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How to know if baby has milk intolerance
What should I do if I think my baby is allergic or intolerant to cows' milk?
If you think your baby is having a reaction to cows' milk, see your GP to discuss your concerns.
They will be able to assess if your baby's symptoms may be caused by a cows' milk allergy or something else. Make sure you get medical advice before taking cows' milk out of your child's diet as it contains important nutrients.
Cows' milk allergy in babies
Cows' milk allergy (CMA), also called cows' milk protein allergy, is one of the most common childhood food allergies. It is estimated to affect around 7% of babies under 1, though most children grow out of it by the age of 5.
CMA typically develops when cows' milk is first introduced into your baby's diet either in formula or when your baby starts eating solids.
More rarely, it can affect babies who are exclusively breastfed because of cows' milk from the mother's diet passing to the baby through breast milk.
There are 2 main types of CMA:
immediate CMA – where symptoms typically begin within minutes of having cows' milk
delayed CMA – where symptoms typically begin several hours, or even days, after having cows' milk
Symptoms of cows' milk allergy
Cows' milk allergy can cause a wide range of symptoms, including:
skin reactions – such as a red itchy rash or swelling of the lips, face and around the eyes
digestive problems – such as stomach ache, vomiting, colic, diarrhoea or constipation
hay fever-like symptoms – such as a runny or blocked nose
eczema that does not improve with treatment
Occasionally CMA can cause severe allergic symptoms that come on suddenly, such as swelling in the mouth or throat, wheezing, cough, shortness of breath, and difficult, noisy breathing.
A severe allergic reaction, or anaphylaxis, is a medical emergency – call 999 or go immediately to your local hospital A&E department.
Treatment for CMA
If your baby is diagnosed with CMA, you'll be offered advice by your GP or an allergy specialist on how to manage their allergy. You may also be referred to a dietitian.
Treatment involves removing all cows' milk from your child's diet for a period of time.
If your baby is formula-fed, your GP can prescribe special infant formula.
Do not give your child any other type of milk without first getting medical advice.
If your baby is exclusively breastfed, the mother will be advised to avoid all cows' milk products.
Your child should be assessed every 6 to 12 months to see if they have grown out of their allergy.
Read more about cows' milk allergy.
Could it be lactose intolerance?
Lactose intolerance is another type of reaction to milk, when the body cannot digest lactose, a natural sugar found in milk. However, this is not an allergy.
Lactose intolerance can be temporary – for example, it can come on for a few days or weeks after a tummy bug.
Symptoms of lactose intolerance include:
stomach rumbling and pains
Treatment for lactose intolerance
Treatment depends on the extent of your child's intolerance. Some children with lactose intolerance may be able to have small amounts of dairy products without having symptoms.
Your child may be referred to a dietitian for specialist advice.
Read more about treatment for lactose intolerance in children.
Food allergies in babies and children
Reflux in babies
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When should I start giving my baby solids?
National Institute for Health and Care Excellence (NICE): food allergy in children
Page last reviewed: 12 July 2019 Next review due: 12 July 2022
Milk intolerance in babies and children
Milk intolerance in babies and children | Pregnancy Birth and Baby beginning of content
Some babies and children have a reaction when they drink cow's milk or formula made from cow's milk. This could be due to 2 things: a lactose intolerance or an allergy to milk. If your child has one of these conditions, you will have to alter their diet to cut down on milk or avoid it altogether.
Call triple zero (000) for an ambulance if your child has the following symptoms. They could be having a severe allergic reaction and will need urgent medical attention.
wheezing or difficulty breathing
a swollen tongue
they are pale and floppy or unconscious
What is milk intolerance and milk allergy?
Around 1 in 10 young children has a reaction when they drink cow's milk. This could be because they have a lactose intolerance or a milk allergy. Milk allergy is much more common than lactose intolerance in children under 5.
Lactose intolerance is a problem with the digestive system – it means your child doesn't have the enzyme needed to digest lactose, which is the sugar in milk.
Milk allergy, however, is a problem with the immune system — the body reacts to the protein in milk. An allergy usually involves other parts of the body as well as the stomach, and may cause symptoms such as a skin rash or swelling of the face.
