Lactose is the main sugar found in chest milk. It is produced in the breast, it doesn't come from a mother'south diet. Lactose is very of import for the normal health and evolution of man babies. It provides nearly twoscore% of a infant'due south energy needs, helps with calcium and atomic number 26 absorption, promotes friendly bacteria Lactobacillus bifidus, keeps pathogenic leaner in the gut at bay, and is of import for development of the large and complex human brain and primal nervous system1.

Lactose intolerance in babies

Lactose intolerance is the inability to assimilate lactose. True lactose intolerance is very rare in babies because breast milk, the biologically normal food, is full of lactose and babies are usually very well adapted to digest it. This article looks at types of lactose intolerance in babies, causes and symptoms of lactose overload and means to avoid it.

Types of lactose intolerance in babies

Babies are either born with lactose intolerance due to a metabolic disorder (a rare but serious take chances to health) or they can get a temporary form of information technology with several possible causes (much less serious). Different names are used for the different types of lactose intolerance and these vary slightly between authors.

#one True lactose intolerance

(too chosen primaryorcongenital lactose intolerance)

A specific enzyme chosen lactase breaks lactose down into glucose and galactose (more than sugars). It is produced in tiny folds (chosen brush borders) in the lining of a baby'due south intestine. There are a few rare metabolic disorders that mean a infant doesn't produce enough of this enzyme. True lactose intolerance is very rare, only when present it volition be diagnosed within a few days of nascency due to the astringent and serious symptoms similar airsickness, diarrhoea, jaundice and failure to thrive2. Your health professionals will advise on a special diet for your baby.

#two Lactose overload

(also calledsecondary or temporarylactose intolerance.)

If there is too much lactose in the gut for the enzyme to assimilate, symptoms of wind (gas), tum ache and copious frothy dark-green or watery stools may exist seen. This is much more mutual than "true" lactose intolerance. The rest of this article discusses causes, symptoms and remedies for this type of temporary lactose intolerance in babies.

Is lactose intolerance the same as cows' milk allergy?

No. Having a reaction to traces of cows' milk protein that enter breast milk via the mother's diet is not the same equally lactose intolerance or lactose overload. However an ongoing food allergy tin can damage the lining of the gut where the enzyme needed to assimilate lactose is produced, causing symptoms of lactose overload. Lactose overload and cows' milk allergy can therefore both be nowadays at the same time.

Eliminating lactose from a mother's diet won't help a infant'southward symptoms of lactose overload because lactose is added to breast milk in the breast. Even so, if the existent event is sensitivity to cows' milk protein then avoiding foods with lactose probably will assistance the symptoms because cows' milk proteins and lactose tend to be found in the same foods.

What causes lactose overload?

Anything that prevents lactose being digested properly in the intestines can crusade lactose overload. This might be damage to the special cells that produce the enzyme in the intestine, or if the volume of depression fat chest milk passing through the intestines overwhelms the available enzyme.

Damage to the intestinal lining

If at that place is whatever harm to the intestinal lining it can impact the production of the enzyme lactase which is produced in the delicate castor borders of the infant's intestines. Types of harm include inflammation (due east.g. irritation from cows' milk allergy or gluten), bacterial or viral infection (east.g. gastroenteritis) or antibiotic apply. Other possible causes of damage include partially digested formula, parasites, and some mothers notice a connection with live vaccines such as rotavirus (Minchin, 2015). If there is not enough enzyme, big amounts of lactose tin can pass undigested to the lower bowel. Here it will be fermented past bacteria giving the familiar symptoms of gas, discomfort and lots of green watery stools.

Impairment to the castor borders may have some fourth dimension to heal. Joy Anderson says:

Average recovery time for the gut of a babe with severe gastroenteritis is 4 weeks, but may be upwardly to viii weeks for a baby nether iii months. For older babies, over about 18 months, recovery may exist as rapid as 1 calendar week.

Too much lactose

A big breast milk feed with a normal lactose content but low fatty content tin can pass through to the lower bowel too rapidly for the lactose to be digested properly. This tin can atomic number 82 to colic type symptoms of air current (gas), tummy anguish and dark-green or watery stools. When breast milk has a higher fat content, it slows the transit fourth dimension in the bowel, giving time for proper digestion3. Possible causes for an excess of low fat milk tend to be connected to breast storage capacity and how often a baby changes breasts while breastfeeding. A lactose overload is more likely for the mother who has a very big amount of breast milk or who tends to stop a feed earlier a infant has finished draining one chest. An IBCLC lactation consultant tin can assist you identify how to avoid this type of lactose overload, and see:

  • Oversupply of Breast Milk
  • Ane Breast or 2 per Feed
  • What is a Fast let-Down?
  • Colic in the Breastfed Baby (by Dr Jack Newman).

