By: Anthony Porto, MD, MPH, FAAP
It can be difficult to know whether your infant or child is having symptoms of lactose intolerance or whether he or she may have a milk allergy.
The following frequently asked questions from parents will help you learn more about the common symptoms of lactose intolerance, diagnosis, and treatment options.
Is lactose intolerance the same thing as a milk allergy?
No. Many parents confuse the terms lactose intolerance and milk allergy. While they may share similar symptoms, they are entirely different conditions. Lactose intolerance is a digestive problem, while milk allergy involves the immune system. So, while lactose intolerance can cause a great deal of discomfort, it will not produce a life-threatening reaction such as anaphylaxis.
Milk allergies tend to appear within the first year of life, while an infant's digestive system is still quite immature. Lactose intolerance can start in childhood into adolescence and can become more noticeable into adulthood.
What is lactose?
Lactose is a sugar found in foods that many children love—milk and dairy products, such as frozen yogurt and cheeses. The list of other foods containing lactose is long and includes some breads, cereals, and frozen or canned foods.
Lactose is broken down by the lactase enzyme located in the small intestine—the organ where most food digestion and nutrient absorption takes place. When we eat lactose, lactase breaks lactose down into two simple sugars: glucose and galactose. The body then absorbs these simple sugars into our intestines. When there is a decrease or loss of the lactase enzyme, we cannot break down or absorb lactose. The unabsorbed lactose can lead to symptoms, which is called an intolerance.
In addition to milk, what other food products contain lactose?
Lactose is present in many food products and in some medications. Manufacturers also often add milk and milk products to boxed, canned, frozen, packaged, and prepared foods. People who have digestive symptoms after consuming a small quantity of lactose should be aware of the many food products that may contain even small amounts of lactose.
You can check the ingredients on food labels and the nutrition facts to find possible sources of lactose in food products. If a food label includes any of the following words, the product contains lactose:
Dry milk solids
Nonfat dry milk powder
What are some key symptoms of lactose intolerance?
The symptoms of lactose intolerance depend on the amount of lactose that's consumed. The more lactose your child consumes, the more symptoms he or she will experience. Symptoms of lactose intolerance can occur within minutes to hours after drinking milk or eating dairy products and range from mild to severe based on the amount consumed and the amount tolerated. Here are symptoms you should look out for:
If I think my child might be lactose intolerant. How can I tell?
One way to check if your child has trouble digesting lactose is to take all the milk products out of your child's diet for two weeks and to then see if his or her symptoms improve. After two weeks, slowly reintroduce the products in small amounts each day to see if symptoms return. Your pediatrician can also test your child for lactose intolerance with a hydrogen breath test.
I've heard lactose intolerance can sometimes be a temporary side effect when kids are sick. Is that true?
Yes. Lactose intolerance can occur temporarily in children after a viral infection (that is why you may be told to avoid milk with lactose in it during a stomach bug) or it may be seen with conditions that lead to inflammation of the intestines, such as celiac disease.
Can infants be lactose intolerant?
Lactose intolerance is actually not very common in infants and typically only starts showing up after age three in children who were born full-term. All babies are born with lactase in their intestines. As they grow older, the lactase enzyme decreases.
Babies who were born premature are more likely to have a type of lactose intolerance called developmental lactase deficiency. This condition usually lasts only for a short time after birth. However, the majority of premature infants will be able to consume lactose-containing formula and breast milk.
Congenital lactase deficiency is a very rare disorder in which babies can't break down the lactose in breast milk or formula. Genes inherited from parents cause this disorder. This type of intolerance results in severe diarrhea, and if not fed a lactose-free infant formula, those babies could develop severe dehydration and weight loss.
If a mother is lactose intolerant, is it safe for her to breastfeed her baby?
It's perfectly safe to breastfeed your child if you're lactose intolerant. Breastfeeding does not put your baby at greater risk of becoming lactose intolerant, and it has important health benefits for your baby.
How can my child get enough calcium in her diet if milk or lactose are reduced?
If your child has lactose intolerance, he or she can still eat lactose-free dairy products including lactose-free milk, cheese, and yogurts—all are good sources of calcium. In addition, your child can get calcium from dark green leafy vegetables such as spinach, broccoli and kale, nuts (almonds), beans (white beans), fish (sardines, salmon) and calcium-fortified orange juice. If you feel your child is not getting enough calcium, talk with your pediatrician about starting a calcium supplement.
Are soy or almond milks adequate substitutes for children who are lactose intolerant?