Your doctor can confirm whether your child is lactose-intolerant or has a milk allergy by doing some medical tests. Don't use unproven tests such as Vega, kinesiology, Alcat or allergy elimination tests for children. A milk intolerance is very unlikely to be the cause of mucus or coughing.
Many young children grow out of their intolerance or allergy. But don't start giving them cow's milk until your doctor tells you it's safe to do so.
Lactose is the sugar found in the milk produced by all mammals, including humans. Sometimes people don't produce enough of the enzyme lactase in their gut to break down the lactose.
Very few babies have true lactose intolerance, a rare genetic condition where they're born without any lactase enzymes at all. (This is called primary lactose intolerance). However, many people develop lactose intolerance later in life, after the age of 5. It is more common in Aboriginal Australians and people from Asia, Africa, the Middle East and some Mediterranean countries.
Babies and young children can become intolerant to milk if the lining of their gut is damaged by an illness such as gastroenteritis, or an allergy or intolerance to another food. This is called secondary lactose intolerance and will go away once the gut heals, usually over a few months.
Symptoms and diagnosis
The symptoms of lactose intolerance in babies and children are:
liquid, sometimes green, frothy stools
passing a lot of gas
not putting on weight
All of these symptoms are common in babies and don't necessarily mean they have lactose intolerance. But if your child has diarrhoea and isn't putting on weight, see your doctor. Don't stop breastfeeding unless your doctor tells you to.
Tests include a breath test to measure the hydrogen in your child's breath, or cutting out dairy to see if their symptoms improve. This is known as an elimination diet.
If the lactose intolerance is caused by a tummy upset, keep on breastfeeding. If your baby is formula fed, talk to your doctor or child and family health nurse before switching to low-lactose or lactose-free formula.
Older children will need to cut down on, but not eliminate, dairy foods from their diet. They can still have some cheeses, yogurt, calcium-fortified soy products, lactose-free milk, butter and cream. Your doctor or a dietitian will advise you on the best diet for your child.
Cow's milk allergy
Cow's milk allergy is one of the most common food allergies in young children. It usually disappears by the time they reach school age. It occurs when your child's immune system reacts to the protein in milk.
Symptoms and diagnosis
Reactions to milk can occur within minutes or not for several days.
Rapid reactions include:
swelling of the lips, face or eyes
noisy breathing or wheezing
a swollen tongue
a swollen or tight throat
a hoarse voice
change in consciousness or floppiness in babies or young children
Delayed reactions include:
an increase in eczema
blood or mucus in stools
vomiting and/or diarrhoea 2-24 hours after having milk
It is very important to see a doctor if your child has the symptoms of milk allergy. The condition is diagnosed using the history of symptoms or can sometimes be confirmed with an allergy test.
If your child is allergic to milk, you need to completely remove dairy products from their diet. Follow your doctor's or allergy specialist's advice and read food labels carefully. You may also need to avoid milk from other animals, such as goats, as well as coconut milk products. Watch out for other words used to describe milk on food labels, such as butter, buttermilk, cream, curd, ghee, milk, cheese, dairy, milk solids, whey, yoghurt, casein and caseinates.
If your baby is formula-fed, you can use soy protein formula (unless they are also allergic to soy), extensively hydrolysed formula (EHF) or amino acid-based formula (AAF). Do not use formula made from cow's milk, goat's milk, sheep milk, HA, A2 milk or lactose-free.
If your child is over the age of one, they can be given soy milk, calcium-enriched rice, and oat or nut milks. It is important to make sure they are getting enough calcium.
You may be advised to carry an Epipen adrenaline autoinjector if your child is allergic to milk. Severe allergic reactions can sometimes lead to anaphylaxis, which is serious and can even be fatal. An adrenaline autoinjector can be used to give first aid in the event of anaphylaxis.
Breastfeeding a baby who can't tolerate milk
If your baby is lactose-intolerant, you don't need to change your diet. It doesn't matter how much dairy you consume, the amount of lactose in your milk will be the same.
