Many parents assume that their children absolutely need to have their daily pinta and it can come as quite a shock to be told that their child has a dairy allergy. A mixture of emotions may be felt - relief that a specific cause to a problem has been found, combined with concern that junior will suffer from dietary deficiencies from a lack of milk, cheese and yoghurt. Finding a way forward can seem a minefield. Here are all the facts you need to know about this growing problem.

The symptoms of dairy intolerance are varied making it hard to diagnose. Add to this a reluctance on the part of many parents and their doctors to take dairy products out of a child’s diet and the problem is compounded. Most people do not realise that dairy products where only introduced into the human diet around 10,000 years ago - the blink of an eye in evolutionary terms - suggesting that we may not be properly adapted for this food.

The list of problems that can be linked to dairy sensitivity can include:

* Asthma                      * Diarrhoea

* Bloating                     * Eczema

* Catarrh and mucus  * Flatulence

* Constipation             * Glue ear

* Dark eye circles       * Upper respiratory

* Diabetes tract infections

We are seeing a serious upswing in problems such as asthma, glue ear and diabetes amongst children. Both asthma and diabetes are increasing by about 10% a year and glue ear is suffered by 17 out of every 20 children by the age of six. There are direct links with these ailments to the quantity and frequency of dairy products in the diet.

The problem often starts in early years and a child can even be sensitised to milk protein when breast feeding, if the mother has milk and cheese in her diet. However, it is more usual for difficulties to start when small children are given formula milk or are introduced to whole milk and cheese. One reason for the increase of dairy-related problems, over previous generations, could be because we tend to breast feed for a shorter time than before - often weeks rather than months. If children can avoid cow’s milk for the first nine months of life, their risk of dairy allergy is significantly reduced. It is also quite possible for an intolerance to develop after a few years. This can be confusing for parents because a staple food which was fine suddenly becomes a problem - what to do?

One straightforward problem is lactose intolerance. Lactose is milk sugar and some children lack the necessary enzyme, lactase, to digest the lactose. Because this milk sugar is left in the gut to ferment, the side effects can include the most uncomfortable wind and bloating - literally brewing up a storm.

* Avoid milk, especially skimmed milk which has more lactose

* Drink lactose-free milk (found in large supermarkets)

* Drink calcium enriched soya milk (in moderation as soya can lead to allergies as well).

* Add lactase enzymes to milk to ‘pre-digest’ it several hours before drinking it (available from good health food shops).

*Butter has only a trace amount of lactose and is almost never an issue.

PROTEIN PROBLEMS

The other main reason for allergy are the thirty proteins found in cow’s milk.

• Casein, the main protein to cause problems, is a large molecule and is so dense in milk that in formula feeds its percentage has been reduced to reflect human milk. It is really designed for small cows, not small people. In the stomach these proteins coagulate into a large, hard to digest, lump which then takes a lot of work to break down. Goat’s milk forms into much easier, small lumps and human milk into tiny little globules. Goat’s milk has a different form of casein which is much better tolerated by children.

• You may have seen posters in your doctor’s surgery urging breast feeding because of the increased risk of insulin-dependant diabetes in children. The reason that cow’s milk is believed to be the culprit is that an anti-body, Bovine Serum Albumin is thought to attack the pancreas in susceptible children, accounting for the sharp upturn in this terrifying disease.

• Milk protein allergy can lead to the symptoms of asthma, eczema, digestive problems, constipation, diarrhoea and also to headaches and dark eye circles. In the worst cases anaphylactic shock have even been reported.

• Mucus build-up is one of the key down-sides of too much dairy and this can lead to one of the most common plagues to affect young children - glue ear. The simple measure of cutting back, or cutting out milk and cheese can usually eliminate this avoiding the long and uncomfortable road of antibiotics and operations to insert a grommet into the ear. The NHS spends £15 million a year on this problem alone, never mind the trauma to so many little people and their parents.

Usually it is sufficient just to cut back on dairy products - cheese once a week and a couple of yoghurts a week along with a bit of milk in desserts is unlikely to be a problem for most children. Butter is often well tolerated as it is almost 100% fat, and yoghurt is easier to digest because of the action of the bacteria on the milk sugars and proteins.

In some cases however there is such an acute allergy that all dairy products, including yoghurt and butter, have to be avoided and this includes packaged products containing dairy. There are many unfamiliar terms for dairy components to look out for in this case, and, in addition to the obvious (milk, cheese, cream, butter, yoghurt) include:

* Buttermilk                     * Lactic acid

* Casein / caseinate     * Lactobacillus

* Crème Fraîche            * Lactose

* Ghee                            * Quark

* Kefir                             * Whey

* Lactalbumin

The main worry for parents who need to take dairy out of their child’s diets, or who may want to cut back as a preventative measure, is where to get calcium in the diet. Here are a few interesting points that may help to relieve some of this anxiety:

• Calcium is best used by the body with magnesium, and while dairy products are rich sources of calcium they offer only tiny amounts of magnesium. This means that while we can take in the calcium, we don’t necessarily use it for bone and tooth health unless it is balanced by magnesium.

