. Investigators studied response to removal of cow's milk in 69 children (age range, 6 months to 14 years) with chronic constipation who were referred to a pediatric gastroenterology clinic in Spain. The trial involved four phases: Clinical factors and laboratory immunologic results were recorded for 1 week during phase I (run-in), cow's milk and cow's-milk formula were replaced with rice milk (for children >2 years) or hydrolyzed cow's-milk protein formula for 3 weeks during phase II, cow's milk was reintroduced for 3 weeks during phase III, and cow's milk was removed again for 3 weeks during phase IV. No other dietary changes were made.

Twenty-seven children (39%) were considered responders; their constipation resolved within 1 to 5 days during phase II (removal of cow's milk), relapsed within 2 to 5 days during phase III (reintroduction), and resolved again during phase IV (removal). Thirty-four children (49%) were considered nonresponders; they did not improve during phase II. The remaining eight children had slower resolution of constipation during phase II and did not relapse during phase III (reintroduction). Responders and nonresponders did not differ in constipation history or symptoms, physical exam findings, dairy or fiber intake, or immunologic lab results. The mean number of stools per week increased in responders from 2.9 to 7.7 and did not change in nonresponders (mean, 2.7 stools per week before and after removal).

Comment: Removal of cow's milk resolved constipation in a substantial subset of children, and, although this was not a randomized blinded trial, the finding that reintroduction of cow's milk led to relapse is compelling. The results do not support an obvious immune mechanism for chronic constipation related to cow's-milk protein, but the authors note that the timing of resolution and relapse might suggest a delayed allergic response. Although no clinical factors helped to predict which children would respond to removal of cow's milk, this relatively simple intervention seems worth trying in children with chronic constipation.

— Cornelius W. Van Niel, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 21, 2010

Citation(s):

Irastorza I et al. Cow's-milk–free diet as a therapeutic option in childhood chronic constipation. J Pediatr Gastroenterol Nutr 2010 May 4. [e-pub ahead of print]. (http://dx.doi.org/10.1097/MPG.0b013e3181cd2653)

Reader Remarks:

Review and add to remarks on this article

Withholding cow's milk in constipation
JS Worth, NZ, 22 Jul 2010 12:56 PM EST
I will indeed try this now that I've seen this article
Milk and Constipation
Margaret L. Turley RN, 22 Jul 2010 12:56 PM EST
Both my children were allergic to milk. Constipation was also an issue with soy milk products. I had to be... [more]
Chronic Constipation? Hold the Milk!
DUANGJAI kasantikul, Chula hospital .bangkok,thailand, 22 Jul 2010 12:56 PM EST
feeding baby with diluted prune juicee water will solve this problem.The experience I hac\ with my two sons
Constipation and cow's milk
Philip G Miller MD, Portland OR, 22 Jul 2010 12:56 PM EST
I believe the concern with milk is the fat content, which wasn't mentioned. Better study is with whole milk versus... [more]
Childhood constipation
Nedunchelliyan Singaravelu, Retired, 22 Jul 2010 12:56 PM EST
I feel it is worth trying in children with chronic constipation. We have to suppliment with soya protein to meet... [more]
Childhood constipation and cow's milk.
Eden Derry, Retired medical nutritionist, 23 Jul 2010 11:15 AM EST
This is an inadequately described, or poorly designed, experiment. One known cause of constipation in many people is calcium, as... [more]
This is evidence??
Charles A. Crotteau, MD, Chicago, IL, 23 Jul 2010 11:15 AM EST
I will not change my management of pediatric constipation on the basis of this small, non-randomized trial. In addition, cow's... [more]
Constipation linked to cow's milk
M. Correa da Silva Luciano, 2 Aug 2010 11:58 AM EST
I agree with other opinions. It is really a small and limited study addressing a so compelling issue as nutrition... [more]

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