Lactose Intolerance in Babies and Breastfeeding

Lactose intolerance is a well-known condition, experienced by high numbers of adults. But it can also be an issue for babies, placing those who are intolerant at risk of adverse reaction when breastfeeding.

What is lactose intolerance?

Lactose intolerance is when the body doesn’t produce or fails to produce enough of the enzyme lactase, which is responsible for digesting lactose.

“Fail to digest lactose in the small intestine, results in the molecule reaching the large intestine and it is broken down by bacteria, producing acids and gases, which causes the symptoms,” says dietitian Kate Save.

Lactase is produced in the tips of the intestinal wall, which means that anything that damages the gut lining can cause lactose intolerance. This is known as secondary lactose intolerance and, if this is the case, often allowing the damaged gut time to heal will resolve symptoms.

But lactose intolerance is different to lactose allergy, which is very serious and a rare genetic condition.

“A baby with a lactose allergy would fail to thrive without medical intervention, due to malabsorption and dehydration,” says Save.

“A baby with a lactose allergy could not be fed breastmilk and would require a special diet/formula from soon after birth.”

What are the symptoms?

Common symptoms of lactose intolerance in babies are:

• Liquid stools
• Frothy and sometimes green stools
• An irritable baby
• A windy baby, characterised by gas and also pulling legs up in pain
• Red/rash on bottom

“If a baby was lactose intolerance, they would present with the symptoms above, they would likely be failing to gain sufficient weight and possibly dehydrated.

“The main ways to diagnose lactose intolerance are with a hydrogen breath test and an elimination diet.”

What next?

If you suspect lactose intolerance, the first step would be to consult a GP, Dietitian or Paediatrician.

“Often removal of cow’s milk products from the mother’s diet can be helpful, although the baby will still be receiving lactose, as it is present in the breast milk.

“It is best to continue breast feeding as the enzyme lactase will increase with age, so unless the lactose intolerance is severe and resulting in failure to thrive and dehydration, then other forms of nutrition are not required.”

If the symptoms are quite severe, then a lactose free formula can be trialled for 1-4 weeks with a view to wean back onto breast milk or a standard formula.

If the baby is eating solids, then it is best to avoid foods with a high cow’s milk content, such as milk, yoghurt and soft cheese. Hard cheese is ok due to its low lactose level.

Alternatives to cow’s milk include:

• Lactose free milk, such as Zymil and Liddels
• Soy milk and soy yoghurt
• Lactose free yoghurt, such as Vaalia and Black Swan
• Rice milk
• Almond milk