Q: Neither of my boys have diagnosed allergies, but they will not drink cows milk. They say they do not like the taste. Could this be their body's way of telling me they have an allergy? - Jenni, Riverdale Park, MD
A: Dear Jenni,
Thanks for your question. I initially trained as a pediatrician, so I have definitely seen my fair share of little one's who either refuse to drink cow's milk or just "don't like" drinking it! It's a common complaint, so don't worry. Let me try to help by giving you some background information about cow's milk allergy first.
Cow's milk allergy is present in about 1-3 percent of the population, with about 2.5 percent being in infants. While we used to believe that the the majority would outgrew their allergy by five years of age, more recent data by the American Academy of Allergy, Asthma and Immunology suggests that is true for only about one-third of those initially allergic. The remaining majority will generally outgrow it anytime between 5 years and their teenage years.
It's also important to understand the difference between a true cow's milk allergy and cow's milk intolerance. A food allergy, or hypersensitivity, is an abnormal reaction to the food -- in this case, cow's milk protein -- that is mediated by the immune system. It generally involves the skin, gastrointestinal tract, respiratory tract, or multiple organ systems, leading to symptoms such as eczema, hives, flushing, swelling of any part of the body, stomach cramps, vomiting, diarrhea or bloody stool, coughing, and/or trouble breathing. Systemic anaphylaxis to cow's milk is life-threatening and entails more than one of these system being involved, including low blood pressure and/or loss of consciousness. If your child has ever had any of these symptoms to cow's milk, you'll need to see an allergist to get diagnosed and be prescribed an epinephrine injector in case of a future life-threatening reaction.
Moooving on...cow's milk intolerance, on the other hand, is not immune-mediated, and is generally related to issues with digestion or metabolism. It is overall a benign condition, even though its symptoms can look like some of those related to a true allergy. These symptoms are generally limited to the gastrointestinal tract, such as abdominal cramping, diarrhea and in more severe cases, possibly weight loss or failure to gain weight. One of the most common milk intolerances is caused by a deficiency of the enzyme lactase, which breaks down lactose, the sugar found in milk. Therefore, it is difficult to digest the lactose, leading to the gastrointestinal problems mentioned, but not related to an immune-mediated allergy.
If your boys don't have any of the symptoms above, it's unlikely to be an allergy or even an intolerance to cow's milk. I don't know how old they are, but in general, when you switch an infant over to cow's milk at age one (based on the American Academy of Pediatrics guidelines), you may have to help your child acquire a taste for the milk. Breast milk and formula both have a slightly different consistency than straight cow's milk, and are generally sweeter. So it's a bit of an adjustment for the child. Some parents will mix it with some formula or breastmilk initially, or just give it with other foods like cereal or milk shakes (with no added sugar), which is fine. And if that still fails, try yogurt and cheese and talk to your pediatrician about incorporating other foods high in calcium and vitamin D in your child's diet.
Hope that helps, and feel free to email me at firstname.lastname@example.org for any other questions!
Dr. Naba Sharif is director of allergy and immunology at Allergy and Asthma Associates, A Division of Riverside Medical Group, located in Upper Marlboro. She'll be answering your allergy questions regularly on Patch. Email questions to Dr. Sharif at email@example.com.