Lactose intolerance and the breastfed baby

[MarcyOne]

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.

[coasterqueen]

Hi there. Good information, but not entirely true - at least our gastro specialist thinks differently. Our daughter is primary lactase deficient. It is a rare, yes, genetic condition. She did gain at first, but after 6 months to a year she stopped growing properly. She did grow, but not as much as she should have. For two years she didn't gain a pound, but did grow in height, some. Hers is definitely primary genetic defect after all the testing he did in her colonoscopy and endoscope - the numbers were so low that they say her deficiency will only get worse and more painful. She will never grow out of it.

So while I agree with most of your assessment, my daughter did gain, some, in the beginning, but ALWAYS had medical issues with her gastro system from day one.

My daughter was breastfed, too.

I completely agree with your assessment on the issue that people do mistake the difference between cows milk protein and lactose intolerance. Also, " lactose intolerance" is considered secondary and "lactase deficiency" is considered primary - genetic defect.

[boyohboyohboy]

our son is also lactose intolerant. He was right from birth, and got really sick on day one, he cont. to lose weight, and have gastroenteritis, also bowel issues right away.
he was diagnosised with failure to thrive before he was 8 weeks old.

He was also breast fed until he was 13 weeks old.

There are many opinions out there, that seem to vary from peds to specialists. It took us many yrs to find an allergist that was able to help.

when our third son started to show signs of distress in the same way our middle son had, we stopped breast feeding and put him on a milk free diet immediately and he has not had the health issues our middle son has had to deal with . I wont know if it made a difference allowing his gut to heal in the first important year of life, but in our experience I think it has.

I am a strong believer in allowing the gut to heal before introducing foods.
I wish I had known about it sooner.