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Lactose Intolerance in Babies and Toddlers
Read time: 4 minutes
It’s never fun when our little one is having tummy issues. And while there may be many things that could cause stomach upset, one thing to consider is lactose intolerance.
Up to 65% of adults’ world-wide experience lactose intolerance.1 Usually, the symptoms don’t prevent us from eating that slice of pizza or bowl of ice cream, but when it comes to our babies and toddlers, we do our best to help minimize any avoidable tummy problems.
While lactose intolerance in babies is uncommon, it is not unheard of.5 And it does become a little more common as your little one gets into their older toddler years.5
Read on to learn about the signs that may be associated with lactose intolerance in babies and toddlers, and what you can do to help your little one if they are experiencing this digestive issue.
What is lactose intolerance in babies and toddlers?
Lactose is the natural sugar found in dairy products. People with lactose intolerance do not have enough of the enzyme lactase, which helps the body break down and digest this milk sugar.
Without lactase we can’t digest lactose, so bacteria in the gut break down the excess lactose. This creates fluid and gas, which is where the signs associated with lactose intolerance can come from.2
What causes lactose intolerance?
Genetics
While rare, sometimes babies are born without the digestive enzyme lactase.2 This means they will experience a lifetime of lactose intolerance.
GI disorders
Other times lactose intolerance may occur because of infections in the intestines, gastrointestinal disorders, or as a temporary symptom of a virus your child may have.34
Prematurity
Premature babies born before 34 weeks may also experience temporary lactase deficiency.5 However, this normally improves fairly quickly as baby’s intestines continue to develop.4
Natural decline in lactase overtime
One of the most common causes of lactose intolerance is the slow natural decline of lactase that happens over time.5 This may start to occur after the age of three to five years.35
Lactose intolerance in babies is rare
Babies born at full term are usually able to digest lactose since it is a primary component of breast milk.5
For this reason, lactose intolerance is generally not common in babies but may start showing up in toddlers sometime after the age of three years.1
Read more: Is Your Baby Reacting to Something in Your Breastmilk?
What are signs of lactose intolerance in babies and toddlers?
Just like with adults, signs of lactose intolerance in babies and toddlers are related to changes in their stool as well as gastrointestinal discomfort.
Signs may include:
Failure to settle at feeding times, coming off the breast or bottle frequently
Gas
Bloating, cramping, abdominal pain
Watery, frothy stools
Failure to gain weight
Signs usually show up between 30 minutes and 2 hours after having dairy.6
Testing for lactose intolerance in babies and toddlers
If you suspect your little one has lactose intolerance, call their health care provider. Sometimes just a medical and diet history can help the pediatrician figure out if your baby is not able to digest lactose well.4 Other times, more tests may be needed.
Tests that may help identify lactose intolerance:
Hydrogen breath test. If your toddler is not able to digest lactose, there will be more hydrogen in their breath than usual.
Stool acidity. Taking a stool sample may help the doctor see if your little one is not digesting lactose. The stool will be more acidic.4
Note that these tests may not work for babies under 3 months of age. Be sure to discuss all options with your baby’s pediatrician.
Management of lactose intolerance in babies and toddlers
If your baby or toddler is diagnosed with lactose intolerance, the best treatment is avoiding or limiting dairy products and choosing lactose-free products when they are available.2
Breastfeeding and lactose intolerance
While lactose intolerance is very rare in babies, should you feel your little one have a problem with lactose, there is usually no need to stop breastfeeding.6
If your little one developed temporary lactose intolerance after having a virus or another illness, continuing to breastfeeding may be beneficial as breast milk contains immune properties and ingredients that can help with baby’s gut health.
If your baby was born prematurely, their lactose intolerance may only last a few weeks or months. During this time, your doctor may recommend a lactose-free formula. If you eventually want to breastfeed, be sure to pump every day as many times as your baby takes a bottle to bring your supply up.67
However, keep in mind that your baby’s signs might actually be ‘lactose overload’ or cow’s milk protein intolerance.
Read more: Breastfeeding Benefits for Mom & Baby - What is in Breastmilk?
Formula feeding and lactose intolerance
For a baby on formula, the pediatrician may recommend trialing a low lactose (‘sensitive’) formula to see if that is helpful. However, many babies may need a lactose-free formula.6
Your baby’s pediatrician can help guide this decision.
Toddlers and lactose intolerance
For a toddler with lactose intolerance, reducing how much dairy is in their diet is the first step.
Foods that contain lactose include: milk (including cow’s milk and goat’s milk), yogurt, cheese, ice cream, butter, cream, buttermilk, and certain packaged foods.