There are many milk substitutes that a child with lactose intolerance can drink, including soy, almond, rice, hemp, and oat milk. Soy milk is a popular milk alternative, because it is a good source of calcium and protein. Almond milk has also become a popular alternative and is safe for children with lactose intolerance or a cow's milk protein allergy. Although almond is a good source of calcium, it is lower in protein and contains fewer calories than cow's milk. Before starting any alternative milks, it is important to talk with your pediatrician about which may be best for your child.
How is lactose intolerance diagnosed?
Your pediatrician will take a medical, family, and diet history to help diagnose lactose intolerance in your infant or child. During this discussion, he or she will review your child's symptoms with you.
In some cases, a hydrogen breath test is done to test for lactose intolerance. For the test, your child breathes into a container that measures breath hydrogen level before and after he or she drinks a beverage that contains a known amount of lactose. Normally, only a small amount of hydrogen is detectable in the breath when a person eats or drinks and digests lactose. An increase in hydrogen levels is considered a positive test for lactose intolerance.
Pediatricians check acidity in the stools of infants and young children who may be unable to properly do the hydrogen breath test. Acidic stool (low pH) may indicate lactose malabsorption. Another stool test (reducing substances) looks for the presence of glucose in the stool, which signifies undigested lactose.
If your child's symptoms persist, he or she may be referred to a pediatric gastroenterologist (GI) for further evaluation. Depending on the severity of your child's symptoms, the GI may perform an endoscopy to measure lactase levels directly from the intestine. This is done with a biopsy.
How much calcium and vitamin D are recommended for my child to eat each day?
The specific amount is based on your child's age. Here is a breakdown of the Recommended Dietary Allowances (RDA) for calcium and vitamin D.
How is lactose intolerance treated?
How lactose intolerance is treated depends on the extent of your child's symptoms. Some children with lactose intolerance may be able to have small amounts of dairy products without having symptoms.
To help alleviate symptoms if/when your child consumes lactose-containing food, your pediatrician may recommend an over-the-counter lactase enzyme supplement.
If your child's symptoms are severe and warrant removing all lactose from his or her diet, your pediatrician may refer your child to a registered dietitian. Since dairy is a good source of calcium and vitamin D—which all kids need—a registered dietitian can suggest other foods to provide those nutrients and may suggest vitamin supplements.
Is lactose intolerance a lifelong condition?
In some cases, lactose intolerance is temporary—if lactose intolerance develops after a viral illness or if it is associated with other conditions, like celiac disease. For example, once celiac disease is treated, lactase levels can become in the normal range and lactose may be tolerated in the diet. More than likely, however, lactose intolerance is long-term and requires many older children and adults to alter their diet to avoid symptoms.
Additional Information & Resources:
About Dr. Porto:
Anthony Porto, MD, MPH, FAAP is a board certified pediatrician and board certified pediatric gastroenterologist. He is an Associate Professor of Pediatrics and Associate Clinical Chief of Pediatric Gastroenterology at Yale University and Director, Pediatric Gastroenterology at Greenwich Hospital in Greenwich, CT. He is also the medical director of the Yale Pediatric Celiac Program. Within the American Academy of Pediatrics, Dr. Porto sits on the PREP Gastroenterology Advisory Board and is a member of the Section on Gastroenterology, Hepatology and Nutrition. He is also a member of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition's Public Education Committee, a pediatric expert on nutrition for The Bump's Real Answers, and is the co-author of The Pediatrician's Guide to Feeding Babies and Toddlers. Follow him on Instagram @Pediatriciansguide.