Immaturity

Some premature babies might non produce plenty lactase until they mature. This is known as developmental lactase deficiency 4.

What causes lactose intolerance in adults?

In many cultures beyond the earth, levels of the enzyme lactase start to fall after three to 7 years of age (to correspond with weaning). They often fall so depression (especially in non-Caucasian groups) that an individual may become lactose intolerant (unable to digest lactose). This may not happen until machismo and will bear on consumption of cows' milk products with lactose.  This is not the same as lactose intolerance in babies5. Mohrbacher, 2010 reserves the name principal lactose intolerance for this adult type.

Lactose intolerance in babies

Symptoms of lactose overload in babies

Skillful weight gain only windy, unsettled, lots of poop

A baby with lactose overload might typically gain weight very well but show several of the following colic type symptoms:

  • Flatulence. Notation that swallowing of air during a feed is not thought to be a cause of a baby's flatulence or colic symptoms every bit excess air is burped out through the mouthhalf-dozen 7
  • Loads of explosive green or yellow frothy, foamy or watery poop. Notation: at that place can be several other causes of green poop too.
  • Tummy ache or "colic"
  • Unhappy, unsettled baby
  • Nappy rash
  • Mucousy poop

Where milk allergy is the underlying cause other symptoms may be present as well meet Milk Allergy in Babies.

Poor weight gain is possible

Not all babies continue to proceeds weight well and some may even fail to thrive as the milk is passing through the gut as well quickly to exist digested and absorbed;

Some babies lose and then much weight from the rapid passage of all food that they fail to thrive, although the mother often has a booming milk supply from all the stimulation, needing breast pads to mop up leakage.

Blood in the stools?

Abiding irritation to the intestines may also give rise to modest amounts of bleeding in the stools. Linda Palmer explains:

Lactose may come in faster than infant'south available amounts of lactose digesting enzyme, lactase, tin can reply. In this case, some of the lactose can sit undigested in the bowel, causing water to blitz in to dilute the sugar, leading to loose stools, and allowing leaner to ferment it, which causes smelly gas. Over time this situation can keep the intestines irritated and cause a little bleeding. Such chronic irritation can cause a drop in lactase enzyme production. This can create a vicious cycle.

Evening colic

Some breastfed babies seem to have colic type symptoms every evening at a set up time but are quite cheerful the rest of the day or nighttime. Author Maureen Minchin hypothesises that this could be due to  "lactose overload" from the showtime feed in the morning time i.e. when there is a lot of depression fat, lactose rich chest milk on a relatively empty stomach (Milk Matters, 2015).

How to avoid lactose overload

Finding the reason for lactose overload and knowing what to do about it will usually better the symptoms without needing to stop breastfeeding. To help find the right answer for you from the ideas below inquire your IBCLC lactation consultant for help. Options include:

Terminate the showtime breast, offering the second

The fat content of breast milk increases during a feed and also increases the closer together the feeds are. If a mother is shortening feeds (perhaps because of painful nipples) or feeding on a schedule this could lower the fat content in chest milk. Less fat reduces the time spent in the stomach (gastric clearance time) resulting in the lactose passing through the tum and bowel without being properly digested (Noble & Bovey, 1998). Finishing the beginning breast before offering the second side will help your infant to go the proportion of higher fatty milk he needs.

Stay on one breast per feed if needed

If a mother has a very large storage chapters she may only demand to feed from ane breast per feed and so that her babe can get a good balance of higher fat milk. Jack Newman explains (with a caution!):

In some situations where the baby is colicky from getting too much milk too apace, and fixing the latch and finishing one side before offering the other chest does not work, information technology may be worthwhile to try giving i breast at a feeding or fifty-fifty 2 feedings in a row. The mother needs to be aware that this may cause her milk product to subtract, and that the baby may fuss because he's not getting as much milk as he wants—fifty-fifty if he is even so gaining weight well.

Breast compressions

Using breast compressions and breast massage can help to mix the fatty content of chest milk and release more college fatty milk. viiinine.

Be flexible

Feeding plans such as block feeding (staying on one chest per feed or for a set period of time) need to be flexible. Just because a infant wants i breast in a morning may non exist the example by the evening when he might need both breasts per feed. Similarly what works at two months of age to cure fussy behaviour may need irresolute in a few weeks time or during a growth spurt.

It is not a skillful idea to feed the babe on just one side, to follow a rule. Yeah, making sure the baby "finishes" the start side earlier offer the 2d tin can assist treat poor weight gain or colic in the baby, only rules and breastfeeding do non go together well. If the babe is non drinking, actually getting milk, there is no point in but keeping the baby sucking without getting any milk for long periods of time. Y'all should "cease" 1 side and if the baby wants more than, offer the other.