There are also dairy products that naturally have less lactose in them or are manufactured to be lactose-free which your toddler may be able to tolerate. These include lactose-free yogurt, lactose-free cow’s milk, as well as hard cheeses which usually have a little less lactose, such as cheddar or Swiss.
And of course, always be sure to provide your baby or toddler with foods in a texture they are developmentally ready to eat!
Expert Tip: Most people who are lactose intolerant can tolerate a certain amount of dairy without it causing issues.2 Some people may be able to have one serving of dairy, while others may tolerate more or less.
Your pediatrician may recommend trying different amounts to see if your toddler can still have a bit of dairy in their diet.
Read about: What Type of Milk Should my Toddler Drink?
What is lactose overload?
Some women produce too much breast milk, causing their little ones to take in a high volume of milk before they’re able to get a decent amount of the fat from the feed.8 This may cause something called ‘lactose overload’, or too much lactose for baby’s little tummy to digest at one time.8
Many times, lactose overload is mistaken for lactose intolerance, but with some changes in breastfeeding this issue can be managed and resolved.89
Signs of lactose overload
Signs of lactose overload include frothy or explosive stools that are a bit smelly and more than 10 urine diapers per day.89
A baby with lactose overload may have good or even higher-than-average weight gain.9
Interestingly, a baby who is suffering from lactose overload may always seem hungry, even though they are gaining enough weight.9 This is because when baby is not getting enough fat, they are not registering the fullness and satisfaction that fat triggers in the brain.8
Management of lactose overload
The most important thing is to first figure out if oversupply is the main culprit. The help of a lactation consultant will be important to get to the bottom of lactose overload.
If oversupply is the issue, the lactation consultant may recommend block feeding for a few days.89
Block feeding is a method that may help manage oversupply. It’s when you feed your baby on one breast for a specific period of time (block) rather than switching breasts during the same feed.9 This helps baby more fully empty a breast and get higher-fat feeds.
Once signs are relieved, it’s time to go back to regular breastfeeding.89
For some mothers, the issue is not oversupply but rather feeding on a schedule or not feeding often enough.89 All of these may allow the breasts to fill up too much and provide baby with too much lactose and not enough fat.
It is recommended to feed your little one on demand, or when baby asks to feed.11 This is normally anywhere between 8 and 12 times per 24 hours depending on baby’s age.10
Read more:
What is Breastmilk Oversupply and How to Manage it
Should I Breastfeeding On Demand or on a Schedule
Getting the right nutrition while minimizing or eliminating lactose
You may wonder how your child’s nutritional status may be impacted when reducing or foregoing dairy products. Fortunately, there are many foods that can supply the important nutrients that dairy provides, such as protein, calcium, and vitamin D.12
Get plenty of other dairy-free foods!
Whole fruits, vegetables, legumes, nuts, seeds, meat, poultry, fish, grains, and eggs are dairy free. When it comes to meeting your and your child’s nutritional needs, choose a variety of these non-dairy-containing foods.
Food sources of calcium: Fortified plant-based milk alternatives, fortified orange juice, canned sardines and salmon with bones, fortified dairy alternatives such as a non-dairy yogurt, tofu, soybeans, spinach, kale.13
Food sources of vitamin D: Salmon, fortified plant-based milk alternatives, fortified cereals, eggs, canned light tuna, and portabella mushrooms. Note that our body makes vitamin D from sunlight, so chat with your child’s pediatrician about small amounts of safe sun exposure.14
Food sources of protein: Fish, poultry, meat, beans, legumes, peas, nuts, seeds, tofu, eggs, whole grains.
Remember to offer these foods to your older baby and toddler in sizes and textures that they are able to handle.
Read more:
Why Calcium Matters for Babies, Tots, and Mama
Why Vitamin D Matters for Babies, Tots, and Mama
Protein: Getting Enough and the Best Sources
Look for dairy alternatives
There are many non-dairy substitutes on the market, such as coconut yogurt, plant-based milk alternatives such as almond- and oatmilk; and even vegan dairy-free butter! These allow you to still cook and bake dairy-free with ease, as well as enjoy dairy-like foods in your day.
If you are choosing a plant-based milk alternative, look for ones that are fortified with calcium and vitamin D and that have no added sugars.
And remember that with lactose intolerance, your toddler may be able to tolerate small amounts of dairy during the day.
Read more: What Type of Milk Should my Toddler Drink?
Reach out to your child’s healthcare provider
If you suspect that your child has lactose intolerance, call their healthcare provider. They can make sure you and your little one are getting the support you need and help you make informed decisions for moving forward.
Remember that lactose intolerance in babies is not very common. Check in with a lactation consultant to help determine if what your baby is experiencing may be lactose overload, and what to do if it is.
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