Understanding Lactose Intolerance and Milk Allergy in Children

Highlights

• Some babies and children react to cow’s milk or formula made from cow’s milk.
• Symptoms may indicate either lactose intolerance or a milk allergy.
• If your child has lactose intolerance, you need to reduce milk and dairy products.
• A milk allergy requires avoiding all milk and dairy products completely.
• Many young children outgrow lactose intolerance and milk allergy, but consult your doctor before altering your child’s diet.

In This Article

• Key facts about lactose intolerance and milk allergy
• Differences between lactose intolerance and milk allergy
• How to diagnose lactose intolerance or milk allergy
• Causes and symptoms of lactose intolerance
• Treatment for lactose intolerance
• Causes and symptoms of milk allergy
• Treatment for milk allergy

Key facts about lactose intolerance and milk allergy

Some babies and children have a reaction when they drink cow’s milk or formula made from cow’s milk. These reactions may be due to either lactose intolerance or an allergy to milk.

If your child has lactose intolerance, you will need to reduce the amount of milk and dairy products in their diet.

If your child has a milk allergy, you will need to alter their diet to avoid milk and dairy products completely.

Many young children grow out of both lactose intolerance and milk allergy, but be sure to speak to your doctor before removing or reintroducing milk into your child’s diet.

Differences between lactose intolerance and milk allergy

Around 1 in 10 young children have 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 years of age.

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 naturally present in milk.

Milk allergy, however, is a problem with the immune system, where 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.

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

How to diagnose lactose intolerance or milk allergy

Your doctor can confirm whether your child is lactose intolerant or has a milk allergy by asking about your child’s symptoms and doing medical tests. Don’t remove milk or milk-based foods from your child’s diet unless your doctor has told you to.

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.

Causes and symptoms of lactose intolerance

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 years. It is more common among certain populations, such as those of Aboriginal or Asian descent.

Lactose intolerance is rare in babies and young children. However, they can become temporarily 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 resolve once the gut heals, usually over a few months.

Treatment for lactose intolerance

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.

Most of the time, young children will recover from lactose intolerance after a few weeks of having a low-lactose diet. Speak to your doctor or dietitian about how to slowly reintroduce milk and dairy products into your child’s diet.

Causes and symptoms of milk allergy

Milk allergy occurs when your child’s immune system reacts to the protein in milk. It is one of the most common food allergies in young children. Most children outgrow milk allergy by the time they reach school age.

Treatment for milk allergy

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. You should use coconut products with caution, as many coconut products may be contaminated with cow’s milk.

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 extensively hydrolysed formula (EHF) or amino acid-based formula (AAF). If your baby is over 6 months old, you can also use soy protein formula (unless they are also allergic to soy). Do not use formula made from cow’s milk, goat’s milk, sheep’s milk, HA or A2 milk or lactose-free formulas.

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

If your child is allergic to milk, you may be advised to carry an adrenaline autoinjector (EpiPen® and Anapen®). Severe allergic reactions can sometimes lead to anaphylaxis, which is an emergency and can even be fatal. An adrenaline autoinjector can be used to give first aid in the event of anaphylaxis.

Tools and Assistance

• Seek advice before making any changes to your baby’s diet, particularly when it comes to dairy products.
• Speak to your doctor or dietitian for advice on managing your child’s diet and introducing or removing dairy products.
• Use an allergy autoinjector (EpiPen® or Anapen®) in case of severe allergic reactions.
• Visit a pediatrician to confirm if your child is lactose intolerant or has a milk allergy.