• The foods that give the best ratio of calcium to magnesium are green leafy vegetables such as cabbage, Brussels sprouts, broccoli and spinach. Nuts (all types) and seeds (sunflower, pine nuts, pumpkin) also give the ideal ratio. Baby cows and goats do not grow into healthy specimens by drinking milk - they eat grass, a rich source of calcium and magnesium-packed chlorophyll.

• "I can’t get little Jane or Johnny to eat his veg" I hear you cry. One of the problems with large glasses of milk, given as a beverage, is that it is actually very filling. Children may enjoy their milk more than their food and it can be quite hard to get them to eat up their veg if they are simply not hungry.

• Children aged 2 to 7 need 1300-1700 calories. One of the temptations of whole milk is that it contributes significantly, at 100 calories per 150ml (1 small glass). However it fills up young tummies quickly, cutting their appetite for other foods. Better to quench their thirst with water or diluted juice, and include high fat foods in their meals such as olive oil, avocado, egg yolks, oily fish, coconut cream, tahini, almond nut butter and fresh nuts and seeds (beware of choking hazard).

• Between the ages of 2 and 7 youngsters need 600mg of calcium a day. If they have a varied, whole-food diet sufficient calcium can be obtained. Even tap water from ‘hard-water’ areas or still mineral water provide significant amounts of calcium.

2 eggs 50mg

Handful of dates 25mg

1 orange 50mg

1 carrot in matchsticks 25mg

1/2 portion broccoli spears 35mg

Sunflower seeds (can be ground as cereal 20mg

topping but avoid if your child has nut allergies)

1/2 small tin pink salmon 75mg

1 calcium enriched soya yoghurt (on cereal) 100mg

2 slices wholemeal bread (or bread sticks) 50mg

2 portions of green vegetables 80mg

1 portion of baked beans 50mg

Fruit salad (kiwi, pear & melon) 40mg

Here there is a divergence of views between the medical profession and the more naturopathic approach to health. It does seem that many children grow out of milk allergies and, as their age moves out of single figures, symptoms such as asthma and eczema often resolve themselves. However, the less orthodox view is that the body is learning to adapt, as a survival mechanism, but that the symptoms will reappear in later years - thirties or forties - in another form, such as migraine or irritable bowel syndrome. Surely the most sensible approach, as no one can be really sure how the problem will develop in any given child, is to make sure that there is variety in the diet and not too much dependency on any one food group. Variety reduces the opportunity for allergy.

THE PROBLEM: Sara and Lawrence were almost at their wit’s end. Their third child, three year old James, was in agonies trying to go to the toilet. He had even stopped pushing and straining and was going for as long as he could without sitting on his potty - sometimes two or three days. He would cry with the discomfort from being so constipated, and frequently there was blood in his stools.

His GP was fast running out of ideas and referred his parents to a specialist at Great Ormond Street Hospital for Children. By then several medications had been tried, including high doses of Lactulose - a lactose (milk sugar) based aid to relieving constipation.

DIAGNOSIS: The doctor took a comprehensive case history and was interested to note a few hints from James’s past: when he was about four months old he had been passing mucus into his nappy when introduced to formula milk; there was a history of allergies in the family, including his brother Peter who had asthma triggered by milk; James had also developed mild eczema when he was put onto formula milk.

The doctor told Sara that around 20% of children with milk allergy had very bad constipation as a major symptom. When told that milk allergy could be at the root of James’s problem, Sara jumped at the chance to solve her son’s predicament. The dietician gave her a long list of foods to avoid and foods that were OK, but on checking with the specialist her mind was put at rest that it need not be so awkward - a little milk in a biscuit or slice of cake was unlikely to be a problem, it was more likely that the glasses of milk and wedges of cheese were to blame.

SUCCESS: She resolved to deal with this immediately despite going away on holiday to Cornwall the next day. She phoned ahead and asked the hotel to provide soya milk - they were totally accommodating. Within three days Sara and Lawrence noticed that James was a changed child. His energy levels improved dramatically, no longer desperate to sleep for two hours in the afternoon, his complexion improved and his appetite was better. Sara’s husband, who was fairly sceptical initially, also noticed the immediate change for the better. When they returned from holiday Sara’s mother remarked on how well he looked and, again, that he was a changed child. His toilet problems resolved during that two week holiday and they were able to cut back his medication over time.

Now, an active five year old, James enjoys a variety of milk substitutes and while he tends to be a picky eater, preferring snacks to sit-down meals, Sara is relaxed because she knows that the snacks she offers are healthy and that calcium can be obtained from a wide variety of foods in his diet.

For more information on What Should I Feed My Baby? (Published by Weidenfeld & Nicolson) click here