Lactose Intolerance in Babies: Symptoms and Treatments
How do you know if your baby has lactose intolerance? What are the symptoms ? How to relieve your child? Which milk for a lactose intolerant baby? All the answers to your questions with Dr. Etienne Bidat, pediatrician and allergist, and Émilie Fumet, dietician.
While lactose intolerance is relatively common in infants, it can be temporary when it occurs, for example, after gastroenteritis or any disease causing damage to the baby's intestine. In this situation, the intolerance will cease when the intestinal mucosa is completely healed. During this period, the use of lactose-free milk or dietary changes, if dietary diversification is already well underway, are recommended.
Allergy to cow's milk proteins or lactose intolerance: what's the difference?
Any allergy, such as that to cow's milk proteins, triggers an immune system reaction with more or less violent manifestations within minutes or even seconds of ingesting the food. In contrast, lactose intolerance is metabolic.
“To digest lactose (a sugar found in milk), the digestive system produces an enzyme called lactase. Its activity naturally decreases over time and quite synchronously with an individual's milk needs. You will rarely see an adult drinking 800 ml of pure milk a day! But it happens that this decrease in activity occurs earlier, generally around the age of 2-3 years. This is called lactose intolerance,” explains pediatrician Dr. Etienne Bidat. No particular concern to have for parents who suffer from lactose intolerance, it is not transmitted.
Read alsoHow do I know if my baby has lactose intolerance?
Lactose intolerant children experience bloating, abdominal pain and may suffer from diarrhoea. These digestive disorders are due to the fermentation of lactose in the digestive tract. "It has absolutely nothing to do with gastroesophageal reflux disease (GERD)", underlines Étienne Bidat. Parents usually notice this because the child complains after drinking a bottle or a cup of milk for breakfast (within about two hours).
There are varying degrees of lactose intolerance. “It is extremely rare for newborns to be affected by lactose intolerance. But in this case, we speak of primary lactose intolerance. The newborn is not growing enough. It is then part of a larger metabolic disease, ”says the pediatrician. He adds that transient lactose intolerance can occur after an episode of severe diarrhea (after gastroenteritis for example). "The digestive tract is damaged and it takes some time for the enzymatic activity to resume", explains Dr Bidat.
“It can also be a congenital deficiency in lactase, an enzyme that helps digest lactose, fortunately very rare. In the latter case, the baby will have to drink only lactose-free infant milk and follow a strict lactose-free diet for life”, continues Emilie Fumet, dietician.
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"Secondary intolerance, on the other hand, appears later, generally around 3-4 years of age, lactase being at its maximum level at birth and gradually decreasing with age in this very frequent case", adds- She. In this case, it is advisable to seek with the doctor or the nutritionist, the lactose tolerance threshold to adapt the advice and the food restrictions.
Which milk if baby suffers from lactose intolerance?
For lactose intolerant babies, there are infant milks formulated without lactose. "If they are made from cow's, goat's or sheep's milk, depleted in lactose, all the nutrients (iron, vitamins D, K, in particular, essential fatty acids, etc.) necessary for the baby's proper development have been added as in all infant milks", notes Emilie Fumet.
Can we turn to vegetable milks or rice milk?
It is also important to specify that vegetable drinks (called milk but corresponding more to purees or juices from almond, soy or rice) not formulated specifically for infants, especially those sold in supermarkets or in organic stores, are not suitable for the needs of babies. And, in exclusive consumption, they lead to serious deficiencies for toddlers. They are therefore strongly discouraged by health professionals.
Lactose-free infant milk: in which case should it be given to an infant?
If your child has poor digestion (diarrhea, cramps, bloating, gas), it is important to consult your pediatrician who will be able to make a diagnosis and recommend a milk that will suit your child.
Lactose-free milk is indicated in case of:
If lactose intolerance is linked to a drop in the activity of lactase – the enzyme responsible for the digestion of lactose – following gastroenteritis for example, a low-lactose milk may be sufficient for the time that the inflammation of the intestinal mucosa disappears. "We generally recommend giving low-lactose milk for 8 days, then reintroducing classic infant milk," says Emilie Fumet.
Read alsoThese types of lactose-free milk are sold in pharmacies, on the advice of your doctor, but they are delivered without a prescription.
How to treat lactose intolerance in children?
If your child has lactose intolerance, it is a question of adapting his diet for a few weeks so that the activity of the lactase gradually resumes. Pediatricians or nutritionists can prescribe low-lactose milks. If the child is already eating “solid”, they will recommend other calcium intakes through dairy products that are easier to digest. "Two pieces of hard cheese (low in lactose) a day are enough to cover a child's calcium needs", cites Dr. Bidat as an example.
"Apart from cases of very strong intolerance, parents easily adapt meals to their child's particular sensitivity (which generally regulates itself, identifying the foods that do it good)", he continues. . In most cases, there is no need to make a more precise diagnosis with laboratory tests or to consider drug treatments based on synthetic lactase. On the other hand, in the event of very strong symptoms despite the adaptation of the diet, it is advisable to consult a gastroenterologist.
Read alsoHow do I know if my baby is allergic to cow's milk proteins?
The allergy triggers a reaction of the immune system with more or less violent manifestations within minutes, even within seconds after ingesting the food. This is the case of immediate allergies (IgE mediated). For delayed (non-IgE-mediated) allergies, such as eczema or digestive disorders, the relationship between food intake and clinical manifestations is less clear. You should know that before the age of one year, cow's milk proteins are most often implicated in allergies. Some allergies can be transient. Thus, in more than 80% of cases, cow's milk protein allergy very often heals around the age of 3-4 years.
What are the symptoms of a cow's milk protein allergy?
If sometimes the symptoms immediately suggest an allergy, such as swelling of the lips just after drinking milk, for example, most of the time it is more difficult to decipher. Itching, allergic rhinitis, bloating, diarrhea, asthma… may very well be signs of an allergic reaction. A few tips to help you. Be aware that in the youngest, food allergy is most often manifested by atopic dermatitis, that is to say eczema. In addition, it is important to identify when these reactions occur. If it is systematically after taking the bottle, it is a good clue.
Read alsoAllergy to cow's milk proteins: the child may be allergic to other foods
In addition, the child may be allergic to other foods. Indeed, the body can react strongly to allergens of very different origins, but which are similar in their biochemical structure. This is cross allergy. For example, a child may be allergic to cow's milk protein and soy or almond and pistachio. Similarly, a child may be allergic to raw milk, but tolerate it just fine when baked into cakes. Hence the importance of consulting an allergist to make a reliable diagnosis and not unnecessarily remove certain foods from the menus of toddlers.
Lactose intolerance: should all dairy products (yogurt, etc.) be eliminated?
Total elimination of lactose when the infant does not have severe intolerance is not the the most suitable solution. Because the less lactase is stimulated, the more its development is compromised. The risk is then to see the intolerance worsen over time. A doctor or nutritionist can help you estimate your baby's cow's milk tolerance threshold to provide the best possible diet.
“But be aware that in the event of lactose intolerance, it may be possible to consume dairy products, such as certain cheeses which are lactose-free, specifies Emilie Fumet. Are recommended for example parmesan, goat cheese, emmental, brie, mozzarella, edam, gouda...
Similarly, the consumption of butter may be permitted, especially in cases of mild lactose intolerance, as this food contains very little lactose. “Note, however, that some children may react to butter, warns the specialist, so you have to act on a case-by-case basis. »
"As for yoghurts, they certainly contain lactose but also lactase which will help digest lactose," says Emilie Fumet. It may therefore be possible for children to consume it.” Here again, the advice of a health professional will allow you to identify the recommended foods and those to avoid.
