Infant milk sensitivity

Milk Allergy in Infants (for Parents)

What Is a Milk Allergy?

When a baby is allergic to milk, it means that his or her immune system, which normally fights infections, overreacts to proteins in cow's milk. Every time the child has milk, the body thinks these proteins are harmful invaders and works hard to fight them. This causes an allergic reaction in which the body releases chemicals like

histamine.

Cow's milk is in most baby formulas. Babies with a milk allergy often show their first symptoms days to weeks after they first get cow milk-based formula. Breastfed infants have a lower risk of having a milk allergy than formula-fed babies.

People of any age can have a milk allergy, but it's more common in young children. Many kids outgrow it, but some don't.

If your baby has a milk allergy, keep two epinephrine auto-injectors on hand in case of a severe reaction (called anaphylaxis). An epinephrine auto-injector is an easy-to-use prescription medicine that comes in a container about the size of a large pen. Your doctor will show you how to use it.

What Are the Signs & Symptoms of a Milk Allergy?

In children who show symptoms shortly after they have milk, an allergic reaction can cause:

wheezing
trouble breathing
coughing
hoarseness
throat tightness
stomach upset
vomiting
diarrhea
itchy, watery, or swollen eyes
hives
swelling
a drop in blood pressure causing lightheadedness or loss of consciousness

The severity of allergic reactions to milk can vary. The same child can react differently with each exposure. This means that even though one reaction was mild, the next could be more severe and even life-threatening.

Children also can have:

an intolerance to milk in which symptoms — such as loose stools, blood in the stool, refusal to eat, or irritability or colic — appear hours to days later
lactose intolerance, which is when the body has trouble digesting milk

If you're not sure if your child has an intolerance versus an allergy, talk to your doctor.

If Your Child Has an Allergic Reaction

If your child has symptoms of an allergic reaction, follow the food allergy action plan your doctor gave you.

If your child has symptoms of a serious reaction (like swelling of the mouth or throat or difficulty breathing, or symptoms involving two different parts of the body, like hives with vomiting):

Give the epinephrine auto-injector right away. Every second counts in an allergic reaction.
Then, call 911 or take your child to the emergency room. Your child needs to be under medical supervision because, even if the worst seems to have passed, a second wave of serious symptoms can happen.

How Is a Milk Allergy Diagnosed?

If you think your infant is allergic to milk, call your baby's doctor. He or she will ask you questions and talk to you about what's going on. After the doctor examines your baby, some stool tests and blood tests might be ordered. The doctor may refer you to an allergist (a doctor who specializes in treating allergies).

The allergist might do skin testing. In skin testing, the doctor or nurse will place a tiny bit of milk protein on the skin, then make a small scratch on the skin. If your child reacts to the allergen, the skin will swell a little in that area like an insect bite.

If the allergist finds that your baby is at risk for a serious allergic reaction, epinephrine auto-injectors will be prescribed.

Avoiding a Milk Allergy Reaction

If You're Breastfeeding

If your breastfed infant has a milk allergy, talk to the allergist before changing your diet.

If You're Formula Feeding

If you're formula feeding, your doctor may advise you to switch to an extensively hydrolyzed formula or an amino acid-based formula in which the proteins are broken down into particles so that the formula is less likely to trigger an allergic reaction.

You also might see "partially hydrolyzed" formulas, but these aren't truly hypoallergenic and can lead to a significant allergic reaction.

If you're concerned about a milk allergy, it's always best to talk with your child's doctor and work together to choose a formula that's safe for your baby.

Do not try to make your own formula. Commercial formulas are approved by the U.S. Food and Drug Administration (FDA) and created through a very specialized process that cannot be duplicated at home. Other types of milk that might be safe for an older child with a milk allergy are not safe for infants.

If you have any questions or concerns, talk with your child's doctor.

Lactose Intolerance (for Parents) - Nemours KidsHealth

What Is Lactose Intolerance?

