Colic is attacks of abdominal pain, caused by muscle spasms in the intestines. Colic is common in infants.
Milk and soy allergies are particularly common in infants and young
children. These allergies sometimes do not involve hives and asthma,
but rather lead to colic, and perhaps blood in the stool or poor
growth. Infants and children are thought to be particularly susceptible
to this allergic syndrome because of the immaturity of their immune and
digestive systems. Milk or soy allergies in infants can develop within
days to months of birth. Sometimes there is a family history of
allergies or feeding problems. The clinical picture is one of a very
unhappy colicky child who may not sleep well at night. The doctor
diagnoses food allergy partly by changing the child's diet. Rarely,
food challenge is used.
If the baby is on cow's milk, the doctor may suggest a change to soy
formula or exclusive breast milk, if possible. If soy formula causes an
allergic reaction, the baby may be placed on an elemental formula.
These formulas are processed proteins (basically sugars and amino
acids). There are few if any allergens within these materials. The
doctor will sometimes prescribe corticosteroids to treat infants with
severe food allergies. Fortunately, time usually heals this particular
gastrointestinal disease. It tends to resolve within the first few
years of life.
Exclusive breast feeding (excluding all other foods) of infants for
the first 6 to 12 months of life is often suggested to avoid milk or
soy allergies from developing within that time frame. Such breast
feeding often allows parents to avoid infant-feeding problems,
especially if the parents are allergic (and the infant therefore is
likely to be allergic). There are some children who are so sensitive to
a certain food, however, that if the food is eaten by the mother,
sufficient quantities enter the breast milk to cause a food reaction in
the child. Mothers sometimes must themselves avoid eating those foods
to which the baby is allergic.
There is no conclusive evidence that breast feeding prevents the
development of allergies later in life. It does, however, delay the
onset of food allergies by delaying the infant's exposure to those
foods that can prompt allergies, and it may avoid altogether those
feeding problems seen in infants. By delaying the introduction of solid
foods until the infant is 6 months old or older, parents can also
prolong the child's allergy-free period.
Most infants consume fruit juices by 6 months of age. However, fruit
juices containing sorbitol may be associated with carbohydrate
malabsorption without clinical symptoms. Increased physical activity
and metabolic rate may be associated with carbohydrate malabsorption.
Fruit juices are an integral part of an infant's diet because of
taste availability, low price, and positive exposure as a healthy snack
food. This has resulted in a multimillion dollar market for fruit
juices packaged exclusively for infant consumption. Intake usually
starts when supplemental foods are introduced to the infant at 4 to 6
months of age. According to a survey conducted by juice manufacturers,
more than 90% of all infants consume some type of fruit juice by 1 year
of age.
The chemical makeup of such a popular food and its absorption from
the infant's gut have been the interest of several investigators. For
example, juices containing sorbitol and high fructose-to-glucose
ratios, such as apple or pear juice, exhibit incomplete carbohydrate
absorption in children from 6 months to 5 years of age. In another
study, children younger than 6 years incompletely absorbed oral
fructose when it was administered alone (0.7 to 2.0 g/kg); if given
with equimolar amounts of glucose, its absorption was enhanced. These
findings have resulted in an advisory from the American Academy of
Pediatrics Committee on Nutrition for moderation in the amount of
sorbitol-containing fruit juices fed to children.
The malabsorption of carbohydrates produces excess hydrogen gas.
This has been suggested as a cause of minor irritability or colic.
Increased physical activity and metabolic rate are the result of
carbohydrate malabsorption after the consumption of sorbitol-containing
fruit juices. We used a recently developed infant respiratory chamber
to simultaneously evaluate carbohydrate absorption from fruit juice
consumption in relation to physical activity and metabolic rate. These
tests were performed under double-blinded conditions on infants who had
ingested either pear or white grape juice.
- From the Research Institute, Miami Children's Hospital,
Miami, Fla. Corresponding author: Russell Rising, MS, PhD, Research
Institute, Miami Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155.
