Parents are often confused between these two common digestive issues in children. Here’s how to tell the difference between Cow’s Milk Protein Allergy (CMPA) and Lactose Intolerance (LI), and most importantly, the effective solutions to both issues.
What is the Difference Between CMPA and Lactose Intolerance?
Cow’s Milk Protein Allergy or CMPA is an allergy to cow’s milk protein. Lactose Intolerance, on the other hand, is not an allergy but it’s an intolerance to the milk sugar, which is also called lactose. So, it doesn’t involve any allergy.
What are the Symptoms of CMPA?
Many children with CMPA develop symptoms in at least two of the following organ systems: gastrointestinal (50–60%), skin (50–60%) and respiratory tract (20–30%)1.
In children, usually the symptoms would involve a lot more digestive problems. For example, tummy pain, diarrhea & vomiting. But of course, there are some children who exhibit some signs of CMPA, which is part of the allergic component. For example some might get hives, rashes, swelling of the face, some flaring of eczema, some wheezing as well but usually, it is a tummy symptom.
However, in a small number of children, colic and just general fussiness remain the only symptoms for CMPA.
Dairy products
How Can We Manage CMPA?
The key principle in the management of CMPA is dietary elimination of Cow’s Milk Protein(CMP)1. The child should avoid milk products made from cow’s milk, but they may also have to avoid milk products from other mammals such as goats as there could be a cross reactivity to the antigen present in those milk as well2.
One of the things that we must be aware of is that, in the market, there are a lot of terms used to describe milk products. For example: butter, butter-milk, whey, yoghurt, casein, cream, ghee and just plain old dairy. Parents must be aware that these terms also represent dairy products.
So, for children who are still on formula, they’ll need to consume a milk substitute that does not contain full cow’s milk protein. They may choose to switch to alternative products such as soy (unless they are also allergic to soy) or extensively hydrolysed protein formula.
Isomil Plus, which is a soy based formula and is lactose-free can be a great alternative for children who are allergic to cow’s milk protein. It is important for these children to get enough milk substitutes so that they get enough nutrients for their growth and development.
What are the Symptoms of Lactose Intolerance (LI)?
The signs and symptoms of Lactose Intolerance are not caused by the immune system. It is wholly focused on the gut because that is where digestion of lactose occurs. So, there should not be symptoms like rash and swelling of the face or wheezing because it is all in the gut, it is not affecting the immune system.
So, the usual symptoms of Lactose Intolerance are usually loose, watery stools, passing of gas, a very irritable bloated stomach. Occasionally, if your child is unable to digest the milk sugars (lactose), it may lead to unhealthy weight loss and interfere with your child’s growth in developing strong and healthy bones3.
How Can We Manage Lactose Intolerance?
A temporary switch to a low lactose or lactose-free formula is essential in helping children with LI to recover. Once the gut starts to produce enough lactase, the symptoms will go away .
Is Constipation a Sign of Poor Digestion?
Constipation is a very common digestive issue. It is defined as a difficult passage of stools or infrequent bowel movements. Normally, this is a problem due to dietary issues such as not having enough fibre in the diet or not enough liquids in the diet, and therefore adjustment in terms of their diet as well as fluid intake would be helpful.
Occasionally, some of these children may require some changes or tweaking of their formula milk products. For example, Similac Total Comfort contains prebiotic as well as easy-to-digest unique vegetable oil blend that may help to soften the stools and make the passage of stools a little bit more easy on them.
References:
1 Vanderplas Y et al, Arch Dis Child 2007;92:902–908. doi: 10.1136/adc.2006.110999 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083222/)
2 Guidelines of the Management of Cow’s Milk Protein Allergy in Children 2012, Malaysian Society of Allergy and Immunology, https://www.allergymsai.org/pdf/guideline-cows-milk.pdf
3 Lactose Intolerance, NHS Inform, https://www.nhsinform.scot/illnesses-and-conditions/nutritional/lactose-intolerance
MAL.2021.14753.ISO -SIM.1
