Lactose intolerance is an inability to properly digest lactose, a major component of milk. It is a digestive problem and does not involve the immune system (unlike cow’s milk protein allergy, CMPA).

Thus, while lactose intolerance can cause stomach discomfort, it will not cause life-threatening reactions such as anaphylaxis.

However, lactose intolerance can start in childhood and slowly become more obvious in adulthood. As milk is a key source of calcium, this may negatively affect your child’s growth.

Signs and symptoms typically happen between 30 minutes to two hours after taking milk or dairy products.

The severity of the symptoms usually depends on the amount consumed and how well your child tolerates lactose.

A common sign in infants is coming on and off the breast during breastfeeding.

Other common symptoms for infants, as well as toddlers and older children are:

• Wind

• Pain and swelling in the tummy

• Crankiness

• Diarrhoea

• Failure to gain weight

Learn and educate

The first thing to do when suspecting lactose intolerance in your child is to learn what foods or drinks she needs to be wary of.

Remember that while it is important to offer your child a variety of foods from each food group, extra care should be taken to reduce/eliminate certain food products, depending on the severity of her intolerance.

Explain to her about lactose intolerance and educate her on what she needs to watch out for in her diet.

Take the time to read ingredient labels on food products before purchasing them. Avoid foods that contain:

• Milk

• Milk solids

• Non-fat milk solids

• Milk powder

• Lactose

• Casein

• Whey

• Cream

Other foods that may contain milk or other dairy products are pizza, protein or energy bars, and cereals.

Do notify caregivers and make sure you inform them of your child’s condition, including family and friends.

Well-meaning friends who are unaware of your child’s lactose intolerance may share foods/drinks that may cause her unnecessary discomfort.

Not enough calcium?

As dairy or dairy products are one of the main sources of calcium for young children, having lactose intolerance can be a problem.

Your strategy in managing your child’s lactose intolerance will depend on the severity of her intolerance.

If her lactose intolerance is mild, then she should still be able to take small amounts of dairy or dairy products, provided that it is both in smaller quantities and spread throughout the day.

On the other hand, if her lactose intolerance is so severe that she cannot take any dairy at all, then she will have to get enough calcium from other foods such as lactose-free dairy products and calcium-fortified food products.

A good alternative would be to explore other milk substitutes such as soy, almond, rice, hemp or oat milk.

Soy milk is a popular alternative as it is a good source of calcium and protein.

Almond milk is also a good calcium source, but contains less protein than cow’s milk.

If you are thinking of giving her calcium supplements, do consult with her paediatrician beforehand.

Taking too much calcium is not advised, as it can cause constipation and there is a possibility of it interfering with the absorption of other nutrients (e.g. iron or zinc).

There may be some period of adjustment needed, but rest assured that you and your child can get used to these minor lifestyle modifications.

Living with lactose intolerance should not represent a major stumbling block – when managed properly, your child can easily adapt, and her growth and development should not suffer.

Dr Amir Hamzah Abdul Latiff is a consultant paediatrician and consultant clinical immunologist/allergist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.