Jack's ADHD was under good control, so I expected a quick and simple visit. Instead, Jack's mom was upset. "He's been messing up the bathroom," she complained, "I mean, all over. I have to clean the floor every night!" This surprised me. There are children who smear feces - the "technical" term I prefer is "poop" - on purpose. They almost all have serious emotional problems. That wasn't the Jack I knew.

Asking more questions, I found out that this had been going on for the last few weeks. After dinner, usually, Jack would have an upset stomach, followed by a lot of gas and cramping. After that, he would feel an explosive need to "go." What came out often splattered; sometimes Jack didn't make it all the way to the toilet.

Jack is a huge fan of milk. Dinner would almost always go with one or two large glasses. Many nights, he'd have cheese, too, on pizza or pasta, and maybe ice cream. (Like a lot of children on ADHD medicine, Jack doesn't eat much at lunch, but he makes up for it at dinner.)  Jack's mother, on the other hand, avoided dairy foods, because they gave her gas and diarrhea. She'd been this way ever since she was a teenager. 

Putting it all together, Jack's BM issue didn't have anything to do with his ADHD or the medication he was taking for it. It sounded more like a classic case of lactose intolerance. This problem is more common in people of African descent than in Europeans (Jack is black). It often starts late in childhood or during the teen years, and it runs in families.

People often think of lactose intolerance as an allergy, but it isn't. In food allergies, even a tiny bit of the problem food can set off a bad reaction. In lactose intolerance, the body simply has lost the ability to digest the sugar in cow's milk. The sugar sits in the intestine, where bacteria take it up. The bacteria grow and make gas. The gas causes cramping and explosive poops -- Jack's problems. Jack could handle a little milk sugar at breakfast and lunch, but not the big dose he was used to drinking with his dinner.

The treatment is simple: cut down on the milk and dairy, or stop them altogether. There are many good substitutes, such as low-lactose milk and ice cream as well as soy milk. Check the label to be sure they provide enough calcium and vitamin D. Kids can also take lactase pills, which supply the enzyme that the body isn't making enough of. Lactose intolerance is common, but it isn't always as dramatic as in Jack's case. Sometimes it just causes nagging belly pains or loose BMs. It's worth keeping in mind if your child's bowels are making him, or you, uncomfortable.