Despite there being multiple similarities between cow’s milk protein allergy and lactose intolerance, the two are not the same and actually possess a number of differences. Learning about these differences and how it can affect toileting can help to best support your child.
Overview:
Cow’s milk protein allergy – also called ‘dairy allergy’, ‘dairy intolerance’ or ‘milk allergy’ among other things – is an abnormal response in the body’s immune system to a protein found in cow’s milk. This can cause damage to the stomach and intestines. This is a non-IgE mediated allergic reaction, so reactions after ingesting the protein are delayed, making it difficult to identify.
Lactose intolerance – also called ‘lactose sensitivity’ – is when the body can’t easily break down or digest lactose (a sugar found in milk and milk products), due to the lack of lactase (the digestive juice that breaks down lactose). Rather than damage to the stomach and intestines, the person may have some unpleasant symptoms.
Symptom Overlap:
The below table shows the symptoms that one may experience, for both conditions. As you can see, there are a number of symptoms that overlap as well as distinct features for each:
When Can it Start?
Cow’s milk protein allergy is most common in babies and young children up to three years old, with most children outgrowing the allergy between three and five years of age. However, cow’s milk protein allergy can be lifelong for some.
Lactose intolerance can affect both children and adults. In children, symptoms often begin at around five years old. However, adults can also develop this over time. In very rare cases, some newborns can’t make lactase from birth. Lactose intolerance can also be short or long-term.
Which One Could My Child Have?
Due to symptom overlap, child age, and individual responses to the conditions, it can be difficult to determine which condition a child may have.
Diagnosing cow’s milk protein allergy can be difficult, as this allergy cannot be identified on a blood test. Diagnosis involves taking a thorough history, detailing symptom timing, child age, and symptoms around feeding. Along with these investigations, symptom improvement (or other changes) following complete cow’s milk elimination, is also key in making a diagnosis. Usually, a 4 week elimination will be recommended, in order to give the body time to reduce inflammation so we can see the full effects of the diet change. Working with a dietician for any elimination diets is recommended, to help support your child’s nutrition through this process.
Diagnosing lactose intolerance usually involves eliminating lactose from the diet for a short time, then slowly reintroducing and monitoring symptoms. However, it can also be diagnosed via hydrogen breath test and in some cases, a biopsy during an endoscopy.
It is important to consult with your doctor, who may refer your child to a specialist, if you are seeking diagnostic clarity.
How Does This Affect Toileting?
Cow’s milk protein allergy can impact a child’s development of toileting skills, which may include:
- Constipation
- Overflow, faecal leakage
- Soiling accidents
- Potential wetting accidents
- Toilet refusals/anxiety
- Little improvement in toilet training skills, after multiple approaches tried
If you feel your child may be experiencing any of the above, see your GP for a bowel and bladder review. At Kids That Go, we can assist with understanding allergies and developing your child’s toileting independence and supporting their health through their diet.
For further information, check out the following helpful pages:
- About cows milk protein allergy:
- About lactose intolerance:
- Cows’ Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review: https://pmc.ncbi.nlm.nih.gov/articles/PMC8955686/
- How to spot a cow’s milk protein allergy by Dr Landon Krantz: https://childrenswi.org/at-every-turn/stories/milk-protein-allergy
EMMA STANAWAY
Occupational Therapist.
