Kabrita Protocol

Functional Constipation in Toddlers

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Kabrita Goat Milk Toddler Formula

16-24oz per day for 12-24 months

  • For children with mild issues associated with cow milk consumption, Kabrita Goat Milk Toddler Formula may be a nutritionally suitable alternative to cow milk. Kabrita contains naturally easy-to-digest goat milk protein and is safely fortified with 22 vitamins and minerals. 
  • Kabrita Goat Milk Toddler formula has little to no alpha s1 casein or A1 beta casein. (8)(9)(10
  • Kabrita is not recommended for children with a confirmed cow milk protein allergy.

Toddler Formula Kabrita Nutrition Comparison

Toddler Formula Kabrita Comparison Chart

Toddler Formula Kabrita Medical Detailer

Infant Probiotic

5 billion colony forming units (CFUs) per day (11)

  • Meta-analysis of 6 randomized placebo-controlled studies shows that probiotics help increase stool frequency in children. (12)
Infant Probiotic in the Fullscript catalog

Fiber 

4 g of inulin-type fructans per day (13)(14)

  • Transit time, stool frequency, stool consistency, and hardness of stool were improved by inulin. (15)
  • 4 g of inulin-type fructans per day improved stool consistency in constipated children aged two to five years of age. (16)(17)
Fiber in the Fullscript catalog

Organic Castor Oil Abdominal Massage

  • Abdominal massage has been shown to decrease the severity of GI symptoms and increase bowel movement frequency. (18)(19)
  • Consider ending the day with a tummy rub for your toddler. When facing your child, massage in a clockwise direction to promote normal movement through the colon.
Castor Oil in the Fullscript catalog

Diet and lifestyle recommendations

  • Elimination of cow milk-based products: Two-week trial
    • Cow milk-based foods have been shown to contribute to constipation in some children. (1) 
    • Cow’s milk contains alpha s1 casein, a protein known to contribute to larger curd formation in the stomach and may be more difficult for some children to digest. (2) 
    • A1 beta-casein, as is commonly found in cow’s milk, has also been shown to slow GI transit and increase GI inflammatory markers in cow milk-sensitive individuals. (3)(4)
    • Eliminating cow milk-based products for two weeks can help determine if cow’s milk is a contributing factor. (5) 
  • Dietary fiber: Toddlers should aim for 18 g of fiber each day (6) 
    • For children who are already consuming solids, it’s recommended they achieve their fiber intake from eating quality whole foods in the form of vegetables, fruits, legumes, seeds, nut butters, and whole grains
  • Water: While water intake varies depending on activity level, temperature, and preference, most resources recommend you offer toddlers 8-34 oz of water daily (7) 

