A Choice for Kids with Cow’s Milk Intolerances and Sensitivities

by Dr. Leah Alexander
Dr. Leah Alexander, M.D., F.A.A.P. began practicing pediatrics at Elizabeth Pediatric Group of NewJersey in 2000. She has been an independently contracted pediatrician with Medical Doctors Associates at Pediatricare Associates of New Jersey since 2005. After graduating from Kalamazoo College and Michigan State University College of Human Medicine, she completed her pediatric residency at Overlook and Morristown Memorial Hospitals. She is board certified in General Pediatrics. Outside of the field of medicine, she has an interest in culinary arts.  

 

Cow’s milk is a common dietary component of the world's population.  For thousands of years, milk has been consumed as a beverage and used to produce a variety of foods.  Despite this, many children have sensitivities to it.  While some kids exhibit allergic reactions, others experience digestive issues.  Such situations present a dilemma for parents; they wish to provide a nutritious source of calcium, protein, and vitamins but have difficulty finding the best milk alternative.  The plethora of options on the market can create even more parental confusion.

 

Types of Milk Intolerances

The World Allergy Organization estimates that 0.25 to 4.9 percent of children have a cow’s milk protein allergy (CMPA) (source).  Other authorities estimate the prevalence to be 2 to 3 percent under the age of three (source).  When a child is allergic to either the casein or whey in milk, he or she can experience a variety of symptoms.  In mild cases, only hives and “throat itching” occur.  Moderate reactions involve facial or tongue swelling, wheezing, throat tightness, vomiting, and diarrhea.  An anaphylactic reaction is life-threatening and may be characterized by hypotension and a loss of consciousness.  Any of these symptoms can progress rapidly, so prompt emergency treatment and evaluation is necessary.  In order to prevent these reactions, cow’s milk must be avoided.

Another type of severe reaction to milk is eosinophilic esophagitis (EE).  While a variety of foods can trigger this condition, milk is one of the most common irritants.  Unlike the histamine-mediated reaction seen in CMPA, symptoms of EE are due to irritation of the esophagus from an increased amount of eosinophils.  This inflammation presents as difficulty swallowing or gagging, but may be severe enough to cause an esophageal stricture (source).  Elimination diets are typically recommended to both diagnose and treat this condition.  Children often require a liquid elemental diet, sometimes for years, until the inflammation resolves.

Lactose intolerance differs from both CMPA and EE.  Lactose is the naturally occurring sugar in cow’s milk.  The enzyme, lactase, is needed for its digestion.  There are four classifications of lactose intolerance (source):

  • Developmental:  seen in premature infants under 34 weeks gestation
  • Congenital:  a rare autosomal recessive disorder in the Finnish population
  • Lactase Non-persistence:  childhood onset typically at age 5
  • Secondary/Temporary:  seen in intestinal disorders or infections

The majority of childhood cases are of the lactase non-persistent type.  Unabsorbed intestinal lactose can cause abdominal pain, bloating, flatulence, and diarrhea.  These symptoms are prevented by either taking a lactase supplement prior to dairy consumption or by avoiding these foods entirely.

 

Clinical Correlations

One of the concerns for children who are unable to consume cow’s milk is the risk of calcium and vitamin D deficiencies.  In clinical practice, parents are often unsure of the best milk alternative.  Frustrated by the lack of options for toddlers, some parents continue giving the partially hydrolyzed or amino acid infant formulas.  In other cases, parents use one of the increasingly popular milk alternatives currently available.  Soy milk products are now in competition with those made from nuts, grains, hemp, and peas.  The true nutritional value of such products, however, has been debated.  In a comparison study, it was discovered that vitamin-fortification was necessary to increase the nutritional value of these kinds of milk (source).   Not every version, however, was found to include vitamin D which is necessary for bone calcium absorption (source).  Soy milk was the only option that had enough of the fat needed for toddler brain myelination.  With so many confusing options, it can be difficult for parents to choose the best one for their child. 

 

ELSE: Healthier Nutrition Drinks For Kids, A Solution For a Growing Problem

The prevalence of food allergies and intolerances continues to increase among children worldwide.  With this increase is a definite need for a better quality option:  ELSE.  This innovative nutritional beverage could be beneficial for children with a variety of milk intolerances.  As a cow’s milk-free product, there is no casein, whey, or lactose.  Instead, ELSE is uniquely formulated from almonds and buckwheat.  This is ideal since studies show that almonds are a significant source of protein, vitamin E, and heart-healthy monounsaturated fatty acids (source).   Additionally, ELSE is fortified with calcium, vitamin D, and other important vitamins.  Also, until now, parents have been left with alternatives that contain excessive amounts of sugar. Else contains significantly less sugar than other options on the market.  While ELSE is an ideal nutritional supplement for any child, it can be especially beneficial for those with cow’s milk intolerances.





The content and advice provided in this article is for informational purposes only and is not a substitute for medical diagnosis, treatment, advice for specific medical conditions. Always consult a pediatrician to understand the individual needs of your child.


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