However, if your baby is diagnosed with milk allergy, you will need to remove all dairy from your own diet too. You will need calcium and vitamin D supplements every day. Your doctor or allergy specialist will advise you.
Where to seek more help
Don't try to deal with milk intolerance yourself. You can get help from:
Pregnancy, Birth and Baby on 1800 882 436
Australasian Society of Clinical Immunology and Allergy
Australian Breastfeeding Association on 1800 686 268
Australasian Society of Clinical Immunology and Allergy (Cow's milk (dairy) allergy), Australasian Society of Clinical Immunology and Allergy (Infant Feeding and Allergy Prevention Clinical Update), Australian Breastfeeding Association (Lactose intolerance and the breastfed baby), Raising Children Network Australia (Lactose intolerance: babies, children and teenagers), Royal Children’s Hospital (Allergy and Immunology), Sydney Children’s Hospitals Network (Allergy - Milk allergy and milk-free diet)
Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: July 2020
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Lactose intolerance and the breastfed baby | Australian Breastfeeding Association
Lactose intolerance is poorly understood in the Australian community. There are lots of myths and misunderstandings about it, especially when it comes to babies. Primary (or true) lactose intolerance is an extremely rare genetic condition and lactose intolerance is very different to intolerance or allergy to cows' milk protein. This article explains the differences between lactose intolerance and other conditions such as food allergies and lactose overload and dispels some of the myths about lactose intolerance in babies.
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Lactose intolerance - MyDr.com.au
Lactase deficient people do not have enough lactase, the enzyme that helps break down lactose and they suffer from lactose intolerance. The main symptoms of lactose intolerance are bloating and wind.
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Lactose intolerance - Better Health Channel
Symptoms of lactose intolerance include bloating, gas, abdominal pain and diarrhoea.
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ASCIA Guide for Milk Substitutes in Cow’s Milk Allergy - Australasian Society of Clinical Immunology and Allergy (ASCIA)
Guide for Milk Substitutes in Cow’s Milk Allergy
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Cow's milk allergy is common in babies and children, and symptoms can range from mild to severe. Avoiding cow's milk and other dairy-containing foods is the only effective way to manage a cow's milk allergy, but it's important to seek specialist advice.
Read more on Dietitians Australia website
Cow’s milk allergy - Better Health Channel
Milk allergy symptoms range from mild to a life-threatening severe allergic reaction. Avoid food containing milk only under strict medical supervision
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Cow's milk is a common cause of food allergy in infants. In Australia and New Zealand around 2 per cent (1 in 50) infants are allergic to cow's milk and other dairy products. Although most children outgrow cow's milk allergy by the age of 3-5 years, in some people cow's milk allergy may not resolve.
Read more on ASCIA – Australasian Society of Clinical Immunology and Allergy website
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Lactase deficiency in infants: symptoms and diagnosis
Signs of lactase deficiency in infants should be known to parents, because this will allow them to suspect this condition in a timely manner, identify its cause and improve the condition of the baby.
Signs of lactose intolerance
Signs of lactase deficiency in a child are diverse. This is a stool with a large water spot and a sour smell, bloating, rumbling, abdominal pain (colic). One of the most common symptoms that worries parents is frequent loose stools in a baby. It is watery, frothy and has a sour smell. It should be remembered that the younger the child, the more frequent his stool, and this is completely normal. So if the baby is developing well and feels good, and his feces are normal, you should not think that these are signs of lactose intolerance in newborns.
Sometimes lactase deficiency in newborns is accompanied by poor weight gain and growth. This is due to the fact that the carbohydrates necessary for the child do not enter the body, and the baby may lack nutrients.
If the baby quickly grew out of the recently purchased sliders and sleepsuits, and his cheeks and handles are round and plump, you should not suspect lactase deficiency in the child.
Intestinal colic may be present in children with lactose intolerance. After eating, the child will experience bloating, anxiety, crying. These signs usually appear on the 3-6th week of a baby's life. This is probably due to an increase in milk consumption by an older baby.
