When a child has a milk allergy, the solution is usually clear: a dairy-free diet. But what about children who are lactose intolerant? Should they consume any dairy? The answer is always up to the parents and their child’s pediatrician, but the following information can help promote an educated discussion.
Should Lactose Intolerant Children Consume Dairy?
This might seem obvious, but it’s important to first confirm that lactose is the absolute issue. Parents and sometimes doctors are often quick to diagnose lactose intolerance, which isn’t extremely common in kids. Here’s why.
Is it Really Lactose Intolerance?
The symptoms of lactose intolerance are digestive in nature, and can range from mild (gas) to severe (vomiting and diarrhea). It’s caused by lactase deficiency. Lactase is the enzyme produced by our bodies that helps us digest the lactose in milk. There are two common types of lactase deficiency.
Primary Lactase Deficiency – This is actually a natural process, not a condition. After weaning, our bodies no longer have the need to digest our mother’s milk, so the lactase production gradually decreases. For most kids, it isn’t enough to notice, but the decrease in lactase production tends to continue throughout our lifetimes. This is why lactose intolerance increases in prevalance as we age. People who don’t have a notable reduction in lactase have “lactase persistence.”
- Secondary Lactase Deficiency – This is typically a temporary condition that results from a small bowel injury. It will often resolve when the medical problem is resolved.
A third condition, called Congenital Lactase Deficiency, is very rare, and is typically diagnosed at infancy. In this condition, a child is born without the ability to digest lactose, so they reject all milk – including their mother’s milk.
As mentioned above, lactase deficiency happens in kids, but it isn’t nearly as common as it is in adults. And most people don’t realize that milk allergies can cause digestive symptoms. So it’s important to confirm with their doctor that lactose intolerance is the sole concern.
Testing for Lactose Intolerance
Lactose intolerance tests are available, but they’re not frequently used on children. Instead, pediatricians often recommend trying a lactose-free diet with your child. This involves eliminating all dairy from their diet, but then adding lactose-free milk (or other lactose-free dairy products) back into their diet. If their symptoms resolve, even while consuming lactose-free dairy, then the doctor will usually give a lactose intolerant diagnosis.
If your child’s symptoms resolve when you remove dairy from their diet, but return when they try lactose-free dairy, then the problem may not be lactose alone.
It is Lactose Intolerance, Now What?
If you and your pediatrician have confirmed that your child has lactose intolerance, and no other medical issues with dairy, then they will usually recommend a lactose-free or low lactose diet. Whether they follow a dairy-free diet or just a lactose-free diet is up to the parents and their child’s doctors. But here are a few facts to aid your decision.
- Dairy-free is the elimination of all dairy products, while lactose-free is just avoiding the sugar in milk (lactose). This is why dairy-free products are lactose-free, but lactose-free products are not necessarily dairy-free.
- Lactose intolerance typically worsens as we age. So your child might be able to tolerate some low lactose foods now, but lose the inability as they get older. But as long as lactose remains the only issue, lactose-free dairy should still be tolerated.
- Lactose is the same in all mammal milks. There are not different compositions of lactose. This means that lactose intolerant individuals will have issues with cow’s milk, goat’s milk, sheep’s milk, etc. If your child tolerates goat’s milk, for example, then the problem most likely isn’t lactose.
- Lactose-free cow’s milk products are available for milk, ice cream, cheese, and some other dairy products. They are usually sold in the dairy section because they are still dairy. Most grocery stores carry some, and they usually cost just a little bit more.
- Hard cheeses are often low lactose, but soft cheeses, and most other dairy products have notable levels of lactose. I have more specific lactose percentages listed in Go Dairy Free: The Guide and Cookbook.
What about Lactase Enzymes?
They do make lactase enzymes for kids in tablet and liquid drop formulas. These can be a great option when you know your child will have trouble avoiding lactose, like at a birthday party. But you do need to time when they take it with their lactose consumption and dose the proper amount for their needs. They can be helpful in a pinch, but most parents prefer not to rely on lactase enzymes for daily use with their children.
The Bottom Line
If you feel dairy is best for your child’s nutritional needs, and their only medical issue is lactose intolerance, then lactose-free dairy is probably okay. But you might want to strictly avoid all lactose-containing dairy to limit their symptoms and suffering. Some children don’t readily communicate when they are having digestive issues. They might have symptoms from even a small lactose load without you knowing.
But you should always speak with a physician before making any changes in your child’s diet. This post is for informational purposes only, and it should not be construed as dietary or medical advice.