Greetings,
Here's an article to share.
I thought this was a good response by Dr. Abell.
Renee Mercier RN IBCLC
Washington State
http://www.tdn.com/articles/2007/02/20/this_day/news08.txt
------------------------------------------------------------------------
Baby likely is not lactose intolerant
By Dr. Sue Abell, columnist
Feb 19, 2007 - 11:31:56 pm PST
Dear Dr. Sue,
My daughter is lactose intolerant, just like her father and his mother.
I'm concerned about getting enough calcium into her once she's no longer
on formula. (My husband won't drink soy milk, so I'm thinking she won't
either.) I'm assuming she'll be lactose intolerant for life. She drinks
soy formula now and is doing much better.
Dear Mother,
I seriously doubt that your daughter is lactose intolerant, and you'll
see why in a moment. It sounds like your baby had some sort of reaction
when she drank one of the cow's milk formulas, and she was switched to a
soy formula and the symptoms resolved. Or she may have even had symptoms
with breastfeeding and improved when you stopped breastfeeding and
changed to a soy formula.
There are several types of reactions that babies can have to milk.
First of all, symptoms of fussiness and discomfort in breastfed infants
can be due to improper breastfeeding technique. If babies do not fully
empty one breast during each feeding, they will receive too much lower
fat foremilk and not enough higher fat hindmilk. This low fat milk
causes the stomach to empty very quickly so that a large amount of
lactose is dumped into the intestines at one time.
Even though these infants produce a normal amount of the enzyme that
breaks down lactose, this huge burden of lactose can cause green,
watery, loose stools and a lot of discomfort. When they are encouraged
to fully empty one breast they receive more calories and more fat, and
lactose is delivered to their intestines more gradually, which often
solves the problem. Some babies, whether breast or bottle fed, are cow's
milk intolerant. This has nothing to do with lactose (milk sugar), but
is thought to be a reaction to milk protein.
Cow's milk protein in the mother's diet does end up in breast milk in
sufficient amounts to cause symptoms in an intolerant baby. Babies being
fed regular formulas, which are made from cow's milk, are receiving
large amounts of cow's milk protein. It is believed that about 2 to 7
percent of infants have this problem, which unlike lactose intolerance
tends to go away. (Many babies outgrow cow's milk intolerance by the age
of six months, even more by a year of age, and nearly all by the time
they are 2.)
Many, but not all, babies who are intolerant to cow's milk are also
intolerant to soy --- approximately 20 to 30 percent. This means,
though, that the majority of babies with this problem do just fine when
there is no longer any cow's milk protein in their mother's milk, or, in
the case of formula fed infants, when they are switched to a soy
formula. For those who react to soy, other, more specialized (and more
expensive) formulas are available.
Actual allergy to cow's milk protein is less common than cow's milk
intolerance. About 2 percent of all infants are truly allergic to cow's
milk.
When a food allergy occurs, the immune system is turned on against
something that it considers an invader. The immune reaction can involve
the whole body (including the heart, the lungs or the skin), or it can
be localized to the stomach and/or the intestines. The three most common
foods that cause allergies are cow's milk protein, soy protein and egg
white. Nearly 50 percent of babies who are truly allergic to cow's milk
protein are also allergic to soy. (Remember, these foods can pass into
the baby through breast milk.)
Symptoms of food allergy can include vomiting, fussiness, unwillingness
to eat or the opposite: what seems like ravenous hunger. Babies who are
milk allergic may pass blood in their stools, which are often quite watery.
Occasionally milk allergic babies can have problems with wheezing, a
constant stuffy nose or difficult to treat eczema. Quite rarely, milk
protein allergy can even lead to anaphylaxis, the overwhelming allergic
response that can lead to shock and death.
But even true milk allergy is usually outgrown between 6 months of age
and entry into school. (Fewer than 0.1 percent of school age children
are allergic to milk.)
So far it sounds as if your daughter could fall into either one of the
above categories, though statistically, she is more likely to be milk
intolerant than milk allergic. Your family history may be helpful here;
if others in the family have had hives or other clearly allergic
symptoms brought on by a food, then food allergy would be a strong
possibility.
Now let's look at the likelihood of true lactose intolerance. Lactose
intolerance occurs because an individual does not make enough of the
enzyme lactase, which is necessary to break down the milk sugar, lactose.
Thankfully, lactose intolerance is quite rare in children under 2 or 3
years of age. If it was not rare, the human race would have been in
trouble before commercially prepared formulas were available, since
breast milk contains lactose, and babies who are lactose intolerant
usually lose weight and do very poorly. (The American Academy of
Pediatrics states that infants with congenital lactase deficiency would
not have been expected to survive before the 20th century.)
In those rare cases in which a healthy, full-term baby is born with
lactose intolerance, it is obvious that something is wrong within a few
days after birth (as soon as the mother's milk begins coming in, or as
soon as the baby has cow's milk formula).
There are three situations in which lactose intolerance is not rare,
though. First, premature infants usually do not make enough lactase
until at least 34 weeks gestational age, and sometimes until they get
close to their original due date. These babies frequently require
supplementation of lactase, or feeds that have a lower lactose content.
Second, after a bout of severe diarrhea it is not uncommon for temporary
lactase deficiency to occur, due to injury of the lining of the
intestine where lactase is found. This is usually a relatively mild
problem, and natural healing takes place fairly quickly, with only a few
extra days of loose stools and crampy stomach pain to hint at the problem.
Third, lactose intolerance is quite common in children over age 3. About
80 percent of all non-Caucasian people world-wide are lactose intolerant
after that age, as well as about 15 percent of U.S. Caucasians. These
people all made a normal amount of lactase as infants, but make less and
less of this enzyme as they get older. Most of these people will not
even develop symptoms until late adolescence or adulthood, even though
they are deficient in lactase at a much younger age.
Lactose intolerance usually causes abdominal distension, gas, abdominal
cramping and diarrhea. These symptoms usually occur within about 30
minutes of consumption of milk or other dairy products.
You should discuss this matter again with your pediatrician, and
together decide whether, at what age and how to reintroduce cow's milk
protein to your daughter's diet. Chances are great that she will outgrow
this problem!
References:
Heyman, Melvin B., MD, MPH for the Committee on Nutrition. Lactose
Intolerance in Infants, Children and Adolescents. Pediatrics Vol. 118
No. 3, Sept. 2006, pp. 1279-1286.
Vonlanthen, Maryelle, MD. Lactose Intolerance, Diarrhea, and Allergy.
From Breastfeeding Abstracts, November 1998, Volume 18, Number 2, pp.
11-12.
------------------------------------------------------------------------
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html
|
