What is Lactose Intolerance?
Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar of milk. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine. Lactase breaks down milk sugar into simpler forms that can then be absorbed into the bloodstream. When there is not enough lactase to digest the amount of lactose consumed, the results, although not usually dangerous, may be very distressing.
Common symptoms include nausea, cramps, bloating, gas, and diarrhoea, which begin about 30 minutes to 2 hours after eating or drinking foods containing lactose. The severity of symptoms varies depending on the amount of lactose each individual can tolerate.
Some causes of lactose intolerance are well known. For instance, certain digestive diseases (i.e. gastro-enteritis) and injuries to the small intestine can reduce the amount of enzymes produced. In rare cases, children are born without the ability to produce lactase. For most people, though, lactase deficiency is a condition that develops naturally over time. After about the age of 2 years, the body begins to produce less lactase. However, many people may not experience symptoms until they are much older.
How is Lactose Intolerance Treated?
Fortunately, lactose intolerance is relatively easy to treat. No treatment exists to improve the body’s ability to produce lactase, but symptoms can be controlled through diet.
In older children and adults: -
Most older children and adults need not avoid lactose completely, but individuals differ in the amount of lactose they can handle. For example, one person may suffer symptoms after drinking a small glass of milk, while another can drink one glass but not two. Others may be able to manage ice cream and aged cheeses, such as cheddar and Swiss but not other dairy products. Dietary control of lactose intolerance depends on each person’s learning through trial and error how much lactose he or she can handle.
For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain lactose, lactase enzymes are available without a prescription. One form is a liquid for use with milk. A few drops are added, and then after 24 hours in the refrigerator, the lactose content is reduced by 70 percent. A more recent development is a chewable lactase enzyme tablet that helps people digest solid foods that contain lactose. Three to six tablets are taken just before a meal or snack.
Lactose-reduced milk and other products are available at many supermarkets. The milk contains all of the nutrients found in regular milk and remains fresh for about the same time or longer if it is super-pasteurised.
In infants and young children: -
Congenital Alactasia is an extremely rare condition whereby babies are born without any lactase (the enzyme needed to break down milk sugars), making human milk unsuitable for the baby, precluding breastfeeding. These babies must be fed a special lactose-free formula to survive (soya formula, or dairy based but lactose free).
Functional Lactase Deficiency describes a thriving breastfed baby who has multiple loose watery stools. The baby may be irritable and may pass flatus frequently. Low fat feeds result in rapid gastric emptying leading to large quantities of lactose being presented for digestion. Thus the ability of lactase to digest the lactose may be overwhelmed. The amount of fat being consumed at any feed should therefore be maximised to delay gastric emptying. This can best be achieved by optimising hind milk intake by:
• Encouraging the infant to finish the first breast before offering the second breast.
• Spacing feeds. Aim for three hours between feeds. If the baby demands again in less than this time offer the “empty” breast again.
As lactose is the main form of carbohydrate in all mammalian milks (including human milk), lactose production at the breast occurs independently of dietary changes. Reducing the amount of lactose in the diet of a breastfeeding mother does not alter lactose production at the breast. It is present at a constant level throughout a feed and throughout a day.
Primary acquired lactase deficiency is an age-related condition and occurs after weaning and before the age of six years. Young children with this form of lactase deficiency should not eat any foods containing lactose; weaned infants require a lactose free formula (soya formula, or dairy based but lactose free).
Secondary acquired lactose intolerance occurs as a result of damage to the small intestinal mucosa that commonly in infants is due to gastro-enteritis. This is treated by the introduction of a lactose free formula to the infant’s diet.
Depending on the severity of the illness partial breastfeeding may still be possible. If the infant has recently had gastro-enteritis average recovery time is four weeks. Weekly challenges with breast milk should be attempted until it becomes tolerated.
Milk Protein Allergy
What is Milk Protein Allergy?
A food allergy exists when a body has an abnormal reaction to food. A person who is allergic to dairy is normally reacting to one or more proteins found in cow’s milk. Typical reactions to milk protein(s) allergy involve problems associated with the skin, the stomach/intestines and or breathing.
Allergies to milk protein are more common in infants and children, and are usually to casein. Generally, adults milk reactions are caused by lactose but adults have been known to be allergic to milk protein. Milk protein allergy in infants can be detected as early as 9 days.
Dietary Therapy for Milk Protein Allergies
The dietary therapy approach to this allergy is to remove ALL obvious and hinder sources or dairy in the diet. This sounds like a simple idea at first until you realise the many forms animal milks take in modem foods. But with dedication to the task and armed with a few new basic shopping and cooking hints, a list of dairy ingredient names and often a good pair of glasses anyone can totally remove dairy from a person’s diet. To be honest it takes two months of focused dedication to adjust your lifestyle and feel comfortable with the changes that are required. But the nice thing is you will see very positive changes in your special child’s or adult’s life within a week or so.
Dietary Therapy for Milk Protein Allergy in Infants
If weaned, usually soy based formula, although 25% of infants allergic to milk are also allergic to soy. These babies are put on pre-digested formula e.g. Pregestimil or Nutramigen, which have all the properties and carbohydrates hydrolysed (broken down).
If breastfed, the mother may need to go on a dairy free diet herself to eliminate the possibility of milk products reaching the baby through her breast milk.
Tips for parents of food allergic / lactose intolerant children
• If you buy a specific brand of food you know contains no dairy, you should still check the label every time you purchase it. Several companies add dairy without changing the artwork on the packaging!
• If your child has been diagnosed with “colic”, question the possibility that he/she cannot tolerate dairy, eggs, peanuts, wheat, dyes or more!
• When filling prescriptions for your child, be sure the medication contains no dairy products. Your pharmacist may need to call the manufacturer to obtain a list of inactive ingredients. Some common caplet/tablet medications use lactose as a binder or sweetener.
