How is lactose intolerance in infants and young children managed?

Removal or reduction of lactose containing foods is advised for the management of lactose intolerance, while ensuring an adequate nutritional intake.1 Unless there is evidence of secondary lactase deficiency, most infants with cows’ milk protein allergy can tolerate lactose.5

Fully breastfed infants
Breastmilk is best for babies and infants with lactose intolerance, breastfeeding should be continued if possible.2 In infants with congenital lactase deficiency, breastmilk or lactose-containing formula may cause persistent diarrhea and failure to thrive.2 Consultation with a healthcare professional is recommended to determine if a lactose-free formula is an appropriate alternative for infants with congenital lactase deficiency.2

Partially breastfed infants
Lactose intolerant infants who are partially breastfed and partially bottle fed may benefit from smaller more frequent breastfeeds during the period of lactose intolerance in order to manage the lactose load. Partially formula fed infants may benefit from the use of a lactose free cows’ milk based formula. Infants who are partially breast and partially formula fed should be breastfed before the formula feed to protect the supply of breastmilk.

Formula fed infants
Formula fed infants with confirmed lactose intolerance may benefit from the use of a lactose free cows’ milk based formula.

Feeding solids to infants and young children
During periods of lactose intolerance, the provision of lactose containing foods should be avoided or minimised. Many lactose containing foods are rich in calcium and Vitamin D, important nutrients for infants, thus an elimination diet should always be performed for a specified period, under strict medical supervision and preferably in consultation with a Paediatric Dietitian.