Loading...
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).
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)
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.