The mechanism of such manifestations of lactose intolerance as intestinal colic, bloating and rumbling is as follows. Carbohydrates that are not digested due to the absence or lack of the lactase enzyme continue their movement through the intestines. In the colon, they are exposed to intestinal microflora, resulting in the formation of an excess of gases (hydrogen, methane, carbon dioxide). Gas stretches the walls of the intestines, causing bloating, pain and increased intestinal peristalsis. Violation of the normal chemical composition of intestinal contents can lead to disturbances in the composition of the intestinal microflora.
When should you not think about lactase deficiency?
Quite often in recent years, when there are problems with digestion, children are diagnosed with lactose intolerance. However, this is not always true. As mentioned above, the frequency of stool in infants is individual. Frequent or rare stools are not in themselves a sign of lactase deficiency in a child. The symptoms of this pathology are multiple.
Sometimes regurgitation is taken as a sign of lactose intolerance by parents. But even if regurgitation is frequent and plentiful, it is unlikely that this is lactase deficiency - the symptoms in children with this pathology are associated with the work of the intestines, and not the esophagus or stomach.
How to identify lactose intolerance
The diagnosis of lactose intolerance usually begins with an organoleptic evaluation of feces. Unformed, watery, frothy yellow or green feces with a sour smell testify in favor of this pathology. In a chemical study, the reaction of feces is acidic (pH less than 5.5).
Another test method is to determine the content of carbohydrates in feces. Exceeding their value by 0.25% is typical for lactase deficiency. Despite the widespread use, this method is not the most accurate, since it does not allow you to determine which carbohydrates are present in the feces.
Whenever lactose intolerance is suspected, a specialist should be consulted. He will prescribe examinations that will allow you to say if the child has lactose intolerance, or if the symptoms are not associated with this condition.
Other methods are used in difficult cases. For example, a specific breath test based on determining the concentration of hydrogen in exhaled air after a load of lactose. The advantage of this method is its simplicity, the disadvantage is the possibility of false positive results and the impossibility of determining the degree of lactase deficiency.
Lactose curve is another test for lactose intolerance. Normally, lactose, under the action of the lactase enzyme, breaks down into simpler sugars, in particular, glucose. Subsequently, glucose is absorbed through the intestinal wall and enters the bloodstream. Accordingly, the determination of the level of glucose in the blood on an empty stomach and after taking lactose makes it possible to judge the breakdown of the latter under the influence of the lactase enzyme. If the rise in blood glucose levels after a lactose load is less than 20%, one should think about the insufficiency of this enzyme.
Reliable but rarely used methods for detecting lactose intolerance include intestinal biopsy and genetic testing.
A biopsy is an examination of cells in the lining of the small intestine. Intestinal tissue is taken during endoscopic examination. In the tissues obtained, the activity of intestinal digestion and absorption using enzymes is determined. This analysis for lactase deficiency is a reference. However, it is difficult to perform, invasive and expensive, so it is used quite rarely.
Diagnosis of lactase deficiency also includes a number of genetic tests to determine the defect in the genes responsible for the production of lactase.
Parents' attention to the health of the crumbs, knowledge of how lactase deficiency manifests itself, timely access to a specialist, effective diagnosis and strict adherence to recommendations will effectively cope with lactase deficiency and improve the health of the child.
Symptoms of lactose intolerance in adults and children - MyGenetics Blog
In addition to the DNA test, there are many more ways to test for lactose intolerance. What are these methods, how effective they are, what tests to pass for their passage and in what cases they can be prescribed, read further in this article.
Why are dairy products not digested?
The main active substance in all dairy products, due to which there are problems with their digestibility, is lactose. And the main enzyme of the body, which contributes to its absorption, is called consonantly - lactase. At an early age, if there is no congenital intolerance, all children equally normally absorb dairy products. But over the years, the production of the lactase enzyme may decrease or stop altogether.
Signs of lactose intolerance
It is often possible to confuse poor absorption of milk with an allergy to it. Allergy symptoms are quite common: difficulty breathing, nasal discharge, tearfulness, rash. An allergy can arise from a very small amount of a product containing an allergen, and the use of all milk in this case is completely prohibited. With intolerance, there is no such complete ban.
