Soy milk decreased chronic constipation in young children

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  1. Lesley Ramsay , RGN, Rscn
  1. Senior Staff Nurse Children'due south Ward, North Tyneside Hospital Tyne and Article of clothing, UK

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Iacono G, Cavataio F, Montalto G, et al. Intolerance of moo-cow's milk and chronic constipation in children. Due north Engl J Med 1998 Oct 15; 339 : 1100 –4.

Question Does soy milk increment stool frequency in immature children who have chronic constipation and are being given cows' milk?

Design

Randomised, controlled, double blind, crossover trial.

Setting

A paediatric gastroenterology clinic at a university hospital in Italy.

Patients

65 children <half-dozen years of age (hateful age 34.6 mo, 55% girls) who were referred for chronic constipation (chronic fecal retentivity of 1 bowel move every 3–15 d often associated with abdominal symptoms). Exclusion criteria were anatomical causes of constipation, constipation acquired past another disorder, previous anal surgery, and use of medications associated with constipation. All children were being fed cows' milk, dairy products, or commercial formulas derived from cows' milk. All had unsuccessful treatment with laxatives. Follow up was consummate.

Intervention

Children who were <15 months sometime were given formula (based on cows' milk or soy milk) and older children were given whole cows' milk or soy milk. In the commencement phase, 33 children were allocated to cows' milk and 32 children were allocated to soy milk for ii weeks. After a 1 week wash out period, during which utilise of soy or cows' milk derivatives was unrestricted, children were given the alternate milk for some other ii weeks. Parents were asked to withhold foods that contained milk during the study. Children with a positive response to soy milk took information technology for an additional month and then were re-randomised to cows' milk or soy milk for a two week period (claiming exam).

Main outcome measures

A positive response defined every bit ≥8 bowel movements during the 2 week study flow. Fecal score was also calculated (one for mushy or liquid stools, 2 for soft carrion, and 3 for difficult stools and difficulty and pain on passing stools).

Main results

44 of the 65 children (68%) had a response while receiving soy milk and none of the children had a response while receiving cows' milk. Children who received cows' milk had a mean of four bowel movements during the two report weeks and children who received soy milk had a mean of 10 bowel movements (p<0.001). Children who received soy milk had better fecal scores (1 or 2 v iii) (p<0.001) than children who received cows' milk. Of the 44 children in the claiming examination, all children who received cows' milk had constipation compared with none of the children who received soy milk. At baseline, children who responded to soy milk had more anal fissures with erythema or edema (91% v 43%, p<0.001), symptoms of intolerance to cows' milk (25% v v%, p=0.05), and positive results for immunological tests (lxx% v 19%, p<0.001).

Conclusion

In young children, constipation was associated with cows' milk; soy milk reduced the constipation.

Commentary

Show to propose that childhood constipation may be caused by milk intolerance has appeared in the medical literature from as far back as 1954.i Several studies have suggested that causes of chronic constipation are either psychological or caused by disturbances in intestinal motility. In 1995, however, Iacono et al carried out a study that linked constipation to milk intolerance.two This follow up research from the same authors provides further evidence that constipation is indeed acquired past intolerance to the poly peptide found in cows' milk. Immunological tests showed hypersensitivity in nearly three quarters of children with constipation, increasing the possibility that the constipation was related to nutrient intolerance. Mucosal inflammation was more frequent in children with an immune response.

This is an extremely well designed, thorough study. A forcefulness of the written report is that the 44 children who had a positive response to soy milk were studied over again afterward a further month on the soy diet. The findings of the study support the authors' theory and are indeed dramatic. It is seldom we find such articulate cut results in healthcare inquiry, and we must therefore exercise a certain degree of circumspection. These children cannot be looked upon as being representative of the general population. They were chosen from a highly specialised heart dealing with the handling of food allergies, and could be regarded as being preselected by the referring paediatrician.

Notwithstanding that farther inquiry needs to exist done in other centres to confirm the findings of this written report, information technology would seem that substituting cows' milk with soy milk for a trial period should perhaps be recommended as the first line of treatment before administering big doses of laxatives. The results of this enquiry should exist of involvement to nurses who deal with children suffering from chronic constipation.

References

  1. ↵

    Clein NW. Cows' milk allergy in infants. Pediatr Clin North Am 1954;4:949–62.

  2. ↵

    Iacono Thousand, Carroccio A, Cavataio F, et al. Chronic constipation as a symptom of moo-cow milk allergy. J Pediatr 1995;126:34–9.

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Copyright 1999 by the RCN Publishing Company and BMJ Publishing Group for Evidence-Based Nursing