Q&A: What should I do for my toddler who I think is lactose intolerant?
My 20-month-old doesn't tolerate milk. It gives him gas and stomachaches. He doesn't sleep well when he has milk and he is generally cranky. He does fine with milk in food (potatoes, cornbread, etc.), but not drinking milk. Incidentally, his brother has the same problem. I give him orange juice with added calcium with his breakfast. What else should I be giving him to make sure he's getting all he needs since he's not drinking milk?
You raise several commonly asked questions having to do with toddlers drinking (or not drinking) milk, starting with the concept of not tolerating milk. While true milk allergies do exist, they are actually relatively uncommon (on the order of less than 3 percent in children), and a majority of them outgrow it by age 4 to 6 years. What is more common, however, is lactose intolerance. Given that lactose is primarily found in dairy products, people who have lactose intolerance often experience symptoms similar to the ones your toddler has after drinking milk (or consuming dairy products). In addition to gas and stomachaches, other symptoms that also suggest lactose intolerance include diarrhea and bloating. Fortunately, children often don’t have as severe symptoms as adults do, and therefore may be able to tolerate small amounts of lactose without noticeable effect.
As your toddler already seems to have figured out, decreasing the amount of lactose in one’s diet is the most straightforward way of avoiding the discomfort of gas and stomachaches. With milk being the most obvious culprit and the most likely thing to be eliminated, it’s important to pay even closer attention to the daily amount of calcium and vitamin D that milk-intolerant children get. You’ve already discovered one of the common alternative sources of calcium—calcium-fortified orange juice. Other commonly recommended calcium-containing non-dairy foods include such sources as calcium-enriched waffles, sweet potatoes, and even some ready-to-eat cereals. You can also try a lactose-free milk (such as Lactaid). For any child who doesn’t drink much (or any) milk, it’s always worth also discussing with your healthcare provider the option of giving supplemental calcium such as a chewable calcium supplement (TumsKids).
The other nutrient that will be important for you to consider is vitamin D. Recent studies have demonstrated that even for children who are not lactose intolerant and don’t intentionally avoid drinking milk, their typical daily vitamin D intake is insufficient to meet their needs. That’s why the American Academy of Pediatrics’ current recommendation is for all children who consume less than a quart a day of vitamin D-fortified milk (or, in the case of infants, formula) to receive 400 IU of supplemental vitamin D each day.
And finally, in addition to discussing your children’s symptoms and dietary needs with your pediatrician, you can also consider discussing the possibility of giving them lactase medication that helps break down lactose and thus helps prevent the unwanted symptoms of lactose intolerance that typically result.