Dairy Intake and Constipation in Little Ones.

Will cutting out dairy help with my little one’s constipation?

Have you recently seen something about this floating around the internet or on social media? We have!

It is being claimed that:

1. dairy is HIGHLY constipating
2. that literature supports that a diet free from cow’s milk improves functional constipation in up to 78% of children

WOW! They are some huge stats.

BUT- is it so simple? What does the research actually say?

Nutrition is a tricky area of science because it is filled with nuance and shades of grey. Sometimes people who are well meaning but inexperienced will read a statistic in an article and hold onto it, share it and live by it. The problem with this is that nutrition is rarely so straight forward. Digging into the review that was used to make this particular claim we can see that is exactly what has happened here.

What does the research actually says?

When taking a deep dive into the review that this advice is based on, you can see straight away that there has been some cherry picking here. Cherry picking is where someone takes a statistic or part of some research to support their point of view without giving you the whole picture.

So, what is the whole picture?

• Wait for it….it was actually 28-78% of children with constipation responded to a dairy free diet. WOW that is a huge range. Not quite the picture that the original post painted when saying “up to 78%”. So, they weren’t wrong, but they cherry picked the part of the statistic that made their advice look stronger.
• When you look at what type of children responded, it was kids that likely had a dairy allergy and had not first responded to changes to fibre intake or laxatives.
• Some of these studies are from over 20 years ago and none of them are within the last 10 years.
• They don’t focus on babies. Many of the people in the studies were children up to the age of 14 years.
• The review itself actually highlights that the quality of the studies they looked at wasn’t great.
• There is more….but this is enough already to discredit the idea that almost 80% of children with constipation will respond to a dairy free diet.

Causes of constipation

There are many causes of constipation in babies and children:

• It can be too little fluid
• Too much or too little fibre
• Some children naturally have slower bowels
• Too much milk which is getting in the way of eating enough solids and therefore fibre
• Allergy or intolerance (may not be dairy though, it can be many foods and hard to identify)
• Medical cause like coeliac disease
• In older children it can be behavioural. Some children have toileting anxiety and may hold stool in. It becomes firmer as the bowel reabsorbs fluid and this can lead to firm and painful stool.

So, should your bub go dairy free to help with constipation?

• The quick answer is no, probably not.
• Although Australia has the highest rates of food allergy in the world it is still not that common with only 10% of children having a food allergy. Not all of these children have a dairy allergy or constipation.
• Cutting out entire food groups can lead to dietary deficiency in important nutrients but also increase the risk of an allergy to that food developing.
• There are many things you can do before cutting out dairy.
• If you are breastfeeding, you will also need to go dairy free, and this has big implications for your nutrition. You may even need a supplement to support calcium intake.
• If your bub is struggling with constipation the entire picture needs to be assessed. This should happen before any changes to your or bub’s diet.

Why you should seek guidance from a paediatric dietitian on this one!

• Constipation is not straight forward and needs an experienced and qualified health care professional to assess it.
• There are some amazing paediatric nutritionists out there, but constipation is not within the scope of practice of a registered nutritionist.
• There may be underlying medical causes and a paediatric dietitian is best placed to assess and liaise with your GP or paediatrician if needed.

References:

Miceli Sopo S, Arena R, Greco M, Bergamini M, Monaco S. Constipation and cow’s milk allergy: a review of the literature. Int Arch Allergy Immunol. 2014;164(1):40-5. doi: 10.1159/000362365. Epub 2014 May 17. PMID: 24853450.

Vriesman MH, Koppen IJN, Camilleri M, Di Lorenzo C, Benninga MA. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol. 2020 Jan;17(1):21-39. doi: 10.1038/s41575-019-0222-y. Epub 2019 Nov 5. PMID: 31690829.