Dear Doctor, I think my baby is lactose intolerant and he is only a week old. He has diarrhoea and my mother says it is because of the lactose in breast milk. I gave him formula and it was the same thing. Is there a special, lactose-free infant formula? What would you recommend? Sharon

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Dear Sharon,

Is your baby exclusively breast fed or is he receiving cow’s milk? Is he having diarrhoea since the first feed of mother’s milk or cow milk or any other formula milk? Usually, an episode of severe diarrhoea in babies can cause temporary lactose intolerance in babies. But that subsides within a week or two.  True lactose intolerance in babies is very rare. It would occur only if both the parents pass the genes of the same to their child.

In lactose intolerance, the body lacks the enzyme lactase, which is the one responsible for digesting milk and other milk products. Thus, milk and other dairy products are not digested and tend to remain in the intestines. This results in increased frequency of stools or mild diarrhoea. It is a harmless condition, but causes much discomfort to the baby and anxiety for parents.

Premature babies cannot produce enough lactase, hence, remain lactose intolerant for some days.

True lactose intolerance usually shows up in the grade-school or teen years. While it’s possible for symptoms to appear earlier, what causes lactose intolerance is not known exactly. A strong genetic component is said to exist. Some medicines can lower the level of lactase and cause manifestations of lactose intolerance. It can also be due to diseases of intestines like celiac disease or Crohn’s disease.

A baby having lactose intolerance will usually have abdominal bloating, cramps and diarrhoea, 30 minutes to about two hours after drinking milk.  Some babies can tolerate a small amount of milk, cheese, etcetera, or any dairy product. Whereas other babies may develop a problem even with a very small amount of milk.

Lactose intolerance is different from allergy to milk protein. One having allergy to milk, or milk proteins, may develop sneezing, running of nose, skin rashes, and breathlessness, one or more of these symptoms after consuming any milk product.

One way to detect lactose intolerance is to avoid all dairy products for a week or so and then resume again. If symptoms improve after stopping them and continue after restarting them, then one would think of lactose intolerance as a cause. But this is not feasible in very small babies.

Before buying any formula feed for the baby, check on the contents. At times, babies are recommended to take whey in place of milk. Soy milk is another thing that can serve as substitute for cow’s or mother’s milk.                        

Dr. Rachna  Pande is a specialist in internal medicine.