Lactose intolerance (milk intolerance) happens when the body cannot break down a sugar called lactose, which is present in all milk, including breast milk, dairy (cow) milk and other dairy products. Lactose makes up around seven per cent of breast milk similar to the amount in infant formula.
Lactose provides around 40 per cent of baby’s energy needs, helps absorb calcium and iron and helps to ensure healthy development. Usually, the enzyme lactase, which is produced in the small intestine, changes the lactose to glucose and galactose – sugars that are more easily absorbed.
Sometimes babies don’t produce enough lactase to break down all the lactose, so the unabsorbed lactose passes through the intestine without being digested. Undigested lactose irritates the intestine and causes a build-up of wind and diarrhoea.
Most children or adults who are diagnosed with lactose intolerance can digest small amounts of lactose which would not cause symptoms.
Primary lactose intolerance happens when babies are born with no lactase enzymes at all. This is genetically carried and extremely rare. This is a medical emergency and the baby would need a special diet from soon after birth in order to grow well. Secondary lactose intolerance can occur if a child’s digestive system is disrupted by illness affecting healthy production of enzymes like lactase, or if there is not enough lactase being produced. Illnesses that might lead to secondary lactose intolerance include tummy bugs that cause gastroenteritis .
Sometimes lactose intolerance is confused with other digestive problems, such as a food allergy. This is because these conditions have similar symptoms. Food allergy is not the same as lactose intolerance and does not affect a baby’s production of lactase.
The symptoms of Lactose intolerance are pain, wind, swelling in the tummy,crankiness, failure to settle at feeding times, coming on and off the breast, failure to gain weight, frothy green stools, diarrhoea, perianal excoriation (redness and peelings of the buttocks) and an irritable baby who may pass wind often. Lactose intolerance doesn’t cause vomiting, but a food allergy does.
Clinitest tablet: This is when a small amount of stool is mixed with water, and then a special tablet is added and checked for colour change. This is mostly used when temporary lactose intolerance is suspected after gastroenteritis.
Hydrogen breath test: This tests the amount of hydrogen gas in the child’s breath. Lactose-intolerant children will have higher levels of hydrogen in their breath because of the process of fermentation in the gut (when bacteria feed on the lactose that hasn’t been broken down).
Elimination diet: This involves removing foods containing lactose from the child’s diet to see whether symptoms improve. If the symptoms come back once the foods are reintroduced, lactose intolerance is most likely the cause of the problem.
Stool PH / Stool acidity test: This test, used in infants and young children, measures the amount of acid in the stool. Lactic acid and glucose produced by undigested lactose and other reducing substances.
The treatment for lactose intolerance can depend on the cause. Primary lactose intolerance is an emergency. It requires the attention of a doctor, pediatrician or nutritionist.
For secondary lactose intolerance caused by gastroenteritis, using lactaid drops that contain the enzyme lactase may help. This is not readily available in Nigeria.
Alternate baby’s breastfeeds with a lactose-free or soy-based infant formula that is readily available in Nigeria. For serious condition, the baby may be weaned onto the formula for a while.
Perianal excoriation: Redness, cuts or abrasions on the baby buttocks due to acidity of the lactose is treated with a good protective cream on the baby’s buttock.
Do you have a baby that is not growing well due to frequent diarrhoea? Be vigilant, it could be due to lactose intolerance.