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Milk intolerance in babies and children

6-minute read

Some babies and children have a reaction when they drink cow's milk or formula made from cow's milk. This could be due to 2 things: a lactose intolerance or an allergy to milk. If your child has one of these conditions, you will have to alter their diet to cut down on milk or avoid it altogether.

Call triple zero (000) for an ambulance if your child has the following symptoms. They could be having a severe allergic reaction and will need urgent medical attention.

  • wheezing or difficulty breathing
  • a swollen tongue
  • vomiting
  • they are pale and floppy or unconscious

What is milk intolerance and milk allergy?

Around 1 in 10 young children has a reaction when they drink cow's milk. This could be because they have a lactose intolerance or a milk allergy. Milk allergy is much more common than lactose intolerance in children under 5.

Lactose intolerance is a problem with the digestive system – it means your child doesn't have the enzyme needed to digest lactose, which is the sugar in milk.

Milk allergy, however, is a problem with the immune system — the body reacts to the protein in milk. An allergy usually involves other parts of the body as well as the stomach, and may cause symptoms such as a skin rash or swelling of the face.

Your doctor can confirm whether your child is lactose-intolerant or has a milk allergy by doing some medical tests. Don't use unproven tests such as Vega, kinesiology, Alcat or allergy elimination tests for children. A milk intolerance is very unlikely to be the cause of mucus or coughing.

Many young children grow out of their intolerance or allergy. But don't start giving them cow's milk until your doctor tells you it's safe to do so.

Lactose intolerance

Causes

Lactose is the sugar found in the milk produced by all mammals, including humans. Sometimes people don't produce enough of the enzyme lactase in their gut to break down the lactose.

Very few babies have true lactose intolerance, a rare genetic condition where they're born without any lactase enzymes at all. (This is called primary lactose intolerance). However, many people develop lactose intolerance later in life, after the age of 5. It is more common in Aboriginal Australians and people from Asia, Africa, the Middle East and some Mediterranean countries.

Babies and young children can become intolerant to milk if the lining of their gut is damaged by an illness such as gastroenteritis, or an allergy or intolerance to another food. This is called secondary lactose intolerance and will go away once the gut heals, usually over a few months.

Symptoms and diagnosis

The symptoms of lactose intolerance in babies and children are:

All of these symptoms are common in babies and don't necessarily mean they have lactose intolerance. But if your child has diarrhoea and isn't putting on weight, see your doctor. Don't stop breastfeeding unless your doctor tells you to.

Tests include a breath test to measure the hydrogen in your child's breath, or cutting out dairy to see if their symptoms improve. This is known as an elimination diet.

Treatment

If the lactose intolerance is caused by a tummy upset, keep on breastfeeding. If your baby is formula fed, talk to your doctor or child and family health nurse before switching to low-lactose or lactose-free formula.

Older children will need to cut down on, but not eliminate, dairy foods from their diet. They can still have some cheeses, yogurt, calcium-fortified soy products, lactose-free milk, butter and cream. Your doctor or a dietitian will advise you on the best diet for your child.

Cow's milk allergy

Cow's milk allergy is one of the most common food allergies in young children. It usually disappears by the time they reach school age. It occurs when your child's immune system reacts to the protein in milk.

Symptoms and diagnosis

Reactions to milk can occur within minutes or not for several days.

Rapid reactions include:

  • hives (urticaria)
  • swelling of the lips, face or eyes
  • stomach pain
  • vomiting
  • diarrhoea
  • noisy breathing or wheezing
  • a swollen tongue
  • a swollen or tight throat
  • a hoarse voice
  • change in consciousness or floppiness in babies or young children

Delayed reactions include:

  • an increase in eczema
  • blood or mucus in stools
  • vomiting and/or diarrhoea 2-24 hours after having milk

It is very important to see a doctor if your child has the symptoms of milk allergy. The condition is diagnosed using the history of symptoms or can sometimes be confirmed with an allergy test.

