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Lactose Intolerance

New Guidelines for Diagnosis and Diet For Toddlers Who Are Lactose Intolerant

There are possibly more myths and misunderstandings about lactose intolerance than any other food-related condition. Katie Cardenas of Greenwich, Conn., is a case in point. After her daughter, Zoe, was born the nurses in the hospital gave the baby some formula to supplement her mom's breastmilk.

Subsequently, a little blood appeared in Zoe's stool. Unable to find any other cause, the staff physician concluded that Zoe was lactose intolerant and ordered Cardenas to stop eating dairy products.

Rather than just taking those orders at face value, Cardenas followed up with her own pediatrician, who told her that was nonsense and she was hurting herself by not getting the important nutrients in dairy products. Cardenas resumed her normal diet and she and Zoe were both fine.

Like Zoe, many infants are misdiagnosed with lactose intolerance, and panicked parents pull all dairy products from their diets. But the results of a new study shows that lactose intolerance almost never is a factor in digestive upsets until ages 3 or 4 – and almost always resolve themselves by the teen or preteen years.

Lactose and Lactase

Lactose is the sugar that is found naturally in milk and other dairy products. Lactase is the enzyme that digests lactose. Lactose intolerance occurs when the small intestine doesn't produce enough lactase. Signs and symptoms of lactose intolerance can include nausea, abdominal cramps, bloating, gas and diarrhea. The severity of these symptoms depends on the amount of lactose consumed, the degree of lactase deficiency and the types of lactose-containing foods.

While lactose intolerance can make a child uncomfortable, it is not a particularly serious condition and is not to be confused with milk allergies. Milk allergies occur as a reaction to one or more of the proteins in cow's milk and can cause digestive, skin and respiratory reactions.

Lactose intolerance does sometimes occur in infants who have genetic conditions or illnesses that affect their digestive systems, but this is rare and is not necessarily related to dietary issues. It can also sometimes be linked to premature birth.

"Lactose intolerance [is] fairly common, but it's a gradual thing," says Dr. Melvin B. Heyman, professor of pediatrics at the University of California at San Francisco and member of the American Academy of Pediatrics' (AAP) committee on nutrition. "Babies are born with the ability to digest lactose, but after they grow out of infancy some gene turns on or off which helps keeps you from digesting lactose. The majority of the world's population start developing lactose intolerance after infancy, but it's rare in Caucasians before 3 or 4 years of age."

Milk Myths

Perhaps the biggest misconception about lactose intolerance is that it has anything to do with breastfeeding or what mom eats while breastfeeding. In fact, breastmilk contains very little lactase and, as Dr. Heyman points out, infants are born with the ability to digest that.

This misdiagnosis commonly happens with colicky babies because the signs and symptoms of lactose intolerance are similar to those of colic. However, lactose intolerance can't just be guessed at. It can only be determined by dietary lactose elimination and other tests, which should only be done under the guidance of a physician.

Another myth is that lactose intolerance prohibits children from ingesting dairy products. All children need some dairy to get the important nutrients provided by this food group.

Terri Verason, director of nutrition education for the Dairy Council of Arizona, says it's important for even lactose intolerant children to consume some dairy foods because bone health and growth is so vital at this stage of rapid growth. "This is particularly true leading up to the preteen and teen years, especially for girls, because this is when you have that window of opportunity to develop those bones," she says.

Verason points out that often it merely requires an adjustment in how children eat dairy. She says that the AAP guidelines for eating for lactose intolerant children are easy to remember using the acronym DAIRY:

Drink milk in smaller amounts and take with food. The food will help with the digestive process so it doesn't have such a heavy lactose load.

Aged cheeses, such as cheddar, are excellent sources of calcium, but most of the lactose is removed in the processing.

Introduce dairy slowly and gradually increase the amount. Research suggests even those who think they're lactose intolerant have just a malabsorption problem. As your system gets used to eating small amounts of dairy you can increase the amount and can train your system to tolerate it.

Reduce your intake of lactose-containing products. Try lactose-free milk and milk products. Or try over-the-counter supplements that assist in digesting lactose.

Yogurt. Look specifically for yogurt with live and active cultures. This helps to digest the lactose as well. Anything that helps break lactose down into its component parts makes it easier to digest.

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