Lactose intolerance is neither a kind of disease nor an allergy syndromes, it is rather a sensitivity to dairy products we consume which contain lactose, exists in our food as natural sugar.
Lactose intolerance in babies means the babies are unable to digest lactose in breast milk or dairy products due to insufficient or no lactase enzyme produced by their bodies. Lactose intolerance since birth is extremely rare case and about 40 cases been reported worldwide. Some preterm babies develop lactose intolerance (insufficient lactase due to immaturity) and will usually be improved after they get a little order.
Sometimes, we are confused about the milk allergy and lactose intolerant due to their share symptoms. These two have different management and symptoms. I have written a post related to symptoms for milk allergy and we are going to focus solely on lactose intolerance symptoms in babies in this article.
What is lactose? What is lactase?
Lactose is the natural sugar found in most dairy products including breast milk and formula made from animal’s milk like cow and goat . Babies need lactose as it is the main source of carbohydrate for their growth and development.
Lactase is a kind of enzyme produced by our body to digest lactose, in this case for babies, their main food is milk and lactose existed in both human and animal’s milk. Lactase break down lactose in our body to glucose and galactose which are easily absorbed from our small intestine into our bloodstream.
Babies who are lactose intolerant, are unable to produce sufficient lactase or with absence of lactase enzyme to breakdown the lactose, pass through small intestine and directly to the colon where bacteria in the colon metabolize the lactose and cause fermentation. This process is causing the symptoms appear to be side effect due to the gas and unabsorbed sugar as a result of fermentation.
Symptoms of lactose intolerance in babies
Lactose intolerance is commonly happened to some preterm babies, babies who are born lactase deficiency since birth (which is very rare) and toddlers above 2 years of age. Most full term babies are high in lactase which enable them to digest breast milk but the level of lactase will be decreased by age. Due to their indigestion of lactose in milk, the symptoms appear to be gastrointestinal. Here are the common symptoms:
- Abdominal pain
- Stomach cramp
Usually babies do not experience vomiting and skin problem like hives. Most significant symptoms is the baby passing watery and frothy poos at least 3 times in 24hours. Babies will become unsettled due to abdominal pain and cause fussiness and crying.
Milk contain lactose
For babies less than 2 years of age, their main food is breast milk and/or cow’s milk formula. When they start eating solid food, there are variety of choices which are suitable for lactose intolerant babies too.
Lactose is found in both human milk and standard cow’s milk. Below are the examples of milk powder in the market which contain lactose as carbohydrate source:
- Standard full term cow’s milk
- Carnation Good Start
- Enfamil with Iron
- Similac with Iron
- Enfamil Lipil
- Good Start DHA & ARA
- Similac Advance
- Similac Neosure
- Enfamil AR
- Similac Sensitive RS
- Enfamil Next Step
- Good Start 2
- Similac Go and Grow
2. Preterm formula cow’s milk
- Enfamil 24 Premature
- Preemie SMA 24
- Similac 24 Special Care
Choice of food for lactose intolerant babies
Lets us look at what are the options do lactose intolerant babies have?
1. Breast milk.
- For some preterm babies and babies who are lactose intolerant since birth, it is better to start with breast milk which is the most natural human milk ( In some studies, breast milk contains around 7% of lactose).
- Monitor the baby’s condition. Is your baby fussy and unsettled after feeding? is your baby passing loose and frothy poo?
- When breastfeeding, let the baby latch on one side and try to empty it before switching to the other side. The purpose is to let the baby get as much as the fatty milk as the fat can slow down digestion so that more lactose can be broken down and absorbed by the intestine.
- Drag the feeding time a bit longer like 3 hours before starting the next feed. It is to let the body has enough time to produce lactase to digest lactose in breast milk. If your baby wants a feed during this time, let her latch on the empty one.
- If the breast milk still make the baby uncomfortable, rest assure that this will not harm your baby and your baby is still gaining weight normally.
- If breast milk does not make your baby feel better and comfortable. Try the next option below:
2. Lactose free formula
- If breastfeeding is not available or the mother has medical reasons for not being able to breastfeed, lactose free formula can be introduced if breast milk and standard cow’s milk can still make the babies feel uncomfortable and unsettled after the feed.
- Lactose free formula is one of the alternatives besides soy milk for lactose intolerant babies. For preterm babies who are having developmental lactase deficiency (usually those who are born less than 34 weeks gestation), lactose free formula can help to improve the symptoms temporary but these type of formula do not fulfill the nutrition requirement for their growth and development. Preterm baby will mostly be able to consume breast milk or standard cow’s milk formula when they get more mature.
- Examples of lactose free formula for infant are Enfamil NeuroPro Sensitive and Similac Sensitive. Some brand in the market which are reduced lactose ( contain 20-30% of lactose, normal cow’s milk formula contain 100% of lactose) which are having good reviews from some parents are and Enfamil NeuroPro Gentlease and Gerber Good Start Soothe.
3. Soy milk formula
Providing soy milk to lactose intolerant babies is always debatable. Soy milk formula is made of corn based carbohydrate and soy protein. They are free of lactose and cow’s milk protein. Supposedly it is safe for both lactose intolerant and cow’s milk protein allergy babies. However, some babies also have allergic reaction to soy milk. Some studies suspected soy protein contain genistein, a plant based estrogen compound which may has effect to our endocrine system and interfere with normal development of hormone to the babies.
As recommended by American Academy of Pediatrics, soy milk is recommended for infant who is galactosemia (babies who are unable to process simple sugar galactose which is the breakdown of lactose and normally is due to genetic condition but it is extremely rare case) and vegan families who do not want animal protein.
Soy milk do not recommend for preterm babies due to some studies show significantly less weight gain compared to those who are fed with same caloric density of standard cow’s milk formula.
There are some soy milk products in the market which is having good reviews from the parents related to soy milk. Here are some examples:
4. Lactase supplement
There are several brands of supplement contain lactase enzyme which can be taken with the lactose contain food like milk. Some examples are:
- Lactase drop from Seeking Health ( suitable for young children 4years old and above)
- Infants drop from Colief (for infant since birth)
5. Acidophilus and Probiotics
In some studies, lactic acid producing bacteria is commonly used as probiotic food, can be used to alleviate the clinical symptoms of lactose intolerance. These bacteria can break lactose into smaller chain and make it easy to be absorbed by the intestine. The probiotic can be found in the market and some examples are shown below:
- BioGaia Probiotics Drops
- Culturelle Baby Grow + Thrive Probiotics + Vitamin D Drops
6. Yogurt culture
Yogurt contain live bacteria which can help lactose digestion. The live bacteria in fermented milk ( yogurt) able to produce their own lactase enzyme. Some lactose in the yogurt is broken down by the excess lactase and make it easily digested than other milk product.
7. Low lactose food
Here are some examples of low lactose food you can give to your babies once they have started solid food.
- Rice milk
- Almond milk
- Hard cheese
- all kind of fresh vegetables, fruits and meat
Always check the label for the ingredient, put a little extra attention if it says ” May contain milk”. Sometimes, it is the matter of amount you take and the duration between the meal.
Always go to dietitian and pediatrician for the choice of formula or food best for your babies for their growth and development.
Lactose intolerance in babies may create a lot of discomfort but it is not life threatening. This article is served as a reference for those who are having lactose intolerant babies who wish to know better about symptoms and giving you some guideline how to deal with it.
Please do not hesitate to drop me a comment to share your experience and your view so that everyone who read this article may be benefited from it.