Treatment

If your child is allergic to milk, you need to completely remove dairy products from their diet. Follow your doctor's or allergy specialist's advice and read food labels carefully. You may also need to avoid milk from other animals, such as goats, as well as coconut milk products. Watch out for other words used to describe milk on food labels, such as butter, buttermilk, cream, curd, ghee, milk, cheese, dairy, milk solids, whey, yoghurt, casein and caseinates.

If your baby is formula-fed, you can use soy protein formula (unless they are also allergic to soy), extensively hydrolysed formula (EHF) or amino acid-based formula (AAF). Do not use formula made from cow's milk, goat's milk, sheep milk, HA, A2 milk or lactose-free.

If your child is over the age of one, they can be given soy milk, calcium-enriched rice, and oat or nut milks. It is important to make sure they are getting enough calcium.

You may be advised to carry an Epipen adrenaline autoinjector if your child is allergic to milk. Severe allergic reactions can sometimes lead to anaphylaxis, which is serious and can even be fatal. An adrenaline autoinjector can be used to give first aid in the event of anaphylaxis.

Breastfeeding a baby who can't tolerate milk

If your baby is lactose-intolerant, you don't need to change your diet. It doesn't matter how much dairy you consume, the amount of lactose in your milk will be the same.

However, if your baby is diagnosed with milk allergy, you will need to remove all dairy from your own diet too. You will need calcium and vitamin D supplements every day. Your doctor or allergy specialist will advise you.

Where to seek more help

Don't try to deal with milk intolerance yourself. You can get help from:

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Last reviewed: July 2020


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Need more information?

Lactose intolerance and the breastfed baby | Australian Breastfeeding Association

Lactose intolerance is poorly understood in the Australian community. There are lots of myths and misunderstandings about it, especially when it comes to babies. Primary (or true) lactose intolerance is an extremely rare genetic condition and lactose intolerance is very different to intolerance or allergy to cows' milk protein. This article explains the differences between lactose intolerance and other conditions such as food allergies and lactose overload and dispels some of the myths about lactose intolerance in babies.

Read more on Australian Breastfeeding Association website

Healthy eating for kids

Encourage healthy eating habits for kids by shopping healthy and planning meals to minimise temper tantrums at the dinner table and keep fussy eaters happy.

Read more on Pregnancy, Birth & Baby website

Lactose intolerance - MyDr.com.au

Lactase deficient people do not have enough lactase, the enzyme that helps break down lactose and they suffer from lactose intolerance. The main symptoms of lactose intolerance are bloating and wind. 

Read more on myDr website

Lactose intolerance - Better Health Channel

betterhealth.vic.gov.au

Read more on Better Health Channel website

ASCIA Guide for Milk Substitutes in Cow’s Milk Allergy - Australasian Society of Clinical Immunology and Allergy (ASCIA)

Guide for Milk Substitutes in Cow’s Milk Allergy

Read more on ASCIA – Australasian Society of Clinical Immunology and Allergy website

Allergy - Cow's milk allergy and milk free diet | Sydney Children's Hospitals Network

How common is cow’s milk allergy? Cow’s milk allergy is one of the most common food allergies in childhood affecting about 1-2% of preschool children

Read more on Sydney Children's Hospitals Network website

Cow's milk (dairy) allergy | Dietitians Australia

Cow's milk allergy is common in babies and children, and symptoms can range from milk to severe. Avoiding cow's milk and other dairy-containing foods is the only effective way to manage a cow's milk allergy, but it's important to seek specialist advice.

Read more on Dietitians Australia website

Food allergy versus food intolerance - MyDr.com.au

A food allergy is an immune response triggered by eating specific foods that cause certain well known symptoms to develop.

Read more on myDr website

Cow’s milk allergy - Better Health Channel

betterhealth.vic.gov.au

Read more on Better Health Channel website

Cow`s milk (dairy) allergy - Australasian Society of Clinical Immunology and Allergy (ASCIA)

Cow's milk is a common cause of food allergy in infants. In Australia and New Zealand around 2 per cent (1 in 50) infants are allergic to cow's milk and other dairy products. Although most children outgrow cow's milk allergy by the age of 3-5 years, in some people cow's milk allergy may not resolve.

Read more on ASCIA – Australasian Society of Clinical Immunology and Allergy website

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