Is food allergy the cause?

The underlying crusade of difficulty digesting lactose could be an allergy or intolerance to cows' milk protein (in chest milk via female parent'south nutrition). Over time an allergy may crusade inflammation and irritation to baby'due south gastrointestinal tract causing the symptoms of lactose overload. For further data see Milk Allergy in Babies and Elimination Diet for further reading.

Not enough milk?

An unhappy baby with scant light-green nappies may not exist getting enough milk rather than the problem beingness milk allergy or lactose overload. Sometimes a fussy baby who seems to want to feed a lot is merely "hanging out" at the breast only non getting plenty milk. Advice to stay on one chest per feed or for several feeds is not appropriate hither. Your IBCLC can help you lot decide what is going on and see How to Make More Breast Milk for lots of ideas to increment your milk supply.

Jack Newman points out on his Facebook page:

Many babies diagnosed with "allergy" to something in the milk get improve when put on special formulas. Why? Not considering they are no longer exposed to the mother's milk, but rather because now the babe gets more milk.

Female parent'due south diet

Lactose is produced in the breast, and the amount of lactose containing foods a mother eats won't make a difference to the lactose content in breast milk. However maternal diet tin be of import:

  • If there isinadequate fat in the mother's diet this tin make lactose overload worse for baby ( Noble and Bovey, 1998). See Best Breastfeeding Diet and Foods to Avoid for more information.
  • If a baby is sensitive to cows' milk protein (in breast milk via female parent'due south diet) this may cause inflammation and irritation to babe's gastrointestinal tract which can then cause symptoms of lactose overload. Meet Emptying Diet for more than information.

Lactase drops

In that location are anecdotal reports that drops containing the enzyme lactase can exist used to predigest lactose in expressed milk (Joy Anderson, 2012)(Palmer, 2015).

Continue to breastfeed

Jack Newman, Canadian paediatrician and breastfeeding expert, discusses breastfeeding direction in more than particular in Colic in the Breastfed Infant. He explains that the best way to deal with lactose overload is to ameliorate the baby'southward latch, know how to spot when a baby isn't really swallowing milk, to use breast compressions before switching sides and then offer the second chest and echo. If baby is gaining weight and feeding well he advises continuing to breastfeed.

My doctor said I should stop breastfeeding

Some doctors are confused about temporary lactose intolerance, milk allergy and colic. They may recommend lactose-free formula or newer 'special' formulas. However the respond to nearly cases of temporary lactose intolerance is to get help with breastfeeding rather than switch to industrial formulas. A baby with an irritated intestine needs the anti inflammatory effects of breast milk and a breastfeeding specialist can help suggest changes to feeding managementten.

it is sinister that artificial baby milks, even so specialised are promoted equally being superior milks for allergic babies. Information technology is even more than insidious to hear such letters reiterated by paediatric specialists working with these children and their families. p46

…formulas are

  • full-bodied sources of the problem proteins
  • without the advantage of having been processed by maternal digestion
  • utterly devoid of the other benefits bestowed by her milk. p47

Laid back breastfeeding

My physician says tests ostend my infant has lactose intolerance

Some doctors might diagnose lactose intolerance if they measure excess acid (reducing sugars) in a baby'south poop or hydrogen gas in a baby's breath due to temporary lactose intolerance (Palmer, 2015, p 141). Noble and Bovey country that the presence of reducing sugars in a baby'south poop tin be quite normal for breastfed babies particularly under half-dozen weeks of historic periodxi while the Australian Breastfeeding Association says both a hydrogen breath test and a examination for reducing sugars in the stool are often positive in normal breastfed babies under three months of age12. James Akre explains:

It is usual to detect reducing substances such as sugars in the stools of healthy breast-fed infants; they contribute to maintaining the acrid environment that retards the growth of pathogens. In contrast, the delayed gut transit time of industrially prepared milks permits about total metabolism of these sugars.

Summary

Lactose is the main sugar in chest milk. It is fabricated in the breast and does non come up from the mother'southward diet. It is very rare for a baby to be truly intolerant to lactose. Withal there tin can be times when there is so much lactose information technology is difficult for the baby to digest. This is oftentimes called a lactose overload and, when undigested in the gut, lactose gets cleaved downwards or fermented by bacteria to give gas, discomfort and lots of frothy watery poop. A food allergy tin be a cause of symptoms of lactose overload or sure breastfeeding management regimes. An IBCLC lactation consultant tin assist identify causes and work with you to help avert a infant getting symptoms of lactose overload.