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Joy Anderson BSc, Dip.Ed., Grad.Dip.Med.Tech., IBCLC, Australian Breastfeeding Association Counsellor
Sourced from Australian Breastfeeding Association - formerly Nursing Mothers' Association of Australia [Australian Breastfeeding Association]
Lactose is the sugar in all mammalian milks. It is produced in the breast and is independent of the mother's consumption of lactose. It is present in a constant concentration in breastmilk. Foremilk, the milk the baby gets when he first starts to feed, does not contain more lactose than hindmilk, but it does contain less fat. Lactase is the enzyme which is required to digest lactose. Lactose intolerance arises when a person does not produce this enzyme (or does not produce enough) and is therefore unable to digest lactose.
The symptoms of lactose intolerance are liquid, frothy stools, and an irritable baby who may pass wind often. If a baby is lactose intolerant, the medical tests, 'hydrogen breath test' and tests for 'reducing sugars' in the stools would be expected to be positive. However these are positive in most normal babies under three months too so their use in diagnosing lactose intolerance is open to question.
There are some common fallacies about lactose intolerance that you may hear in the community:
- Lactose in the breastmilk will be reduced if the mother stops eating dairy products.
- Lactose intolerance in other family members (adults) means baby is more likely to be lactose intolerant.
- If a mother is lactose intolerant then her baby will be as well.
- A baby with symptoms of lactose intolerance should immediately be taken off the breast and fed on soy-based infant formula, or other special lactose-free formula. Lactose intolerance is the same as intolerance or allergy to cow's milk protein.
Read on to see what is wrong with these ideas!
Lactose intolerance in Babies
Primary (or true) lactose intolerance is an extremely rare genetic condition and is incompatible with normal life without medical intervention. A truly lactose intolerant baby would fail to thrive from birth (ie not even start to gain weight), and show obvious symptoms of malabsorption and dehydration - a medical emergency case needing a special diet from soon after birth.
Anything that damages the gut lining, even subtly, can cause secondary lactose intolerance. The enzyme lactase is produced in the very tips of folds of the intestine, and anything that causes damage to the gut may wipe off these tips and reduce the enzyme production, for example
- gastroenteritis
- food intolerance or allergy (In breastfed babies, this can come from food proteins, such as cow's milk, soy or egg, in the mother's milk originating in her diet, as well as from food the baby has eaten.)
- coeliac disease (intolerance to the gluten in wheat products)
- following bowel surgery
Note that cow's milk protein allergy (or intolerance) is often confused with lactose intolerance, and they are thought by many people to be the same thing. This confusion probably arises because cow's milk protein and lactose are both in the same food, ie dairy products. Also contributing to this confusion is the fact that allergy or intolerance to this protein can be a cause of secondary lactose intolerance, so they may be present together.
Secondary lactose intolerance is a temporary state as long as the gut damage can heal. When the cause of the damage to the gut is removed, for example the food to which a baby is allergic is taken out of the diet, the gut will heal even if the baby is still fed breastmilk.
Occasionally it is considered preferable to speed up the healing, and reduce the immediate symptoms, by reducing the amount of lactose in the diet for a time, particularly if the baby has been losing weight. In this case, it may be suggested that the mother alternate breastfeeding and feeding the baby with a lactose-free articifical baby milk, as types other than the truly hypoallergenic ones may make the problem worse. Although commonly advised, there is no good evidence to suport taking the baby off the breast altogether. In the case of a baby recovering from severe gastroenteritis, average recovery time for the gut is four weeks, but may be up to eight weeks for a young baby under three months. For older babies, over about 18 months, recovery may be as rapid as one week.
When even partially taking the baby off the breast temporarily is being considered, thought should also be given to other aspects of the breastfeeding relationship. These include:
- How will alternative feeding methods affect this baby? Could it result in breast refusal later?
- How easily will the mother be able to express her milk to maintain her supply?
A mother needs to be aware of exactly what is happening, and understand that this episode need not undermine her confidence in breastfeeding. Her breastmilk is still the normal and proper food for her baby in the long term.
You may have heard about giving 'Lactaid' drops to babies who have symptoms of lactose intolerance. There is no proof that these are of any value used this way. These drops do contain the enzyme, lactase, but need to be put into expressed breastmilk and left overnight for the enzyme to digest the lactose in the milk. In practice they are rarely useful for babies.
In conclusion, there are several types of lactose intolerance, as explained above, but it is very rare for a baby to have to stop breastfeeding because of this condition. Except for the extremely rare primary type, there is always a cause behind lactose intolerance in babies. Getting to the cause and fixing that is the key to resolving the baby's symptoms of lactose intolerance.
References
Brodribb W (ed), 2nd ed. Breastfeeding Management in Australia, Merrily Merrily Enterprises Pty Ltd 1997.
Lawlor-Smith C & Lawlor-Smith L, 1998, Lactose intolerance, Breastfeeding Review 6(1): 29-30
Leeson R, 1995, Lactose intolerance: What does it mean? ALCA News 6(1): 24-25, 27.
Minchin M, Food for Thought, Alma Publications 1986. Rings EHHM et al, 1994, Lactose intolerance and lactase deficiency in children, Current Opinion in Pediatrics 6: 562-567.
Woolridge M & Fisher C 1988, Colic, 'overfeeding' and symptoms of lactose malabsorption in the breast-fed baby: a possible artifact of feed management? Lancet (ii): 382-384.
Internet resources
Updated February 2007
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