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Most problems in infants like bloating, flatulence and abdominal discomfort, especially during the first is commonly blamed on lactose intolerance. But before forming any opinions, it is important to take a sensible perspective on what lactose intolerance is.
Lactose is a form of sugar found in milk or milk-based products. It is present in both breast milk and formula feeds. Our body digests this form of sugar using an enzyme called "Lactase". This enzyme helps break the compound form of sugar into two simple sugars "Glucose" and "Galactose", which are easier for the body to absorb into the bloodstream and is an important source of energy for babies.
Malproduction of lactase leads to decreased absorption of lactose and excessive lactose in the intestine. This can lead to diarrhea, abnormal gaseous distension, abdominal discomfort, rash around the anal area (diaper rash) and in very severe cases, failure to gain weight. Not many people know that primary lactose intolerance is extremely rare, wherein there is a deficiency of the lactase enzyme, which leads to malabsorption of lactose and results in symptoms of lactose intolerance.
What we commonly see is secondary lactose intolerance which usually happens after a severe bout of gastroenteritis. The baby can exhibit all symptoms of lactose intolerance for a period of two to three weeks and go back to normal, being able to digest lactose.
Most cases are diagnosed based on clinical signs and symptoms exhibited by the baby. If the baby has persistent diarrhea, difficult to treat perennial rash (diaper rash) or failure to gain weight, a special stool test can be done to confirm the diagnosis. However, a positive stool test without clinical signs may not necessarily mean lactose intolerance.
Labelling a baby lactose intolerant means that the baby cannot have breast milk, cow's milk based formula feeds or milk based products. Eliminating breast milk from a baby's diet is a drastic measure and should not be done unless there is enough evidence of lactose intolerance. In practice, most babies suffer from a temporary form of lactose intolerance, secondary to gastroenteritis, making breastfeeding safe, which can be replaced by lactose-free formula feeds. This is a temporary measure and most babies will be able to go back to the normal feeds after a few weeks. It is not advisable to continue lactose-free formulas endlessly.
For those babies who are truly lactose intolerant and those who develop temporary lactose intolerance, lactose free milk should be given. Currently this can be soy based formula or hydrolyzed formulas. Most of these formulas are not easily palatable and the baby may take a while to get used to them.
The first choice for feeding a baby should be breast milk and in rare events, one can use cow milk based formula. Babies who are healthy should not be diagnosed as lactose intolerant because of bloating and flatulence alone or if they suffer from gastroenteritis (which is very common in infants and toddlers) and should not be put on lactose free diet.
Raghuram Mallaia, Director Neonatology, Fortis la Femme
