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What is Lactose Intolerance

Lactose is a form of sugar in milk products. It is a good and useful nutrient, but some people have trouble digesting it. Doctors call this condition “lactose intolerance.” Symptoms are bloating, cramps, gas, and often diarrhea soon after drinking milk or eating certain dairy products. The condition is not a food allergy, because there is no immune system problem. Some people have only very mild lactose intolerance that is not much of a problem. Others have to stay away from almost every kind of milk product to avoid getting sick. Many children who did well in infancy develop problems as they grow older. Today many doctors believe that this is actually a normal process in most of the world’s populations. They believe that older children and adults who do not digest lactose well are not “abnormal” and do not need medical treatment.

Many doctors today make the diagnosis of “possible lactose intolerance,” and feel that it’s well worth a trial of a lactose- or milk-free diet for a while. This is sometimes called an “avoidance/re-challenge” test. If symptoms improve while avoiding milk, and return when milk is added back to the diet, then a diagnosis of true lactose intolerance applies. This also gives families and children a chance to see for themselves if giving up milk provides enough relief of symptoms to be worth the sacrifice. Then they can make a more informed choice about how to proceed.

In especially cases where the diagnosis is difficult to make, or if there are other concerns, doctors sometimes order a test called a “breath hydrogen test.” This is a fairly simple way of learning whether a child is digesting milk sugars properly in the intestine.

What is the biggest concern?

In infants, who get most or all of their nutrition from milk or formula, lactose intolerance can be a problem, of course. The biggest concern is to make sure that the baby gets enough nutrition and fluid to grow normally. Infants with severe lactose intolerance can have continuous diarrhea. They can become malnourished or dehydrated. In milder cases infants may be very uncomfortable from gas pains, cramps, and diaper rash. These infants usually grow normally. For infants with lactose intolerance, it is important to choose a feeding strategy that avoids lactose but offers a balance of nutrients.

In older children and teens, lactose intolerance is less of a nutritional issue. It is more of a question of comfort and convenience. Children and teens have a much wider variety of foods to choose from to get proper nutrition. With careful attention to what they eat, children and teens can manage very well even if they do not tolerate lactose-containing foods.

Lactose Intolerance treatment

Doctors usually recommend a non-lactose containing formula for infants who seem to be lactose intolerant. Most infants do well with one of the standard soy-based, lactose-free formulas such as ProSoBee®, Isomil®, and others. There are also some milk-based lactose free formulas. Some infants with formula intolerance also have true allergies to the proteins in soy formulas. Doctors often recommend a formula that contains broken down proteins in such cases. These so-called “pre-digested” or “elemental” formulas include Pregestamil®, Nutramagen®, Alimentum®, and others. Each of these special formulas is slightly different. They are designed to treat specific conditions, so please follow your doctor’s recommendations carefully.

Older children and teens with lactose intolerance can usually do quite well by avoiding milk products. Please remember that this does not mean that they must avoid all so-called “dairy products.” Eggs are always fine (unless the child also has an egg allergy). Most cultured milk products such as yogurt and cheeses (especially hard cheeses) contain much less lactose than plain milk. Please remember that low fat milk, such as 2% or skim milk, actually contains morelactose per serving than whole milk. Dairy products are a good source of protein and other nutrients. It can be well worthwhile to cautiously introduce one cultured dairy product at a time. If your child tolerates a product, s/he can add that to the “OK” list. It will be important to help your child remember that small amounts of certain foods may work fine, but overdoing them will probably bring on the symptoms. Over time you and your child will learn which products work and which you should avoid. Some children and teens find that they are willing to put up with a small amount of discomfort in order to enjoy a favorite food. Giving your child this much control over his or her diet can be an important and healthy step in preparing him or her for mature decision-making.

Several products are available to help people with lactose intolerance. Some people take a lactose-digesting enzyme called “lactase” (Lactaid® and others) before having milk products. This is an over-the-counter tablet, and you and your child can learn the best doses to use. The tablets also contain mannitol, which can cause diarrhea if the child takes too much. You and your child will want to work together to learn the right dose of lactase to use, and what kinds of foods will require using it.

You can also buy milk that contains lactase, which is sold as Lactaid® Milk. Milk that contains bacteria which break down lactose is often sold as “acidophilus” milk. This is not a lactose-free product, but it contains much less lactose than regular milk. Many people also like to use non-dairy milks such as soy, rice, or other grain-based milks. These are good substitutes for dairy milk, and you can buy them enriched with vitamins as well. Please do remember that these products lack some of the “essential fatty acids” that children need for normal development, especially in their first years of life. Please talk with your doctor about finding other sources or supplements for these important nutrients.

Dangerous Lactose Intolerance Symptoms

Infants with true lactose intolerance usually do very well with a soy-based, lactose-free formula. It does take a few days before you see improvement, though. If your infant continues to have problems even after 3 to 4 days of taking a lactose-free formula, there is a good chance that s/he has a milk- or soy-protein allergy. Doctors treat this differently from simple lactose intolerance. Here are a few things to look for:

  • Continued abdominal bloating, gas, or diarrhea
  • Blood or mucous in the stool
  • Extreme fussiness or irritability
  • Extreme sleepiness or lethargy
  • Evidence of abdominal pain, like drawing the knees up to the chest
  • Vomiting more than just “spitting up”
  • Fever
  • Rash

If any of these occur, please be sure to call your doctor’s office right away.

Other points of concern

As we noted above, many doctors now believe that a gradual loss of ability to digest lactose is normal as children grow out of infancy. This can be hard for children and teens who may feel deprived at being unable to eat some of the many dairy products that are available. It is important to help your child or teen understand that they are not “deficient” in any way if milk products cause him or her problems. In the long run it will be important for your child or teen to learn to prioritize his or her comfort and food preferences. Making informed decisions about important choices is part of growing up. There are many options available, including simply avoiding milk products, using soy-based products, and using digestive enzymes like Lactaid® and others.

Other Conditions that Might Be Present with Lactose Intolerance

Lactose intolerance is the most common food intolerance in infants. It is not the only one. Some infants are allergic to the proteins in milk, soy, and other products. These children may have diarrhea and may fail to grow well. Later in life they may turn out to have other forms of allergies as well. Allergic reactions to formula proteins often include diarrhea with mucous or blood in it.

If your infant’s only symptom is vomiting and there is no diarrhea, there is a good chance that your infant does not have lactose intolerance. Babies who “spit up” a lot may have a mild condition known as “reflux,” or “GERD.” Please discuss this with your doctor. There are a few more serious causes of vomiting without diarrhea, so if the condition persists, please get in touch with your doctor. Your baby may have one of a number of other problems that may or may not improve with formula changes. Please talk to your doctor and make sure you are thoroughly informed before making any formula or other diet change for your baby.