• Be careful when purchasing children’s vitamins, which often contain lactose.
• If your child is egg allergic, you can substitute a mixture of 1 1/2 tablespoons water + 1 1/2 tablespoons oil + 1 teaspoon baking powder, mixed together, for one egg. For two eggs, just double this. Also, 1 heaped teaspoon of arrowroot powder to each cup of flour in non-dairy, non-egg baking in addition to the egg substitute will keep your baking product firm and crisp!
• Many children become hyper or aggressive when eating food additives such as dyes, MSG, sulfites and phosphates. Hydrolysed Vegetable Protein is 40% MSG. If your child tends to be “hyper”, try to stay away from these additives.
• It is important to have a good physician or allergist who can guide you on your allergic child’s health and diet.
Laureen Lawlor-Smith BMBS IBCLC, Carolyn Lawlor-Smith BMBS IBCLC FRACGP – Lactose Intolerance
National Digestive Diseases Clearinghouse – Lactose Intolerance
Non Dairy: Something to Moo About – Newcomers Guide
Children with Milk Allergies and other Food Allergies
Other useful links:
Cows Milk Allergy – An Update on Adverse Reactions – http://www.allergyclinic.co.nz/guides/43.html
Everybody Allergy Centre:- Understanding allergy
Milk Free Diet for Breastfeeding Mothers – Crown Public Health
© Gastric Reflux Association for the Support of Parents/babies (GRASP) and Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) 2004. Used and edited by GRSNNZ with permission.
Page may be printed or reproduced for personal use of families, as long as copyright and Crying Over Spilt Milk‘s URL are included. It may not be copied to other websites or publications without permission and acknowledgement. This information (unedited) was also provided (by GRASP) to health professionals in New Zealand to use ” to continue to support and inform families with babies/children with Gastro-oesophageal Reflux.”
Baby Sleep Consultant is a nationwide infant and child sleep consultancy service, we offer affordable in home, email or phone consultations. Our methods are science and practice based, whether its establishing healthy sleep habits in your 6 week old, teaching your 9 month old to sleep through the ni...
Hi there, just wanted to say that this page and your website has been a huge help! It has provided ideas, helping me and my 8 week old son cope with his reflux. He was diagnosed @ 4 weeks old, and has been on gaviscon since. I have also gone dairy free, not sure if it's helping but he's definitely settled over the weeks. Hopefully he 'grows out of it' as the Dr says, grateful for all tips and advice from other parents experiencing the same...'I'm not alone'....this is a photo of our son in his Happy Place, where he goes from crying to smiling straight away!
Hi, Just wondering if you could help me with a question please. I got given Losec Suspension today. Since it's in suspension form and not the granules how long before a feeding should I give it to my baby or can it be given at the same time?
My baby has been diagnosed with reflux, her dr prescribed her ranitidine 150 mg/10 ml. It says 1 ml 3x a day, shes 5.7 kgs, does this sound right? That seems alot to me...
Hi there. I've been reading your website and Facebook page with interest over the past few months and it's been really helpful. My daughter is coming up 4 months old and her reflux seems to be improving. We tried gaviscon but it didn't make much difference. Main thing for us has been that I cut dairy out of my diet. I now have food with dairy in it but just don't do the core basics like cheese, yoghurt, milk etc and although she still spills often, the associated pain seems to be almost gone. Am hoping she's growing out of it but the dairy still seems to have a bit of an effect. Anyway, in two months time I have to go back to part-time work and will need to start using a formula on those days. I usually used karicare gold with my kids but have no idea what options would be best for my reflux baby. Can you make some suggestions? I'd like to try some out to see how she reacts etc before I go back to work but don't know what brands to try. Thanks.
Hi, I have a wee girl Matilda, 3.5 months, who has been diagnosed with gerd and is currently on Ranitidine and Domperidone. We have tried Losec and gaviscon infant too, and after trying pepti jnr and neocate we are now on elecare formula. Also have done the usual, raise cot, chiro, upright after feeds etc. We don't seem to be making much progress and its really heart-breaking to try all these medications on such a wee person! We do seem to have 3-4 great days when she is happy and contented but then have 3-4 terrible days with constant crying, not much drinking, so much vomit and terribly unsettled, not much sleeping etc; my question is, is this 'normal' ?! Is gerd cyclonic? Thanks, Amanda :)
My four month old son has recently been diagnosed with reflux after his feeding has become worse and worse over the last month. He will cry before and during a feed and constantly turns his head from side to side. It takes alot of coaxing to get him to drink. He has also started waking almost hourly through the night. We have tried gaviscon which gave him terrible constipation and now ranitidine. After reading the dosages on the spilt milk site we realized the dose we were given was far too low so have now been on a high ish dose for a week with little change. How long should it take to see a change? We also have a script for omeprazole so can try that next. Anyone else with a reflux baby also had these sleeping issues? Any tips welcome, we have raised the bed and keep him upright after feeds. Thanks in advance
Anyone recommend a good paediatrician in Auckland, son has reflux and looking to get some help!
How can I give my omeprazole granules to a 5 month old? I have been putting in pear puree but now want to introduce food and think this is putting her off wanting to eat!
Our membership form is now working again. Sorry for the delay. We are looking forward to meeting some new members. http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz.../ Joining Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust gives access to our Newsletters and Private Local and National Support Networks. Membership is free, and this gives you opportunities to discuss gastric reflux related issues with others in a safe and confidential setting.
hi i have a nearly 8 month old girl, she is on ''Kari-care anti reflux AR'' now they say by six months the reflux or spewing up heaps of milk should be fine now. but im scared to put her on normal kari care cause she use to vomit like crazy, what formula should i be going on? thanks :)