Anthony Porto, MD, MPH, FAAP, anasema: Inaweza kuwa ngumu kujua ikiwa mtoto wako ana dalili za kutovumilia lactose au ikiwa anaweza kuwa na mzio wa maziwa. Maswali yafuatayo yanayoulizwa mara nyingi na wazazi yatakusaidia kujifunza zaidi kuhusu dalili za kawaida za kutoweza kuvumilia laktozi, utambuzi, na njia za matibabu. Je, kukosa uwezo wa kuvumilia maziwa ni sawa na kuwa na mzio wa maziwa? La, sivyo. Wazazi wengi huchanganya maneno kutoweza kuvumilia laktozi na mzio wa maziwa. Ingawa huenda zikawa na dalili zinazofanana, ni hali tofauti kabisa. Kutoweza kuvumilia laktosi ni tatizo la utumbo, ilhali mzio wa maziwa huhusisha mfumo wa kinga. Kwa hiyo, ingawa kukosa uwezo wa kuvumilia laktosi kunaweza kusababisha matatizo mengi, hali hiyo haitokezi hali inayoweza kuhatarisha uhai kama vile anaphylaxis. Msaada wa Allergy ya maziwa huanza katika miaka ya kwanza ya maisha, wakati mfumo wa kumeng'enya chakula wa mtoto bado haujakomaa. Ugonjwa wa kutoweza kuvumilia laktosi waweza kuanza utotoni hadi ujana na unaweza kuonekana zaidi ukiwa mtu mzima. Lactose ni nini? Lactose ni sukari inayopatikana katika vyakula ambavyo watoto wengi wanapenda - maziwa na bidhaa za maziwa, kama vile mboga iliyogandishwa na jibini. Orodha ya vyakula vingine vyenye laktosi ni ndefu na vinatia ndani mikate, nafaka, na vyakula vilivyohifadhiwa kwenye barafu au kwenye makopo. Lactose huvunjwa na enzyme ya lactase iliyoko katika matumbo madogo - kiungo ambapo kumeng'enywa kwa chakula na kunyonya virutubisho hufanyika. Wakati wa kula, lactase hugawanya lactose katika sukari mbili: glukosi na galaktozi. Kisha mwili huchukua sukari hizo sahili na kuziingiza ndani ya matumbo yetu. Wakati kuna kupungua au kupoteza ya enzyme lactase, hatuwezi kuvunja au kunyonya lactose. Laktosi isiyoingizwa inaweza kusababisha dalili, ambazo huitwa kutoweza kuvumilia. Mbali na maziwa, ni vyakula gani vingine vinavyoweza kuwa na lactose? Lactose inapatikana katika vyakula vingi na katika dawa fulani. Mara nyingi watengenezaji wa vyakula huongeza maziwa na vyakula vinavyotokana na maziwa kwenye vyakula vilivyohifadhiwa, vilivyohifadhiwa, vilivyohifadhiwa, vilivyohifadhiwa, vilivyohifadhiwa, na vilivyohifadhiwa. Watu ambao wana dalili za kumeng'enya baada ya kula kiasi kidogo cha lactose wanapaswa kuwa na ufahamu wa bidhaa nyingi za chakula ambazo zinaweza kuwa na kiasi kidogo cha lactose. Angalia viungo kwenye lebo za vyakula na habari za lishe ili uone chanzo cha lactose katika bidhaa za chakula. Ikiwa bidhaa ina alama ya chakula, bidhaa hiyo ina lactose, ambayo ni dawa ya kulevya isiyo na mafuta, ambayo ni dawa ya kulevya isiyo na mafuta, ambayo ni dawa ya kulevya isiyo na mafuta. Dalili za kutoweza kuvumilia lactose hutegemea kiasi cha lactose kinachotumiwa. Kadiri mtoto wako anavyokula lactose, ndivyo atakavyokuwa na dalili zaidi. Dalili za kutovumilia lactose zinaweza kutokea dakika chache hadi masaa baada ya kunywa maziwa au kula bidhaa za maziwa na huanzia laini hadi kali kulingana na kiasi kilichotumiwa na kiasi kilichovumiliwa. Kwa mfano, kuna dalili ambazo zinaweza kuathiri mtoto wako, kama vile: Ninawezaje kujua? Njia moja ya kujua kama mtoto wako ana matatizo ya kumeng'enya lactose ni kuondoa bidhaa zote za maziwa katika mlo wa mtoto wako kwa wiki mbili na kisha kuona kama dalili zake zinapungua. Baada ya wiki mbili, chukua dawa hiyo kwa kiasi kidogo kila siku ili uone ikiwa dalili zinarudi. Daktari wa watoto anaweza pia kumchunguza mtoto wako kwa ajili ya kutoweza kuvumilia lactose kwa kufanya mtihani