December 02, 2024

Understanding Lactose Intolerance In Babies

A common question among many parents surrounds the tolerance of formula or breast milk in infants who spit up more frequently or seem to have gas. Does my infant have an intolerance?

Gas is normal and just like in adults it can be more common for some than others. Gas, spit up or the appearance of abdominal distension may not be of concern or bothersome to your baby but it is important to know when they may be experiencing pain or have other concerning symptoms.

Standard formula is designed to mimic breast milk and both of these are tolerated well by the majority of babies. If you are concerned about lactose intolerance you may see signs of discomfort within the thirty minutes to two hours of feeding your baby and should prompt you to discuss these with your health care team.

Babies can be sensitive to formula or even breast milk. Lactose intolerance is a recognized problem in infants and if properly diagnosed, might require a dietary change.

Definition

Lactose is a sugar found in dairy products, made up of two simpler sugars (glucose and galactose). Milk and ice cream contain the highest concentration of lactose per serving, but it can also be found in yogurt, cheese, butter and sherbet. Lactose may be present in breast milk, standard infant formulas or with the above dairy products that you may have introduced into your child’s diet.

Humans require an enzyme called lactase to break down and digest lactose so it can be absorbed into the intestines. Intolerance to lactose containing foods is common and may be associated with low levels of the lactase enzyme in the small intestine. Lactose intolerance describes a condition where your child may develop gastrointestinal symptoms within a few hours of ingesting lactose containing foods; it may have a genetic basis in some individuals.

Lactose intolerance should be distinguished from a true milk allergy, as the latter involves an immune system response and can be more severe.

Accurate Diagnosis

There may be less severe or perhaps more serious reasons why your child could be having gastrointestinal symptoms. It is important to have regular contact with your healthcare team and physician who can make an accurate diagnosis of your child’s condition. Often, if your baby is growing well, some helpful feeding tips and reassurance is all that is needed.

Lactose intolerance may have very few symptoms but can present with:

Abdominal pain
Increased flatulence (gas)
Bloating
Nausea
Diarrhea within a few hours of ingesting a meal containing lactose

Your child’s stools be also be frothy or watery. Often, concerns regarding rashes are expressed by parents but these typically are not associated with lactose intolerance alone. Importantly, lactose malabsorption should not lead to weight loss or nutrient deficiencies. The severity of the above symptoms can vary considerably between individuals. Symptoms usually resolve within a few days of avoiding lactose containing foods.

Alarming symptoms as identified by your physician can prompt the need for imaging studies or further evaluation, but for most children, these studies aren’t necessary. A hydrogen breath test is a common test performed to evaluate both children and adults for lactose malabsorption and it is both quick to perform and non-invasive for your child.

Management

The goal of managing lactose intolerance is to stop the bothersome symptoms your child may be experiencing and to ensure your child still maintains an adequate intake of calcium and vitamin D for normal bone growth. Treatment involves limiting the amount of dietary lactose consumption; many children do not need complete elimination. Calcium and vitamin D supplementation may be required.

For children or infants where lactose intolerance is suspected:

There are lower or no lactose infant and toddler formulas that may be helpful to achieve nutrition needs
Mothers who are nursing can follow a lactose free diet to remove this from their expressed break milk.
Lactase enzyme preparations are also commercially available and can be taken orally with lactose containing foods, but they cannot completely break down all dietary lactose and results achieved through supplementation are variable.

If symptoms continue to persist in your child despite these treatments, medical attention may be required to assess for alternative diseases.