Lactose Intolerance in Babies & Toddlers

Lactose is a form of sugar that is naturally found in milk and milk products. It is typically broken down into glucose and galactose when it reaches the small intestine, but when the body doesn’t have enough lactase (a type of enzyme that helps to digest lactose) to process it efficiently, it moves through to the large intestine, where it produces excess acids and gases. These acids and gases then cause the symptoms of lactose intolerance in babies and toddlers, such as bloating, stomach pain and wind.

While the symptoms of a dairy allergy may appear to be quite similar to those experienced by a toddler or baby with lactose intolerance, they have very different causes. As aforementioned, lactose intolerance is caused by a lack of the enzyme lactase. A dairy allergy, however, is caused by an immune response to the proteins found in cow’s milk and other dairy products. The body reacts to the proteins as if they were attacking it, releasing chemicals that cause the symptoms of an allergic reaction. In addition to digestive discomfort, a cow’s milk protein allergy may also cause hives, itchy eyes, vomiting, dizziness, loss of consciousness and swelling of the tongue, lips, eyes or face.

What are lactose intolerance symptoms in babies and toddlers?

If the small intestine does not properly process lactose, it moves through to the large intestine, where excess acids and gases are produced, causing the symptoms of lactose intolerance. Lactose intolerance symptoms in toddlers and babies can vary but commonly include:

  • Stomach pain
  • Bloating
  • Wind
  • Diarrhoea

Additional lactose intolerance symptoms in babies may include:

  • Significant nappy rash
  • Irritability
  • Difficulty settling
  • Poor growth¹

If you spot the symptoms of lactose intolerance in your baby or toddler, it’s best to seek medical advice from your doctor or child health nurse. They can perform a proper assessment, investigating whether your child has an intolerance to lactose, a cow’s milk protein allergy or another digestive condition.

Diagnosing lactose intolerance

There are several different tests used to diagnose lactose intolerance in babies and toddlers. Your doctor may recommend trialling an elimination diet, where all foods containing lactose are removed from your child’s diet for a period of time. Foods are then slowly reintroduced into their diet over time, with careful monitoring helping to identify symptoms as they develop. 

Another common test used to diagnose lactose intolerance is the hydrogen breath test. This test involves seeing how much hydrogen is present in the breath, with higher levels typically detected after those with an intolerance consume lactose.

In some situations, a sample of your child’s stool may be collected for testing. Your doctor may also recommend an endoscopy to detect the presence of lactase.

What can I do if my child is lactose intolerant?

While there currently aren’t any cures, your doctor may recommend strategies to help manage and reduce the symptoms of lactose intolerance in your baby or toddler. Some children may be sensitive to the tiniest traces of lactose, while others may be able to tolerate the occasional intake of foods containing lactose, which will influence the approach used in treating your child. Your doctor or child health nurse will discuss the best option for your child, as well as strategies that can be used to ensure that your child continues to receive adequate nutrition.

What if my child is diagnosed as not Lactose intolerant and does not have a diagnosed cows milk protein allergy, but still has difficulty digesting cows milk?

In this stituation, whilst all milk does contain lactose, there are some sources of milk, for example goats milk which does contain lower levels of lactose than cows milk, and may be easier to digest. 

Goat milk has smaller fat globules in comparison to other widely used milks and a much higher composition of medium fatty acid chains. This allows goat milk to be more easily digested as each individual fatty acid has a larger surface-to-volume ratio leading to a quicker and more comfortable digestion process. 

Once goat milk reaches the stomach it undergoes denaturation, where it clumps together, into a much softer curd then normal cow’s milk. This soft curd is much easier and smoother for the body to digest. Goat’s milk is also packed with natural oligosaccharides which act as a prebiotic. This supports beneficial microflora to grow in the stomach, creating an environment much better suited for a comfortable digestion overall.²,³,⁴

Low lactose diet

A common strategy used to manage the symptoms of lactose intolerance in toddlers and babies is a low lactose diet. As the name suggests, a low lactose diet involves reducing the amount of lactose consumed by your child. This is typically done by avoiding foods high in lactose, such as milk, yoghurt, cheese, ice cream and cream, or that contain milk, milk solids, non-fat milk solids, milk protein, or skim milk powder.

Before making any changes to your child’s diet, it is important to consult your doctor or child health nurse first. They can provide guidance on the best approach for your child.

What if I am breastfeeding?

Lactose is present in all milk produced by mammals, including human breast milk. No matter how much lactose a mother consumes within her diet, this will not affect the amount of lactose in breast milk. Therefore, there is generally no need for a mother to adjust her lactose intake.⁵

If you are concerned about the amount of lactose in breast milk and how this may affect a child with lactose intolerance, speak to your doctor or a lactation specialist.

How can I provide my child with calcium?

No matter the age or stage of growth your child is in, calcium is required to help strengthen their bones and teeth while also assisting various important bodily processes, from muscle and heart function to blood clotting. The amount of calcium your child requires will vary depending on their age. 

The recommended daily dietary intake of calcium for babies and toddlers is as follows:

  • 0-6 months (breastfed) - approximately 210 mg
  • 0-6 months (formula-fed) - approximately 350 mg
  • 7-12 months - 270 mg
  • 1-3 years - 500 mg ⁶

Dairy foods are common sources of calcium for most children, but when faced with lactose intolerance, ensuring that your little one receives an adequate amount in their diet may feel like a daunting task. However, if your child cannot consume dairy products, some non-dairy foods may help boost their calcium intake. These include:

  • Calcium-fortified soy milk, fruit juices and non-dairy milks
  • Salmon and sardines
  • Green leafy vegetables, such as broccoli, bok choy, spinach and kale
  • Calcium-fortified cereals
  • Almonds and Brazil nuts
  • Soybeans, tofu and tempeh
  • Dried fruit

If you have any questions about your child’s health, contact your doctor or healthcare professional for expert advice.

 

¹ https://www.rch.org.au/kidsinfo/fact_sheets/Lactose_intolerance/ 

² Lad, S., Aparnathi, K., Mehta, B. and Velpula, S., 2017. [online] Research gate. Available at: < https://www.researchgate.net/publication/317021326_Goat_Milk_in_Human_Nutrition_and_Health_-_A_Review >

³ Stergiadis, S., Nørskov, N., Purup, S., Givens, I. and Lee, M., 2019. Comparative Nutrient Profiling of Retail Goat and Cow Milk. Nutrients, 11(10), p.2282. URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835441/

⁴ Petherick, A., Petherick, A., Ravindran, S., Tellam, R. and Petherick, A., 2022. Goat’s Milk: An Easily Digestible and Hypoallergenic Option - International Milk Genomics Consortium. [online] International Milk Genomics Consortium. Available at: < https://milkgenomics.org/article/goats-milk-an-easily-digestible-and-hypoallergic-option/ >

⁵ https://www.breastfeeding.asn.au/bf-info/lactose

⁶  https://www.betterhealth.vic.gov.au/health/healthyliving/calcium