wa pumzi ya hidrojeni. Kwa mfano, unahisi kuwa lactose intolerance ni athari ya muda mfupi ya ugonjwa wa watoto. Je, hilo ni kweli? Ndio, nina hakika. Lactose intolerance inaweza kutokea kwa muda katika watoto baada ya maambukizi ya virusi (kwa hiyo unaweza kuambiwa kuepuka maziwa na lactose ndani yake wakati wa bug tumbo) au inaweza kuonekana na hali ambayo husababisha uvimbe wa matumbo, kama vile celiac ugonjwa. Je, watoto wachanga hawawezi kuvumilia laktosi? Lactose intolerance ni kawaida katika watoto wachanga na huanza kuonekana baada ya miaka mitatu katika watoto waliozaliwa kwa muda kamili. Watoto wote huzaliwa wakiwa na laktasi katika matumbo yao. Kadiri wanavyokua, enzyme ya lactase hupungua. Watoto waliozaliwa kabla ya wakati wana uwezekano mkubwa zaidi wa kuwa na aina ya kutoweza kuvumilia lactose inayoitwa upungufu wa lactase wa ukuzi. Kwa kawaida hali hiyo hudumu kwa muda mfupi tu baada ya kuzaliwa. Hata hivyo, watoto wengi waliozaliwa kabla ya wakati wataweza kula formula na maziwa ya mama yenye laktosi. Ukosefu wa lactase ya kuzaliwa ni ugonjwa wa kawaida ambao huathiri watoto ambao hawawezi kuondoa lactose katika maziwa ya mama au formula. Chembe za urithi kutoka kwa wazazi husababisha ugonjwa huo. Aina hii ya kutovumilia huongoza kwenye kuhara kali, na ikiwa watoto hawajaandaliwa chakula kisicho na laktosi, wanaweza kuharibika sana na kupoteza uzito. Ikiwa mama hawezi kuvumilia sukari ya maziwa, je, ni salama kumnyonyesha mtoto wake? Ni salama kabisa kumnyonyesha mtoto wako ikiwa huna uwezo wa kumnyonyesha lactose. Kunyonyesha kunamfanya mtoto wako awe na hatari ya kuwa na ugonjwa wa lactose intolerance na pia kunamletea faida kubwa za afya. Jinsi gani mtoto wangu anaweza kupata kalsiamu ya kutosha katika mlo wake ikiwa maziwa au lactose hupunguzwa? Ikiwa mtoto wako hana uwezo wa kuvumilia laktosi, bado anaweza kula bidhaa za maziwa zisizo na laktosi ikiwa ni pamoja na maziwa yasiyo na laktosi, jibini, na yogati - zote ni vyanzo vizuri vya kalsiamu. Kwa kuongezea, mtoto wako anaweza kupata kalsiamu kutoka kwa mboga zenye majani ya kijani-kibichi kama vile mchicha, broccoli na kale, karanga (almonds), maharagwe (maharagwe meupe), samaki (sardini, salmon) na maji ya machungwa yenye kalsiamu. Ikiwa mtoto wako anapata kiasi cha kutosha cha kalsiamu, wasiliana na daktari wako wa watoto kuhusu kuongeza kalsiamu. Je, maziwa ya soya au ya lozi ni mbadala unaofaa kwa watoto wasioweza kuvumilia laktozi? Kuna vitu vingi vinavyoweza kuchukua nafasi ya maziwa ambavyo mtoto asiyeweza kuvumilia laktosi anaweza kunywa, kutia ndani maziwa ya soya, ya almond, ya mchele, ya bangi, na ya shayiri. Maziwa ya soya ni mbadala maarufu wa maziwa, kwa sababu ni chanzo kizuri cha kalsiamu na protini. Maziwa ya almond pia yamekuwa mbadala maarufu na ni salama kwa watoto wenye kutoweza kuvumilia lactose au mzio wa protini ya maziwa ya ng'ombe. Ingawa lozi ni chanzo kizuri cha kalsiamu, ina protini chache na ina kalori chache kuliko maziwa ya ng'ombe. Kabla ya kuanza kutumia maziwa ya ziada, ni muhimu kuzungumza na daktari wako wa watoto kuhusu ambayo inaweza kuwa bora kwa mtoto wako. Ugonjwa wa kutoweza kuvumilia laktozi hutambuliwaje? Daktari wako wa watoto atachukua historia ya matibabu, familia, na lishe ili kusaidia kugundua kutoweza kuvumilia lactose katika mtoto wako. Wakati wa mazungumzo haya, atazungumzia dalili za mtoto wako pamoja nawe. Katika visa fulani, mtihani wa pumzi ya hidrojeni hufanywa ili kupima kutoweza kuvumilia laktozi. Kwa mfano, mtoto anapumua