Study one
---------------
Cow's milk allergy is a common cause of chronic constipation in
children,
and the mechanism may be perinal fissure, according to a study published
this week in the New England Journal of Medicine. The symptoms will
resolve
in most instances with simple substitution of soy milk for cow's milk.
Researchers from Italy performed a double blind crossover study in 65
children (11-72 months old) who had been unsuccessfully treated for
chronic
constipation using laxatives.
After a 15 day observation period, patients were placed on either soy or
cow's milk for 2 weeks. The treatments were reversed after a one week
washout.
Positive response was seen in 68% of the soy-treated children, compared
with 0% of the cow's milk children. Every case of soy-treated response
was
confirmed as a cow's milk allergy using double-blind challenge with
cow's
milk.
In those two thirds of children who were responsive to soy substitution,
there were significant differences compared with the one third who were
not
(see table)
Responsive
Yes No Signif.
----------------------------------------------------------------------------
------
Coexistent allergic disease 25% 5% p=0.05
(rhinitis/dermatitis/bronchospasm)
Anal fissures and 90% 42% p<0.001
erythema/edema
Rectal mucosal inflammation 60% 24% p=0.008
Hypersensitivity 70% 19% p<0.001
(specific IgE to cow's-milk)
Ref: NEJM 1998; 339: 1100-1104
Study two
---------------
Cow's milk elimination can have adverse effects on overall growth in
toddlers, according to results from a recent Finnish study. One hundred
children (average age 7 months) with atopic dermatitis and
challenge-proven
cow's milk allergy were followed both before and after a cow's milk
elimination diet.
Although all patients achieved symptomatic control, these children had
significantly less length and weight-for-length than control healthy
children (p<0.0001 and p=0.03 respectively). There was a significant
relationship between growth impairment and earlier onset of symptoms.
The authors concluded that there is a delicate balance between the
benefits
and the risks of elimination diets.
Ref: J Pediatr, 1988; 132:1004-9
Study three
------------------
Yoghurt is often said to be a more suitable food than whole milk in the
treatment of acute diarrhoea situation, but Indian researchers failed to
confirm this. They compared the clinical outcome of acute diarrhoea in
96
malnourished boys (aged 4 to 47 months) randomly selected to receive
either
full-strength milk or yoghurt formula, as part of a mixed diet.
Although stool-reducing substances were detected more frequently in the
milk formula group, total stool weights were comparable over the first 3
days, as was median duration of diarrhea and treatment failure rates.
Moreover, children consuming milk had higher median percent weight gain
at
the end of 72 hours of the study (p = 0.04) and at recovery (p = 0.02).
Ref: J Pediatr, 1988; 132:999-1003
COMMENT:
Reactivity to cow's milk is one of the perennial controversies of
clinical
nutrition, particularly in primary care. On the one hand are those who
maintain that true cow's milk allergy is quite rare and any other
attribution of illness to this food a fiction, On the other are those
who
believe it to be so common as to be a prime suspect in many allergic
like
diseases. Most primary care physicians sit somewhat bewildered in the
middle ground of the debate.
The first study from Italy is one of a number reported over the last 15
years that suggests that cow's milk reactions may be really quite often
the
cause of common symptoms, particularly in children. Similar results
based
on elimination studies have been claimed for children with headaches,
asthma and eczema. Few of these studies until now have been quite as
rigourous as the current one, with its cross-over double blind design
and
confirmation using challenge testing.
On the other hand, the second study shows that elimination of cow's milk
is
something to be done with caution, as it may have an impact on
nutritional
adequacy and growth. A similar impact on short term growth was seen in
the
third study.
Not all studies have been so positive towards the conclusion that cow's
milk allergy is such a common problem. Putting all the evidence
together,
it would be reasonable for the primary care clinician to consider cow's
milk elimination in any child who has chronic constipation which has not
responded to conventional measures.
However, the practical difficulties involved (particularly for poorer
families where soy substitution may be difficult) and the impacts on
growth
suggest that this measure should not be considered lightly, and not
ahead
of simpler treatments.
::::: WEB SITE OF THE WEEK ::::::
---------------------------------------
http://arborcom.com/frame/50101/u1.htm
Provided by the apple industry in Washington State, this site is built
around lesson plans on healthy lifestyle and nutriiton. This translates
to
lots of information for kids and their caregivers, both parents and
teachers. This includes a story book, colouring sheets and lesson
plans.
It also features a search engine and email updates.
MORE ON THE WEB:
To see another children's nutrition education resource on click the web
reference
above and follow the highlighted link.
--
^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^
Cindy Curtis , RN, IBCLC ~ Virginia , USA
ICQ # 412812 mailto:[log in to unmask]
Benefits of Breastfeeding Home Page http://www.erols.com/cindyrn
|
