Inside: Understanding the difference between Lactose Intolerance & Milk Allergy in Kids.
As a parent, all you want is for your children to be happy and healthy. So discovering that the very food you are giving them is causing them pain and discomfort can be upsetting and stressful.
The fact you are reading this means you are wondering whether dairy could be the culprit. More and more children are being born with sensitivities to dairy so it could well be the issue. But is it lactose or milk proteins causing the problem?
Though they both involve reactions to dairy, they differ significantly in their causes, symptoms, and management.
In this post, we’ll break down the distinctions between lactose intolerance and a dairy allergy in children, discuss how to recognise each, and offer guidance on treatment and lifestyle adjustments.
Of course, this post is not a substitute for the advice given by a healthcare provider. If you have concerns, make an appointment with your doctor and if you are dealing with serious symptoms then call the emergency services immediately.
What is Lactose Intolerance?
Lactose intolerance occurs when the body lacks or produces insufficient amounts of lactase, the enzyme responsible for breaking down lactose. Lactose is a sugar found in milk and other dairy products.
Without enough lactase, the undigested lactose passes into the colon, where it is fermented by bacteria, causing uncomfortable digestive symptoms.
Causes of Lactose Intolerance in Kids
Lactose intolerance is more common in adults, but children can also develop the condition. It can be triggered by several factors:
- Primary Lactose Intolerance: This form of lactose intolerance develops with age as lactase production decreases naturally over time. While rare in young children, it can manifest during late childhood or adolescence.
- Secondary Lactose Intolerance: This type arises due to illness or injury to the small intestine, such as after a bout of gastroenteritis, celiac disease, or Crohn’s disease. When the intestine is damaged, lactase production can temporarily decrease.
- Congenital Lactase Deficiency: In rare cases, babies are born without the ability to produce lactase, leading to lactose intolerance from birth.
Symptoms of Lactose Intolerance
Symptoms of lactose intolerance in children usually appear within 30 minutes to 2 hours after consuming dairy products. They can range from mild to severe depending on the amount of lactose ingested and include:
- Stomach pain
- Bloating
- Gas
- Diarrhea
- Nausea
These symptoms are often uncomfortable but not life-threatening, and they usually resolve once the lactose is eliminated from the digestive system.
What is Dairy Allergy?
A dairy allergy, also known as cow’s milk protein allergy (CMPA), is an immune system response to one or more proteins found in cow’s milk, such as casein or whey. In this case, the immune system mistakenly identifies these proteins as harmful invaders and releases chemicals like histamines to fight them, resulting in an allergic response.
Causes of Dairy Allergy in Kids
Dairy allergies are among the most common food allergies in children, particularly in infants and toddlers. Some children outgrow the allergy by age five, while others may continue to have reactions into adulthood.
Unlike lactose intolerance, dairy allergy is not caused by a deficiency of lactase but by an overreaction of the immune system.
There are two types of dairy allergies:
- IgE-Mediated Dairy Allergy: This type is the most common and involves the production of immunoglobulin E (IgE) antibodies. Reactions can occur within minutes to a few hours of consuming dairy and range from mild to severe.
- Non-IgE-Mediated Dairy Allergy: In this case, the immune system reacts differently, without producing IgE antibodies. Symptoms tend to be delayed, occurring several hours to days after exposure to dairy.
Symptoms of Dairy Allergy
Symptoms of a dairy allergy can vary significantly, depending on whether the reaction is IgE- or non-IgE-mediated. They may include:
- Skin reactions: Hives, eczema, redness, or itching
- Respiratory symptoms: Wheezing, coughing, nasal congestion, or shortness of breath
- Digestive issues: Vomiting, diarrhea, stomach cramps, or colic in infants
- Anaphylaxis: In rare but serious cases, a child may experience a life-threatening allergic reaction, known as anaphylaxis, which requires immediate medical attention.
Unlike lactose intolerance, which mainly causes uncomfortable symptoms, a dairy allergy can affect multiple systems in the body, making it potentially more dangerous.