Lactose intolerance is when someone has trouble digesting lactose, a type of sugar found in milk and other dairy foods.

If people with lactose intolerance eat dairy products, the lactose passes into their intestines, leading to gas, cramps, a bloated feeling, and diarrhea.

Some people can have small amounts of dairy without problems. Others have a lot of stomach trouble and need to avoid all dairy products. Many foods, drinks, and digestive aids are available to help manage lactose intolerance.

What Happens in Lactose Intolerance?

Normally, when we eat something with lactose, an enzyme in the small intestine called lactase breaks it down into simple sugars. The bloodstream absorbs these simple sugars, which are turned into energy.

In lactose intolerance, the body doesn't make enough lactase to break down lactose. Instead, undigested lactose sits in the gut and gets broken down by bacteria, causing gas, bloating, stomach cramps, and diarrhea.

Lactose intolerance is fairly common. Kids and teens are less likely to have it, but many people become lactose intolerant in adulthood. Some health care providers view lactose intolerance as a normal human condition and not a disease or serious health problem.

Besides age, people can become lactose intolerant due to:

Ethnic background. People of Asian, African, Native American, and Hispanic backgrounds are more likely to develop lactose intolerance at a young age.
Other problems with the digestive tract. People who have inflammation of their upper small intestine, such as celiac disease or Crohn's disease, have less of the lactase enzyme.
Medicines. Some antibiotics can trigger temporary lactose intolerance by affecting how the intestine makes lactase.
Infection. After having diarrhea, some people have a temporary lactose intolerance that usually gets better after a few days or weeks.

What Are the Signs & Symptoms of Lactose Intolerance?

Lactose intolerance can cause a variety of symptoms. It all depends on how much dairy or milk-containing foods people consume and how little lactase their body makes.

Usually within 30 minutes to 2 hours after eating, someone with lactose intolerance will have:

nausea
stomach cramps
bloating
gas
diarrhea

How Is Lactose Intolerance Diagnosed?

To diagnose lactose intolerance, doctors ask about a child's symptoms and diet. They might test the breath for hydrogen levels before and after the child drinks lactose. Normally very little hydrogen gas is detectable in the breath. But undigested lactose in the colon breaks down and makes various gases, including hydrogen.

If your child has a hydrogen breath test, they'll blow into a tube for a beginning sample. Then they'll swallow a drink with lactose in it, wait a while, and breathe into the tube again. Your child will blow into the tube every half hour for 2 hours to measure hydrogen levels. The levels should go up over time if your child has lactose intolerance.

Doctors also can find out if someone can digest lactose by testing for the presence of lactase with an endoscopy. During this procedure, doctors view the inside of the intestines by inserting a long tube with a light and a tiny camera on the end into the mouth.

A doctor can then take tissue samples and pictures of the inside of the gut. The amount of lactase enzyme can be measured in one of these tissue samples.

How Is Lactose Intolerance Treated?

Kids and teens can manage lactose intolerance by not drinking less milk and eating fewer dairy products. Most can eat a small amount of dairy. But they need to eat it with other foods that don't contain lactose and not eat too much dairy at once. For example, instead of drinking a milkshake by itself, your child should drink it while eating a dairy-free sandwich.

Other dairy products, such as yogurt and cheeses, can be easier to digest than milk. Lactose-free milk is also a great way to get calcium in the diet without the problems. It can also help for kids and teens to keep a food diary to learn which foods they can or can't tolerate.

A lactase enzyme supplement can help too. Taking this before eating foods that contain dairy helps the body digest the lactose sugar in dairy. This can prevent pain, cramping, bloating, gas, and diarrhea.

What About Calcium?

Dairy foods are the best source of calcium, a mineral that's important for bone growth. Growing kids and teens need about 1,300 milligrams (mg) of calcium each day. So experts recommend that even those with lactose intolerance include some dairy in their diet.

