Lactose intolerance

• What is lactose?
• What is lactose intolerance?
• What happens when a baby has lactose intolerance?
• What are the symptoms of lactose intolerance?
• When can lactose intolerance occur?
• What tests are available?
• What you can do!
• Degrees of lactose intolerance

HOW WE CAN HELP you to discover the solution to your baby's discomfort.

What is lactose?

Lactose is the main carbohydrate (sugar) found in milk and in varying quantities in dairy products made from milk including yogurt, ice cream, soft cheeses and butter. It's present in the milk of all mammals, but is not found anywhere else in nature. It is an important source of energy for babies during their first months of life.

Galactose, a simple sugar that comes from the break down of lactose, is vital to a healthy brain and nerve tissues. Galactose can be found is some foods BUT for a baby, milk containing lactose may be his/her only source of galactose.

What is lactose intolerance?

Our body produces an enzyme called 'lactase'. Lactase is necessary to break down lactose, so that it can be absorbed. In lactose intolerance there is insufficient lactase enzyme produced and as a result lactose is poorly digested. (The amount of the lactase enzyme produced can be low but it's rarely absent).

What happens when a baby has lactose intolerance?

Lactose is a disaccharide, (which means it's a combination of 2 sugars). In its original form as a disaccharide, it's too large to be absorbed by the body, so it needs to be broken down into monosaccarides (single sugars), glucose and galactose, by the digestive enzyme 'lactase'. Glucose and galactose can then be absorbed from the small intestines into the blood stream and used by the body for growth and energy needs. When there are insufficient quantities of the lactase to break down lactose, as occurs in lactose intolerance, lactose passes into the large bowel undigested.

The undigested lactose draws additional fluid into the bowel, resulting in watery stools. Bacteria, present in the bowel, ferment the undigested lactose which then produces abdominal gas. As lactose is not broken down into glucose and galactose, the infant is deprived of their major source of energy. When deprived of energy (calories) from the diet, the body will use body fat as an energy source and the infant will loose weight.

What are the symptoms of lactose intolerance?

When can lactose intolerance occur?

Primary lactose intolerance is an extremely rare condition where infants are born with an inability to digest lactose. If your baby was born with this condition, you will know in the first few days of life. Babies with this condition do not gain weight, are dehydrated and extremely unwell.

Secondary lactose intolerance can occur as a temporary condition following an episode of gastroenteritis (also known as a tummy upset, bowel infection, stomach flu or infectious diarrhea). After the inflammation in the small intestine has gone, the cells that produce lactase return and so does tolerance to lactose. This type of lactose intolerance usually lasts only a couple of weeks.

An inherited form of lactose intolerance, known as acquired lactose intolerance is quite common. However, it will only begin to affect a child over the age of 4 years (often not developing until late adolescence). This occurs in people who originate from countries were milk is not traditionally given after infancy e.g. Asian people, Native Americans, Indigenous Australians and people from the Middle East, Mexico, the Mediterranean and Africa. Most people of Anglo-Saxon origin (Caucasians) keep producing lactase and rarely develop lactose intolerance.

Often mistaken for lactose intolerance, lactose overload from frequent, large volumes of milk, presents with identical gastric symptoms. Lactose overload is also known as functional lactase deficiency meaning that it is related how the body functions rather than a condition. Unlike the child with lactose intolerance, who fails to gain weight and is very unwell, these babies are healthy and gain very good (even large) amounts of weight.

What tests are available?

Although tests can be undertaken, they don't offer definite proof of lactose intolerance in young babies and can often be misleading. Tests are often positive in normal babies under the age of three months and can be positive in up to 2/3 of healthy breast fed babies in the first 5 months, so they are not always helpful for infants.

Lactose tolerance test

Diagnosis of intolerance is made if blood sugar is not raised after consuming a lactose rich drink.

Hydrogen breath test

Diagnosis is based on the presence of hydrogen in the breath due to incomplete digestion of lactose.

Stool acidity test

Diagnosis is based on increased acidity of the stools due to incomplete lactose digestion.

Small bowel biopsy

This procedure can be performed to diagnose malabsoption problems. It's an invasive procedure and is only indicated where the child in failing to thrive for unknown reasons.

What you can do!

For a breast fed baby

A breast fed baby may experience a secondary lactose intolerance following a bout of gastroenteritis. As breast milk aids the recovery of the small intestines breast feeding should be continued.

Many breast fed babies will experience symptoms similar to lactose intolerance (which provide positive test results). For the healthy thriving infant this is normal and is related to an oversupply of breast milk or from frequent feeding patterns and NOT lactose intolerance. Symptoms can nearly always be helped without stopping breast feeding. See our article of lactose overload for feeding tips.

For a formula fed baby

If lactose intolerance is suspected, then milk and milk products can be eliminated from the diet for a period of time. If the symptoms go away, it's normally possible to return your baby to his normal diet within a few weeks. Reintroduce regular formula by substituting the lactose-fee formula in increasing proportions over 2 or 3 days.

If no improvements in bowel movements or abdominal symptoms are seen following a trial on lactose-free formula, or if other symptoms develop, have your baby seen by a doctor, so that he/she can be assessed other reasons for these symptoms.

If you child is healthy and thriving and gaining excessive amounts of weight, gastric symptoms may be due to overfeeding. See lactose overload and hungry baby for more details.

Degrees of lactose intolerance

Contrary to popular belief, lactose intolerance does not mean your child must avoid every drop of milk or dairy food. People experience different degrees of sensitivity to lactose. Those with lactose intolerance can still digest some lactose without developing any symptoms.

Dairy foods are an important source of calcium and protein for babies and young children. The amount of lactose contained in different dairy foods varies. It's possible to select nutritious, calcium enriched foods that are low in lactose.

Full-cream milk products are often tolerated by those with lactose intolerance better than low-fat milks. This is partly because the fat in full-cream milk slows down the digestive process, so that lactose leaves the stomach and small intestine more gradually. Drinking milk with meals will also help to slow down the digestive process, meaning symptoms are less likely to occur.

Yogurt can often be tolerated by many children with lactose intolerance, because the bacteria that thicken the yogurt help to breakdown the lactose. However, some may find yogurt causes symptoms.

Cheese and butter are not a problem for lactose intolerant children. Neither contain more than tiny amounts of lactose, with the exception of ricotta cheese. However, even ricotta has relatively small amounts of lactose and is unlikely to cause problems.

HOW WE CAN HELP you to discover the solution to your baby's discomfort.

Back to

Top

See also:
Infant colic
Crying baby
Hungry baby
Milk allergy or intolerance

For a Printer friendly version