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

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References

  1. Iacono G, Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, Notarbartolo A, Carroccio A. Intolerance of cow’s milk and chronic constipation in children. N Engl J Med. 1998 Oct 15;339(16):1100-4. doi: 10.1056/NEJM199810153391602. PMID: 9770556
  2.  Park YW. Hypo-allergenic and therapeutic significance of goat milk. Small Rumin. Res. 1994;14,151–161
  3. Brooke-Taylor, S., Dwyer, K., Woodford, K., & Kost, N. (2017). Systematic Review of the Gastrointestinal Effects of A1 Compared with A2 β-Casein. Advances in nutrition (Bethesda, Md.)8(5), 739–748. https://doi.org/10.3945/an.116.013953
  4. Biggs, W. S., & Dery, W. H. (2006). Evaluation and treatment of constipation in infants and children. American family physician73(3), 469–477.
  5. Finn K, Jacquier E, Kineman B, Storm H, Carvalho R. Nutrient intakes and sources of fiber among children with low and high dietary fiber intake: the 2016 feeding infants and toddlers study (FITS), a cross-sectional survey. BMC Pediatr. 2019;19(1):446. Published 2019 Nov 18. doi:10.1186/s12887-019-1822-y
  6. Lott M, Callahan E, Welker Duffy E, Story M, Daniels S. Healthy Beverage Consumption in Early Childhood: Recommendations from Key National Health and Nutrition Organizations. Consensus Statement. Durham, NC: Healthy Eating Research, 2019. Available at http://healthyeatingresearch.org
  7. Moatsou, G. Casein fraction of bulk milks from different caprine breeds. Food Chem. 2004 Aug;87(1):75-81
  8. Jung, T. H., Hwang, H. J., Yun, S. S., Lee, W. J., Kim, J. W., Ahn, J. Y., Jeon, W. M., & Han, K. S. (2017). Hypoallergenic and Physicochemical Properties of the A2 β-Casein Fraction of Goat Milk. Korean journal for food science of animal resources37(6), 940–947. https://doi.org/10.5851/kosfa.2017.37.6.940
  9. Pattanayak S. (2013). Human health impact of bovine Beta-casomorphin-7 of milk — a question for milk products or our breeding policy? Explor.Anim.Med.Res. 3(2): 93-94.
  10.  Kligler, B., & Cohrssen, A. (2008). Probiotics. American family physician78(9), 1073–1078.
  11.  Huang, R., & Hu, J. (2017). Positive Effect of Probiotics on Constipation in Children: A Systematic Review and Meta-Analysis of Six Randomized Controlled Trials. Frontiers in cellular and infection microbiology7, 153. https://doi.org/10.3389/fcimb.2017.00153
  12.  Closa-Monasterolo, R., Ferré, N., Castillejo-DeVillasante, G., Luque, V., Gispert-Llaurado, M., Zaragoza-Jordana, M., Theis, S., & Escribano, J. (2017). The use of inulin-type fructans improves stool consistency in constipated children. A randomised clinical trial: pilot study. International journal of food sciences and nutrition68(5), 587–594. https://doi.org/10.1080/09637486.2016.1263605
  13.  Micka, A., Siepelmeyer, A., Holz, A., Theis, S., & Schön, C. (2017). Effect of consumption of chicory inulin on bowel function in healthy subjects with constipation: a randomized, double-blind, placebo-controlled trial. International journal of food sciences and nutrition68(1), 82–89. https://doi.org/10.1080/09637486.2016.1212819
  14.  Collado Yurrita, L., San Mauro Martín, I., Ciudad-Cabañas, M. J., Calle-Purón, M. E., & Hernández Cabria, M. (2014). Effectiveness of inulin intake on indicators of chronic constipation; a meta-analysis of controlled randomized clinical trials. Nutricion hospitalaria30(2), 244–252. https://doi.org/1
  15.  Closa-Monasterolo, R., Ferré, N., Castillejo-DeVillasante, G., Luque, V., Gispert-Llaurado, M., Zaragoza-Jordana, M., Theis, S., & Escribano, J. (2017). The use of inulin-type fructans improves stool consistency in constipated children. A randomised clinical trial: pilot study. International journal of food sciences and nutrition68(5), 587–594. https://doi.org/10.1080/09637486.2016.1263605
  16.  Micka, A., Siepelmeyer, A., Holz, A., Theis, S., & Schön, C. (2017). Effect of consumption of chicory inulin on bowel function in healthy subjects with constipation: a randomized, double-blind, placebo-controlled trial. International journal of food sciences and nutrition68(1), 82–89. https://doi.org/10.1080/09637486.2016.1212819
  17.  Sinclair M. (2011). The use of abdominal massage to treat chronic constipation. Journal of bodywork and movement therapies15(4), 436–445. https://doi.org/10.1016/j.jbmt.2010.07.007
  18.  Lämås K, Lindholm L, Stenlund H, Engström B, Jacobsson C. Effects of abdominal massage in management of constipation–a randomized controlled trial. Int J Nurs Stud. 2009 Jun;46(6):759-67. doi: 10.1016/j.ijnurstu.2009.01.007. Epub 2009 Feb 12. PMID: 19217105.

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