Management of lactose intolerance in formula-fed infants
Symptoms can be distressing for both infant and parents and the pharmacy is likely to be the first port of call for help and advice. It should be noted that individual symptoms alone would not indicate lactose intolerance, but a combination of symptoms associated with recent gastric infection would suggest this diagnosis. Diagnosis should be confirmed by the GP and so where lactose intolerance is suspected, the family should be referred onwards. In severe cases the infant may be acutely unwell and require rehydration and correction of electrolyte imbalance, supply of oral rehydration salts and referral to secondary care may be warranted.
In the majority of cases, the principle treatment option is the removal of lactose from the diet by the use of low-lactose or lactose-free formulae, including Aptamil Lactose Free, SMA-LF and Enfamil O-Lac. The description 'lactose-free' can be applied to any formula containing less than 10mg of lactose per 100kcal.13 This is equivalent to around 6-7mg per 100ml.
Aptamil Lactose Free is suitable for the dietary management of primary and secondary lactose intolerance from birth to twelve months of age.
- It helps relieve symptoms of temporary lactose intolerance including diarrhoea, bloating and wind.
- It is classed as lactose free and uses glucose as the carbohydrate source.
- It is sucrose and gluten free.
- It contains LC-PUFAs for brain, nervous system and visual development.
- It contains nucleotides for growth and development.
- Can be used by older children and adults on lactose-free diets.
An alternative form of treatment for temporary lactose intolerance is to supplement the diet with lactase enzyme in the form of Colief® drops. These can be administered to both breastfed and formula-fed infants allowing the digestion of lactose thereby relieving symptoms. It is listed as a borderline substance for the treatment of lactose intolerance and is also indicated for the relief of colic symptoms.
When to refer
- Use appropriate questioning to determine:
- if the infant is breast or formula-fed.
- the type and extent of symptoms.
- the onset and duration of symptoms.
- possible trigger factors e.g. gastroenteritis.
- Refer to GP if:
- Patient history suggests diagnosis of lactose intolerance.
- If there has been no improvement following use of lactose-free formula or lactase drops.
- Infant is not putting on weight or thriving.
Counselling tips
- Explain that symptoms of lactose intolerance can be managed with the use of a lactose-free diet.
- Reassure that lactose intolerance following gastroenteritis will resolve itself once the gut heals itself.
- Once a lactose-free diet is introduced the infant should recover very quickly.
- Ensure the parents are clear on reconstitution instructions for the relevant formula.
- Taste, smell and appearance may differ from other previous milk.
- Provide dietary advice on foods that contain lactose.
- Dairy products including milk, cream, cheese, butter, margarine.
- Condensed/evaporated milk, artificial cream, buttermilk.
- Many processed foods also contain lactose as do some medicinal products - always check the labels.
- Advise on low-lactose alternatives such as soya and oat milks.
- Weaned infants on a dairy-free diet should receive vitamin supplements including vitamins A and D and calcium.
- Lactose should be re-introduced once any underlying factors are resolved.