What are the alternatives for a lactose intolerant baby?

Question

I have a 2 month old granddaughter and she is potentially lactose intolerant (she's been spitting up, has runny stools, a low grade fever, fussy, and the doctor suggested it). She's been on a milk-based formula since the breast milk dried up a month ago. What is the best alternative? Neither soy-based formula nor formula where the first ingredient is dried corn syrup solids seems best to me. Goat milk? And if so, is it ok pasturized? (We live in Washington state (US), where it is illegal to sell unpasturized milk, and my daughter is fearful of raw milk anyway.)

What are the options, what are the pros and cons of each, and what is best?

Answer 1

Goat's milk is not a better option than cow's milk in terms of nutrition. Just like you don't give an infant cow's milk (regardless of lactose intolerance), you can't just start giving it goat's milk because it lacks nutrition.

Using goat’s milk before 6 months or regular use between 6 and 12 months is not recommended. Goat’s milk is no more appropriate to give baby than cow’s milk. If you need to supplement and breastmilk is not available, formulas are a more nutritionally complete product. There are several comparisons of goat vs. cow vs. human milk in the links below. ...

Goat’s milk is high in sodium (like cow’s milk) and is very high in chloride and potassium, which makes the renal solute load too high for babies. This can cause gastrointestinal bleeding and can result in anemia and poor growth (these problems are usually undetected until months later). Goat milk is also deficient in folic acid, which can lead to megaloblastic anemia. Also, infants who are allergic to cow’s milk protein are often allergic to goat’s milk too.

While it’s true that whole goats milk (and whole cow’s milk) was commonly used prior to the advent of infant formulas it is also true that the infant mortality and morbidity rate during the times of such substitutions was very high. source

You can also read about the dangers of goat milk from the American Academy of Pediatrics (AAP):

Goat's milk contains 50 mg of sodium and 3.56 g of protein per 100 mL, approximately 3 times that in human milk (17 mg and 1.03 g per 100 mL, respectively).6 The estimated requirements of sodium and protein for infants <6 months old are 100 to 200 mg/day and 9 to 11 g/day, respectively.7 The infant described here was receiving ∼500 mg/day of sodium and 30 g/day of protein, with a total intake of 32 oz of goat's milk per day. The immature kidneys in very young infants have difficulty handling the byproducts of foods with a high renal solute load.8 Sodium excretion capacity matures more slowly than glomerular filtration rate and does not attain full capacity until the second year of life.9 Therefore, infants fed fresh goat's milk are at substantive risk for hypernatremia and azotemia, particularly in the face of dehydration (as in the case described here), which may in turn result in major central nervous system pathology, including diffuse encephalopathy, intraparenchymal hemorrhage, or thromboses10 as manifested in our patient.

This article from the Canadian Paediatric Society describes an infant with severe anemia and a murmur due to a diet of exclusive goat’s milk:

Goat’s milk is known to be deficient in vitamin D, vitamin B12, iron and especially folate. Infants younger than six months of age need 65 μg/day of folate (the recommended daily allowance increases with age). Goat’s milk contains 6 μg/L of folate (breast milk and cow’s milk contain approximately 45 μg/L to 50 μg/L). The infant’s serum folate was less than 1.4 nmol/L (normal 7 nmol/L to 39.7 nmol/L), her serum vitamin B12 was 141 pmol/L (normal 200 pmol/L to 540 pmol/L) and her serum iron level was also low. The diagnosis of macrocytic anemia secondary to a combined folate and iron deficiency was made.

Young children should only be given pasteurized milk; please read about myths around raw and pasteurized milk. Raw milk isn't sterile (like breastmilk) and may carry serious diseases (source 1, source 2, source 3). People do die from it. Having said that, my relatives own a dairy farm and they all swear by raw milk - none of them have ever been sick. I also know a 90-year old man who has been smoking since he was 11, and he doesn't have lung cancer.

Since breastfeeding is no longer an option, you are going to have to try formula. In an effort to promote breastfeeding, there has been a lot of negative propaganda around formula. However, formula closest represents breastmilk. It isn't equal by any means, but a lot of work has gone into making it nutritionally similar to breastmilk.

I can understand your concern about sugar in formula, however, even breastmilk is a lot of sugar - it just happens to be provided by lactose. Sugar also provides the carbohydrate source that babies need:

For infants with lactose intolerance, formulas that contain no lactose can be used. Lactofree is an example of a milk-based formula that contains corn-syrup solids rather than lactose as its carbohydrate calorie source. Many soy-protein formulas also do not contain lactose and are suitable for lactose intolerant infants. In addition to corn-syrup solids, other examples of carbohydrates contained in lactose-free formulas include sucrose (table sugar), tapioca starch, modified cornstarch, and glucose polymers (short chains of glucose molecules). source

I found one product in US that doesn't use cane sugar or corn syrup solids: it uses brown rice syrup as a carb source instead. There are a lot of options in Europe (Aptamil pepti) due to a ban of sucrose in their infant formulas, but I am not sure if you can arrange for that.

I hope this helps.

Answer 2

Try Similac Sensitive (or similar products).

It's designed for babies that exhibit some lactose sensitivity to traditional formula, and we found that it eliminated all of the symptoms you describe for our son. It's also widely available both online (we found it cheapest at Amazon) and in brick and morter shops (both Duane Reade and Costco stock it).

One side note that I wasn't aware of: Infant lactose sensitivity has little connection with real lactose intolerance. Many infants who have sensitivity can drink normal whole milk when they switch at one year, and many of those that still have a sensitivity at one don't have adult lactose intolerance (or any issues) after age two or so.

Answer 3

Stick with formulas made for infants!

To problem with using milk (cow or goat) as opposed to formula at such a young age is that all the child's nutrition must come from that liquid -- it's the only thing they're ingesting. Infant formulas are made to deliver the nutrients they need to develop and grow. Switching to milk at too young an age when they are unable to eat other foods for nutrition is going to seriously malnourish the child.

The nutrition content of infant formula is highly regulated in the US -- I'm not sure its worth spending too much effort worrying about corn syrup when your infant's health and nutrition are more pressing matters.

Soy-based formula is generally the first thing to try when infants are having problems processing milk-based formulas. If that doesn't work, then you might need to look at some of the more specialized formulas (e.g. Alimentum or Nutramigen), though they are significantly more expensive.

Answer 4

Both my sons had milk-protein sensitivities when they were born (which is different than lactose intolerance, but still requires a dairy-free diet). We gave them Nutramigen, which is similar to Alimentum, but Alimentum didn't work for either of them. I mention it because it took me a while to realize that if one dairy-free formula doesn't work, it is worth it to try a different formula. They are not really all the same.

Also as a side note, our pediatrician told us that soy-based formulas would probably not help, since there is often a cross-reaction to soy in babies with milk-protein sensitivity. But if you are certain that your granddaughter is lactose intolerant (the symptoms are similar), then that shouldn't been an issue for you.