Solutions to This Catchall Phrase
By Lisa Hurt Kozarovich
The buzzword to explain colicky, gassy babies these days seems to be lactose intolerance, a condition that is often misdiagnosed and actually very rare, according to pediatrician Jack Newman. This breastfeeding expert is the author of The Ultimate Breastfeeding Book of Answers, and the founder of the first hospital-based breastfeeding clinic in Canada in 1984.
According to Newman, most symptoms of lactose intolerance, such as fussiness, gas and watery, green bowel movements, are typically the result of either misguided breastfeeding techniques or a sign that the baby is allergic to proteins in the cow’s milk that his mother is drinking. “Lactose intolerance is often an artifact of poor breastfeeding advice,” explains Newman. “The answer to these symptoms is not simply to take the baby off the breast, as too many pediatricians recommend, but to fix the breastfeeding. The symptoms are easily treatable 90 percent of the time.”
In most cases, the symptoms improve dramatically when the mother eliminates cow’s milk from her diet or alters her breastfeeding methods.
In most cases, the symptoms improve dramatically when the mother eliminates cow’s milk from her diet or alters her breastfeeding methods, according to both Newman, who practices in Toronto, Canada, and Mary Kay Smith, a certified lactation consultant at Mt. Sinai Hospital in Chicago, Illinois.
That’s something Constance Grason of Chicago, Illinois, learned the hard way. In a matter of months, Grason had been through three pediatricians, joined La Leche League and spent hours doing research—all in the hopes of determining what was causing her son to be colicky, gassy, and slow in gaining weight. Grason’s frustration grew as each day passed and no one seemed to be able to identify just what was causing Jack’s symptoms. Her frustration intensified when her pediatrician’s only recommendation was to stop breastfeeding.
Taking matters into her own hands, Grason first eliminated cow’s milk from her diet. With that, she saw a slight improvement. Then a La Leche League leader offered up some advice: Let Jack feed on one breast until it was empty, then offer the second breast. Within a week, the improvement was remarkable, Grason says. “It was such a simple thing, but the pediatricians weren’t aware of it—the first ones really weren’t supportive of breastfeeding at all,” says Grayson. “The wrong pediatrician can make a situation like this even more stressful.”
Newman says he wasn’t at all surprised the by the results, noting that the majority of such cases can be treated by altering breastfeeding methods—something that’s been known for years. In fact, a study in The Lancet, an international medical journal, reported that allowing the baby to empty the first breast alleviated the problems in 79 percent of the infants.
Because lactose intolerance is so difficult to confirm, the only sure way to diagnose infants is through a biopsy of the small intestine. According to La Leche League, the diagnosis seems to be handed out somewhat casually. “I think lactose intolerance is just a catchall phrase some pediatricians are using to explain away problems with breastfeeding that they don’t understand,” says Smith.
What often is to blame for such symptoms is that mothers are frequently advised to automatically switch the baby from one breast to another, which doesn’t allow the baby to empty the first breast. Because the amount of fat in the milk increases the longer the baby nurses at the breast, switching him too soon may mean he’s getting a low amount of fat—leading to fewer calories and more feedings. Due to the low fat content of the milk, the stomach empties quickly and a large amount of milk sugar, also known as lactose, reaches the baby’s intestines all at once. The baby’s system may not be able to handle so much milk sugar and in turn have the symptoms of lactose intolerance, Newman explains.
To prevent this, Smith recommends that the mother allows the first breast to empty before offering the second breast—even if she needs to compress it to keep the baby nursing. Newman points out that even if the baby is at the breast for two hours, he may have only fed for a few minutes and gotten low-fat milk (another reason to compress the breast). However, if there is still no improvement and the baby is vomiting, having repeated episodes of diarrhea, abdominal pain and rash, he may be allergic to the proteins in cow’s milk. This is different than being lactose intolerant, Newman says.
Lactose intolerance is the body’s inability to digest the milk sugar, or lactose, in dairy products; whereas with an allergy, the body reacts to the proteins in those products. The confusion likely arises because cow’s milk proteins and lactose are in the same products, Smith says. While true lactose intolerance in infants is unusual, a reaction to cow’s milk is the most common allergy in children.
In the case of milk allergies, the mother should stop taking dairy products for seven to 10 days to see if there’s a change, Newman says. If not, she can begin using dairy again. And even if there is improvement, she should slowly reintroduce dairy back into her diet to determine how much, if any, the baby can tolerate. Most often, cow’s milk is the main reason for the allergy.
That’s something Trenda Bumps of Bowling Green, Kentucky, was happy to finally discover. From her son Joshua’s birth until he was nearly 2 months old, Joshua was colicky and passing green stools. The bigger problem, however, was that he wasn’t gaining weight and his abdomen was distended. When she quit drinking cow’s milk, Joshua improved, but not completely. That’s when Bumps learned that as a baby she had had a severe allergy to milk, and soon discovered that her son did as well. But even after cutting dairy from her diet, Joshua was still not gaining weight, leading Bumps to supplement Joshua’s diet with a soy-based formula. “Within three days, he was a new child,” she says. “He started growing, he was so much happier and healthier now.”
There are still rare cases of true lactose intolerance in infants. According to Smith, this is something that would be evident in the days immediately after the mother’s milk started coming in. The baby would have extreme cases of diarrhea and would not be gaining weight. Even then, the mother can almost always continue breastfeeding, and supplement the baby’s diet with a lactose-free formula by tube feeding. A pediatrician may also recommend a medication, such as lactase drops, to help the baby digest the lactose.
“There are a lot of steps for nearly every case that you can take before you stop breastfeeding,” Newman points out. In fact, even with very serious conditions like phenylketonuria (PKU) a rare, inherited metabolic disorder that can cause severe neurological damage if not detected, the mother can continue to breastfeed. “The infant cannot tolerate high levels of phenylalanine, but studies have shown that the level of phenylalanine in breastmilk is much lower than in formula,” explains Newman. “So, instead of giving a bottle, I’d recommend breastfeeding and supplementing it with a low phenylalanine milk given through a tube.”
“Oftentimes, when you have an infant with one of these conditions, the pediatricians tell the mother to stop breastfeeding, which is the worst thing they can do,” says Newman. “Breastfeeding is the best source of nutrients for all infants, but in some cases you’re going to have to make adjustments. It’s not always going to be easy, but with the help of a good pediatrician who understands breastfeeding, or the help of a La Leche League leader, you can almost always continue breastfeeding.”