Key Differences Between Lactose Intolerance and Dairy Allergy
- Underlying Cause
The primary difference between lactose intolerance and dairy allergy lies in the underlying cause. Lactose intolerance is due to a deficiency of lactase, the enzyme that breaks down lactose. In contrast, a dairy allergy is an immune response to the proteins in cow’s milk. - Symptoms
Lactose intolerance causes primarily gastrointestinal symptoms like bloating, gas, and diarrhea, while dairy allergy can trigger a wider range of symptoms affecting the skin, respiratory system, and digestive system. Dairy allergies can also result in a severe allergic reaction, such as anaphylaxis, whereas lactose intolerance does not. - Onset of Symptoms
In lactose intolerance, symptoms typically appear gradually and worsen over time after dairy consumption. With a dairy allergy, symptoms can occur rapidly, especially in IgE-mediated reactions, and may start within minutes of consuming dairy. - Severity of Reactions
Lactose intolerance is generally uncomfortable but not dangerous. Dairy allergy, however, can cause severe and life-threatening reactions, particularly in cases of anaphylaxis, where immediate medical intervention is required. - Testing and Diagnosis
Diagnosing lactose intolerance typically involves a lactose breath test or lactose tolerance test, which measures the body’s ability to break down lactose.
For a dairy allergy, doctors may use a skin prick test or blood test to check for IgE antibodies, or use elimination diets followed by food challenges to determine the presence and severity of the allergy.
My experience
My eldest was lactose intolerant and the main symptoms were bloating, inability to sleep, & green explosive poo. The fact that it was explosive signalled to me that it was the gases building up in her system that was to blame. As soon as we switched to lactose-free products it all went away. By the time she was 2 years old she was able to tolerate lactose again.
My other two children both had a cows milk protein allergy (as well as soy) and the main symptoms were very similar to lactose intolerance. However the poo, although green, was not explosive. They both had hives on their cheeks and would struggle with being laid down on their backs. As soon as dairy was eliminated, all symptoms disappeared. By the age of 3 they had made it up the milk ladder.
Managing Lactose Intolerance in Kids
For children with lactose intolerance, the key to managing the condition is controlling lactose intake. Most children with lactose intolerance can tolerate small amounts of lactose, so it’s not necessary to completely eliminate dairy foods from their diet. Here are some strategies for managing lactose intolerance:
- Lactose-free dairy products: Many lactose-free alternatives, including milk, cheese, and yogurt, are available. These products contain added lactase, which helps break down the lactose.
- Lactase supplements: Lactase enzyme supplements can be taken before consuming dairy to help the body digest lactose.
- Gradual introduction: Introducing small amounts of dairy slowly may allow your child’s digestive system to adjust to lactose over time.
- Alternative calcium sources: Since dairy is a primary source of calcium, ensure your child gets enough from other foods such as fortified plant-based milks, leafy green vegetables, and calcium-fortified orange juice.
Managing Dairy Allergy in Kids
For children with milk allergies, strict avoidance of all dairy products is essential to prevent allergic reactions. This includes foods that contain even small amounts of milk proteins like casein or whey. Some tips for managing a dairy allergy include:
- Reading labels: Learn to read the ingredient list on food labels carefully to identify hidden sources of dairy. Look out for terms like “casein,” “whey,” and “lactalbumin,” which are proteins found in milk.
- Dairy substitutes: Many dairy-free alternatives are available, including plant-based milks (almond, soy, oat), dairy-free cheeses, and non-dairy yogurts and even ice cream. Be mindful that some children with dairy allergies may also have cross-reactivity to soy.
- Allergy action plan: If your child is at risk of severe allergic reactions, work with your doctor to develop an allergy action plan, which may include carrying an epinephrine auto-injector (EpiPen) in case of anaphylaxis.
- Education and awareness: Teach your child, their caregivers, and their school staff about the allergy, what foods to avoid, and how to recognise the signs of an allergic reaction.
Similarities in Managing Both Conditions
While lactose intolerance and dairy allergy differ in cause and symptoms, there are some overlapping strategies for managing both conditions:
- Dairy alternatives: Whether your child has lactose intolerance or a dairy allergy, there are many dairy-free products available that can help meet their nutritional needs.
- Calcium and Vitamin D: Since dairy is a primary source of calcium and vitamin D, children with either condition should consume other fortified foods or take supplements to ensure they are meeting their daily requirements.
When to Seek Medical Advice
If your child experiences persistent digestive issues, skin reactions, or respiratory problems after consuming dairy, consult with a paediatrician or allergy specialist. They can conduct the appropriate tests to determine whether your child has lactose intolerance or a dairy allergy.
Early diagnosis and management are crucial to preventing discomfort and ensuring your child’s growth and development are not affected.
Understanding the differences between lactose intolerance and dairy allergy is essential for parents navigating dietary restrictions with their children. While both conditions involve dairy, they have distinct causes, symptoms, and treatment approaches.
The good news is, by recognising the signs and seeking professional diagnosis, parents can make informed decisions and adopt effective strategies to help their children lead healthy, balanced lives with the hope that they will grow out of their issues over time.