Symptoms of poor absorption:
Bloating, grumbling, colic.
Belching and gas.
Stool disorders, vomiting.
In some cases, pain in the abdomen or intestines.
It takes about half an hour to two hours from the moment of eating for the symptoms to appear. The symptoms themselves and the degree of their manifestation depend on the ratio of the amount of dairy products consumed and the amount of lactase present in the body for its absorption, respectively.
Lactose intolerance test
Usually, the diagnosis of lactose intolerance is established by the doctor based on the symptoms voiced by the patient. But, in case of doubt, additional studies may be assigned.
How to identify lactose intolerance
A study aimed at collecting data and plotting a comparative graph of glucose (sugar) and lactose levels. The subject drinks on an empty stomach a glass of liquid containing lactose. And for some period, blood samples are taken from him. Samples are analyzed and a schedule is drawn up. If the lactase line does not exceed the glucose line, then conclusions are drawn about the insufficiency of the lactase enzyme.
Small intestine biopsy
One of the outdated methods for testing food digestibility. It consists in the fact that a small area of the small intestine is selected and its sample is taken, which is further examined. The technique is traumatic and is prescribed less and less, it is not prescribed to children at all.
Fecal analysis for lactose deficiency
This analysis is mainly prescribed to infants as the safest research method. And it is on infants that the most accurate results are obtained. Before taking the test, it is recommended not to change the daily diet of the baby, but to transfer the sample to the laboratory no later than 4 hours from the moment it was taken.
The sample is examined for the presence of a percentage of carbohydrates. If the carbohydrate content is from 0.25% to 0.5%, then this is within the normal range. For a baby, the norm can reach up to 1%.
Hydrogen breath test
It is believed that of all tests, a study for the presence of hydrogen is the most accurate. The testing method consists in the fact that the subjects drink a specially prepared liquid containing lactose, and after a while breathe into a special device. If the device detects hydrogen exhaled by a person, then this 100% confirms problems with absorption. Attention! The analysis is carried out on an empty stomach.
Another method for determining problems with the assimilation of dairy products in children. As with the analysis of stool in infants, before taking a sample, it is necessary to follow the usual diet. The sample must be submitted to the laboratory no later than 12 hours after its receipt.
The biomaterial is analyzed for acidity content. It is believed that if the level of acidity is exceeded, this is a consequence of the fermentation of undigested lactose.
Urine lactose test
The test is not very accurate, but in order to dispel your doubts, it is quite suitable. It is carried out at home and is similar to a pregnancy test. The litmus test paper is wetted in urine and acquires a certain color. The color value must be determined on a special scale.
Blood test for lactose intolerance
If we are talking about the study of blood and urine, then this is an analysis for the content of galactose, a by-product of the breakdown of lactose. At the beginning, a control blood sample is taken from the patient to determine the normal level of galactose, after which they are allowed to take a special mixture and, after a certain time, samples are taken for analysis again.
In what cases an examination is prescribed
Lactose intolerance testing may be ordered if:
For young children with bowel problems.
If there are obvious symptoms of intolerance.
To determine the risk of developing osteoporosis.
In a comprehensive study of the gastrointestinal tract in adults.
A genetic marker is a gene whose position on the chromosome is precisely known. The main gene responsible for the absorption of lactose by the human body is called MCM6, and it is this gene that is examined during genetic testing. Although the gene itself is not directly involved in the production of lactose, it affects the LAK gene, which is directly involved.
Genetic lactose intolerance
Modern medicine makes it possible to cure all the causes of poor digestion of fermented milk products, except for genetically determined disorders. It remains only to choose where to take a DNA test, which analysis gives the best results and follow the instructions of the doctors exactly.
It is worth noting that in most people (about 80% of humanity), over the years, the loss of the ability to absorb lactose well is genetically determined, and the remaining 20% are a kind of “genetic lucky ones”. However, eliminating all milk from the diet requires replenishing the beneficial substances that it contains through the use of multivitamins.
But there is a downside to multivitamin use: some vitamins and minerals can accumulate, and the wrong dosage can lead to an overabundance and undesirable consequences.