Choosing Lactose-Free Baby Formula

True lactose intolerance is rare in babies

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When choosing an infant formula, many parents select one made from cow's milk. In fact, 80% of infant formulas are made with cow's milk. However, some babies have difficulty digesting this type of formula because they have a milk allergy or lactose intolerance.

Even more rarely, infants might have a condition called galactosemia in which exposure to lactose-containing formulas can be life-threatening.

What Is Lactose-Free Formula?

Lactose-free formula is typically made from cow's milk that has been refined to remove the lactose and replace it with a different form of sugar. Many people misunderstand the differences between lactose-free formula, cow's milk-based formula, and soy formula.

While neither lactose-free formula nor soy formula contains lactose, lactose-free formula is created from cow's milk and therefore contains cow's milk protein.

These formulas are not tolerated by babies who are truly allergic to the proteins found in cow's milk.

Lactose Intolerance in Babies

To digest lactose, the body needs to produce an enzyme called lactase. Some babies do not produce enough of this enzyme. A primary or permanent inability to make any lactase at all is rare.

However, many infants and children experience a temporary reduction in lactase availability. This often occurs after a bout of diarrhea, during which the lining of the intestine is damaged. It usually doesn't require a switch to lactose-free formula. 

Other babies lack the ability to produce enough lactase in the long-term, which causes symptoms of lactose intolerance such as gas, bloating, diarrhea, and colic. Babies with a long-term issue producing lactase may benefit from lactose-free formula if it helps them avoid experiencing symptoms of lactose malabsorption.

Milk-Protein Allergy

Cow's milk is one of the top allergens for children. However, this allergy is typically because of the protein in milk, and not the lactose (which is a sugar). A milk-protein allergy may be present at birth or can develop as a child grows up. Lactose intolerance is more common in children 2 years old and above.

The symptoms of a milk-protein allergy include hives, runny nose, diarrhea, vomiting, and irritability. Parents sometimes confuse the symptoms of a milk-protein allergy with those of colic, gas, or other common digestive issues in babies.

More serious reactions to milk-protein include swelling of the lips, tongue, and throat, and anaphylaxis. If your baby is having a severe reaction to a potential allergen, call 911.

Babies with a milk-protein allergy will not tolerate any cow's milk-based formulas—even those that are lactose-free.

Does My Baby Need Lactose-Free Formula?

A baby who is allergic to cow's milk protein allergies can also be allergic to soy, in which case the infant will require a specialized formula. Research has shown that few babies truly need a lactose-free formula. For example, a study published in 2015 demonstrated that lactose-free formulas don't reduce babies' fussiness.

However, babies with a rare, inherited medical condition called galactosemia do need a formula that is lactose-free. Infants with the condition are unable to safely digest galactose, one of the two sugars that make up lactose.

The condition is diagnosed at birth through newborn screening tests or might be detected prenatally. Babies with galactosemia cannot tolerate breastmilk and must be given lactose-free formula that is not derived from cow's milk. 

Most major formula manufacturers make specialized formulas for babies with all types of allergies. If your not sure which type of formula is best for your baby, ask your pediatrician.

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  1. American Academy of Pediatrics. Choosing an infant formula. Updated July 24, 2018.

  2. Brill H. Approach to milk protein allergy in infants. Can Fam Physician. 2008;54(9):1258-64.

  3. Sherman AL, Anderson J, Rudolph CD, Walker LS. Lactose-Free Milk or Soy-Based Formulas Do Not Improve Caregivers' Distress or Perceptions of Difficult Infant Behavior. J Pediatr Gastroenterol Nutr. 2015;61(1):119-24.

  4. Bosch AM. Classic galactosemia: dietary dilemmas. J Inherit Metab Dis. 2011;34(2):257-60. doi:10.1007/s10545-010-9157-8

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