ndani ya chombo cha kupima kiwango cha hidrojeni ya pumzi kabla na baada ya kunywa kinywaji kilicho na kiasi cha lactose. Kwa kawaida, kiasi kidogo tu cha hidrojeni huonekana katika pumzi wakati mtu anakula au kunywa na kumeng'enya laktosi. Ongezeko la viwango vya hidrojeni huonwa kuwa mtihani mzuri wa kutoweza kuvumilia laktozi. Wataalamu wa afya ya watoto huangalia asidi katika matope ya watoto wachanga na watoto wadogo ambao wanaweza kuwa hawawezi kufanya vizuri mtihani wa pumzi ya hidrojeni. Mvua yenye asidi (pH ya chini) yaweza kuonyesha upungufu wa lactose. Uchunguzi mwingine wa matope (vitu vinavyopunguza) hutafuta uwepo wa glukosi katika matope, ambayo inaonyesha laktosi isiyoweza kumeng'enywa. Ikiwa dalili za mtoto wako zinaendelea, anaweza kuelekezwa kwa mtaalamu wa magonjwa ya tumbo (GI) kwa ajili ya tathmini zaidi. Kulingana na uzito wa dalili za mtoto wako, daktari anaweza kufanya endoscopy ili kupima viwango vya lactase moja kwa moja kutoka kwa matumbo. Hii hufanywa kwa kutumia uchunguzi wa viungo. Ni kiasi gani cha kalsiamu na vitamini D kinachopendekezwa mtoto wangu kula kila siku? Kiasi hicho husika kinategemea umri wa mtoto wako. Kwa mfano, kwa mfano, kiwango cha chakula kinachopendekezwa (RDA) cha kalsiamu na vitamini D, na kwa nini hakuna matibabu ya lactose intolerance? Jinsi ya kutibu kutoweza kuvumilia lactose inategemea kiwango cha dalili za mtoto wako. Watoto wengine wenye kutoweza kuvumilia lactose wanaweza kula kiasi kidogo cha bidhaa za maziwa bila kuwa na dalili. Ili kupunguza dalili za ugonjwa huo, daktari wa watoto anaweza kupendekeza dawa ya lactase. Ikiwa dalili za mtoto wako ni kali na zinahitaji kuondolewa lactose kutoka kwa chakula chake, daktari wako wa watoto anaweza kumpeleka mtoto wako kwa mtaalamu wa lishe aliyesajiliwa. Kwa kuwa maziwa ni chanzo kizuri cha kalsiamu na vitamini D - ambazo watoto wote wanahitaji - mtaalamu wa lishe aliyeandikishwa anaweza kupendekeza vyakula vingine kutoa virutubisho hivyo na anaweza kupendekeza virutubisho vya vitamini. Je, kukosa kuvumilia laktosi ni ugonjwa wa kudumu? Katika baadhi ya kesi, lactose intolerance ni ya muda - kama lactose intolerance inaendelea baada ya ugonjwa wa virusi au kama ni kuhusishwa na hali nyingine, kama celiac ugonjwa. Kwa mfano, mara tu ugonjwa wa celiac unapotibiwa, viwango vya lactase vinaweza kuwa katika kiwango cha kawaida na lactose inaweza kuvumiliwa katika mlo. Hata hivyo, inawezekana zaidi kwamba ugonjwa huo ni wa muda mrefu na unahitaji watoto wengi wakubwa na watu wazima kubadilisha lishe yao ili kuepuka dalili. Kwa mujibu wa taarifa ya Dk.Porto, Dk.Anthony Porto, MD, MPH, FAAP ni daktari wa watoto aliyeidhinishwa na bodi ya daktari wa gastroenterolojia ya watoto. Yeye ni Profesa Mshirika wa Pediatrics na Mkurugenzi Mshirika wa Kliniki wa Pediatric Gastroenterology katika Chuo Kikuu cha Yale na Mkurugenzi wa Pediatric Gastroenterology katika Hospitali ya Greenwich, Connecticut. Yeye pia ni mkurugenzi wa matibabu wa Yale Pediatric Celiac Program. Katika Chuo cha Marekani cha Pediatrics, Dk Porto ni mwanachama wa Baraza la Ushauri la Gastroenterology la PREP na ni mwanachama wa Idara ya Gastroenterology, Hepatology na Lishe. Yeye pia ni mwanachama wa Jumuiya ya Amerika ya Kaskazini ya Pediatric Gastroenterology, Hepatology na Nutrition's Public Education Committee, mtaalam wa watoto juu ya lishe kwa The Bump's Real Answers, na ni mwandishi mwenza wa Mwongozo wa Pediatrician wa Kulisha Watoto na Watoto. Mfuateni kwenye Instagram @PediatriciansGuide.