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Is my baby lactose intolerant?
By Kelly Bonyata, BS, IBCLC
If your baby is sensitive to dairy products it is highly unlikely
that the problem is lactose intolerance, although many people may
tell you so.
There are three types of lactose intolerance:
- Primary lactose intolerance
- Congenital lactose intolerance
- Secondary lactose intolerance
Primary lactose intolerance (also
called developmental, late-onset or adult lactose intolerance) is
relatively common in adults (and more common in some nationalities
than others), and is caused by a slow decrease in the body's production
of lactase, the enzyme that breaks down lactose (milk sugar). This
occurs gradually, over a period of years, and never appears before
2-5 years old and often not until young adulthood. Almost all adults
who are lactose intolerant have this type of lactose intolerance,
which is not related to lactose intolerance in babies.
Congenital lactose intolerance and similar congenital
disorders
- Congenital
lactose intolerance is very rare and is an inherited metabolic
disorder rather than an allergy. This disorder is generally apparent
within a few days after birth and is characterized by severe diarrhea,
vomiting, dehydration and failure to thrive. It resolves after
the age of six months.
- A similar, less severe, metabolic disorder is congenital
lactase deficiency. This disorder, apparent within 10 days
of birth, occurs when brush-border lactase activity (required
for the digestion of lactose) in the small intestine is low or
absent at birth and is characterized by diarrhea and malabsorption.
It is also very rare.
- Galactosemia
is another rare metabolic disorder that occurs when the liver
enzyme GALT, needed to break down galactose, is partially or completely
absent. Although this disorder does not directly concern lactose,
babies with the more severe forms of galactosemia will not be
able to tolerate any lactose since lactose is formed from the
two sugars galactose and glucose. The classical form of galactosemia
is characterized by vomiting, diarrhea, jaundice and failure to
thrive within a few days after birth.
- Some premature babies have a temporary form of lactose
intolerance because their bodies are not yet producing lactase.
This will go away as baby matures, and in fact the maturation
process can
be accelerated by baby's ingestion of lactose.
Secondary lactose intolerance (also
called acquired lactose intolerance) can appear at any age and occurs
when the intestinal brush border is damaged by an infectious, allergic
or inflammatory process, thus reducing lactase activity. Causes
of secondary lactose intolerance include gastroenteritis, food intolerance
or allergy, celiac disease (gluten intolerance), and bowel surgery.
Per Joy Anderson, IBCLC (in Lactose
intolerance and the breastfed baby):
"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.
"...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."
Although cow's milk protein sensitivity and lactose intolerance
are not the same thing, they can sometimes occur at the same
time, since food allergy can cause secondary lactose intolerance.
Page last modified:
05/10/2005
Written: 10/26/1999
See also: Dairy
and other Food Sensitivities in Breastfed Babies @ 
Additional information
- Lactose
Intolerance and the breastfed baby by Joy Anderson
- Lactose
Intolerance, Diarrhea, and Allergy by Maryelle Vonlanthen,
MD (from Breastfeeding Abstracts, February 1998, Volume
18, Number 2, pp. 11-12)
Resolution
of Lactose Intolerance and “Colic” in Breastfed Babies
by Robyn Noble & Anne Bovey, presented at the ALCA Vic (Melbourne)
Conference on the 1st November, 1997 - Lactose
Intolerance: Solutions to the New Catchall Phrase by Lisa
Hurt Kozarovich
- Borderline
Galactosemia by Rama Ganesan, from New Beginnings,
Vol. 14 No. 4, July-August 1997, pp. 123-24.
- Woolridge MW, Fisher C. Colic,
"overfeeding", and symptoms of lactose malabsorption
in the breast-fed baby: a possible artifact of feed management?
Lancet. 1988 Aug 13;2(8607):382-4.
General information