They also can eat non-dairy products like:

calcium-fortified juice or soy milk
green, leafy vegetables like broccoli, collard greens, kale, and turnip greens
beans
salmon
almonds
soybeans
dried fruit
tofu

Talking to a registered dietitian is a good idea. They can help your child come up with eating alternatives and develop a well-balanced diet with lots of calcium to build strong bones. Some kids and teens might need calcium and vitamin D supplements.

How Can Parents Help?

To help your child deal with lactose intolerance:

Buy lactose-reduced or lactose-free milk and calcium-fortified juices.
Remind your child to take a lactase enzyme supplement (such as Lactaid) right before eating dairy products. These come as drops or tablets that can even be added to milk.
Serve a variety of dairy-free foods that are rich in calcium, such as broccoli, beans, tofu, or soy milk. Buy hard cheeses such as cheddar, which are lower in lactose.
Yogurts that contain active cultures are easier to digest and much less likely to cause lactose problems.
Check food labels. Lactose is added to some boxed, canned, frozen, and prepared foods. Some words are clues that the food has lactose in it: butter, cheese, cream, dried milk, milk solids, powdered milk, and whey, for example.

Breast milk testing for infections

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Testing breast milk for infection

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Microbiological examination of breast milk for aerobic, anaerobic and fungal infection of breast milk

Culture of breast milk for microflora with the determination of sensitivity to antibiotics - a microbiological study that allows to identify pathogenic microflora with subsequent selection of drugs for treatment.
Breast milk in the ducts of the mammary glands is normally sterile, but in some cases it is possible for pathogenic microflora to penetrate through the ducts or through small cracks in the nipples. Reproducing, microorganisms cause diffuse purulent inflammation of the breast (mastitis) .

Indications for breast milk testing

Human milk testing is indicated in the following cases:

Postpartum lactational mastitis .
Diarrhea in a child , manifested by liquid dark green stools in combination with insufficient weight gain.
Control of the performed treatment.

Method of analysis

An important condition for obtaining an informative analysis result is complete sterility when collecting biological material for examination. It is necessary to prepare a sterile dish into which milk will be expressed. Before starting the collection, a woman should thoroughly wash her breasts and hands with soap, wipe the glands with alcohol. Milk from different mammary glands is decanted into different containers, the first portion of milk should be poured out. The material for research should be examined within 2.5 hours.

Interpretation of the results of the study of breast milk for infection

In the laboratory, breast milk is sown on various nutrient media and the growth of bacterial colonies is monitored. Normally, 1 ml of breast milk should contain no more than 250 CFU - this is a kind of sterility threshold. The grown colonies are microscopically examined and the type of pathogens is determined - anaerobic and aerobic bacteria , fungi . Most often, golden and epidermal staphylococci, streptococci, pseudomonads, enterobacteria are detected.

After detection of the pathogen, antibiotic sensitivity test is carried out - microorganism is applied to disks impregnated with antibiotic solutions and growth is observed. Rapid reproduction indicates the insensitivity of the pathogen to this type of antibiotics, the lack of growth suggests the opposite.

According to the sensitivity range of each type of microorganism, resistance to the following main drugs is tested:

Staphylococcus aureus: Cefazolin, Penicillin, Clindamycin, Ciprofloxacin, Amoxicillin, Gentamicin.
Enterobacteria: Ampicillin, Cefotaxime, Gentamicin, Ofloxacin, Amoxiclav.

Determination of the sensitivity of microorganisms to the action of bacteriophages

Bacteriophages is a type of virus that can adversely affect the cells of harmful bacteria. For the effectiveness of treatment, it is necessary to check the sensitivity of microorganisms to their effects - the identified bacterial culture is placed in a nutrient medium containing a bacteriophage and the number of dead microbes is estimated.

In conclusion, data on the type of microorganisms detected, the titer in numerical display, data on sensitivity to various antibacterial drugs and bacteriophages are entered. Based on the data obtained, rational drug therapy is prescribed.