to the editor: In the March 1, 2003 issue of American Family Physician, the department “Clinical Evidence”¹ addressed the effects of various treatments for childhood constipation. The author only briefly touches on the factor of dietary factors by stating that there are “no randomized controlled trials on the effects of increasing dietary fiber in children.”

In my experience, intolerance of cow's milk is a significant cause of childhood constipation. A popular pediatric textbook² lists excessive milk intake as a cause of constipation in children. A double-blind study³ of 65 children with chronic constipation who failed to respond to laxatives showed resolution of the constipation in 66 percent of the subjects while on soy milk.