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When Should Dairy be Restricted from a Child?

The most commonly received special dietary request at Yummies for Little Tummies is to restrict Dairy. This is also one of the more confusing restrictions for centres and parents to manage. So why does dairy need to be restricted and why is there so much variation in the dairy that children can tolerate?

The two most common conditions requiring Dairy to be restricted from the diet are

1) Dairy Allergy OR

2) Lactose Intolerance.

And both should be managed by a health professional. Many people don’t realise that these are two very different conditions. It’s important to understand the differences so that diet can be managed effectively.

What is Lactose Intolerance?

Lactose intolerance involves the digestive system and a carbohydrate, lactose. Lactose is the sugar that is naturally found in cows milk. It is also found in the milk of other mammals, including humans! Lactose must be broken down in our small intestine before it can be absorbed into the bloodstream. An enzyme called lactase is responsible for this breakdown process. Lactase splits the lactose into two smaller sugars - galactose and glucose - which can then be absorbed into the bloodstream.

Some people don’t produce, or don’t produce enough of the lactase enzyme. Deficiency of this enzyme is what causes of lactose intolerance. The Lactose can’t be broken-down in the small intestine and makes its way into the colon. Here, it is fermented by bacteria producing gasses such as hydrogen, which can cause bloating and flatulence. The presence of lactose in the colon draws water into the colon, resulting in loose stools or diarrhea.

Lactose intolerance is more prevalent in older people and typically doesn’t impact young children. Babies have high amounts of lactase so that they can digest breast milk. After weaning, the level of lactase decreases but not usually to a level that causes a significant problem. Lactose intolerance is also more commonly present in those of Asian or African descent.

Lactose intolerance can cause discomfort, but it is not highly dangerous.

What’s a Dairy Allergy then?

Dairy Allergy involves the immune system and the proteins in cow's milk. If your body doesn’t recognise one or more of the proteins in cow’s milk it will treat it as a dangerous invader. The body initiates an immune response to defend against this foreign substance, releasing substances that cause allergy symptoms and an allergic reaction. This reaction can vary in severity, from mild symptoms to an anaphylactic response.

Interesting Fact: when dairy is cooked or fermented the protein is altered into a form that the body doesn’t see as dangerous and no allergic reaction results. Because of this, people may be allergic to raw dairy, but not other forms of dairy (ie cooked dairy or cheese).

What are the Symptoms?

The symptoms of Lactose Intolerance are limited to the digestive system. They include gas, bloating, diarrhea, nausea and abdominal cramps.

Dairy allergy shares the same digestive system symptoms as Lactose intolerance. Dairy allergy can also extend to the skin and respiratory system. These symptoms include skin rash, eczema, hives, swelling of the face, swelling of the lips and eyes, wheezing, swelling of the throat, and difficulty breathing.

Those who are highly allergic to dairy can have an anaphylactic reaction, which is very serious and life threatening.

Getting a Diagnosis

When it comes to any food allergy or intolerance, it is always recommended children are assessed by a medical practitioner so that they are correctly diagnosed and managed during their crucial development years. Your medical practitioner can use several tests to assess whether the lactose intolerance or dairy allergy is present.

Firstly, is it dairy…

Exploratory Elimination Diet:

Elimination of all Dairy from the diet for a period (usually 2 weeks) will help to see if symptoms resolve. However, an elimination diet will not indicate if it is specifically a dairy allergy or lactose intolerance so further investigation is required. As dairy is a key food group supplying calcium, protein and other essential vitamins and minerals we do not want to be restricting it from the diet unnecessarily.

And if symptoms resolve then here are a range of other tests your medical practitioner may request…

Testing for Lactose Intolerance:

1) Stool Acidity Test.

This method of testing is commonly used in small babies or children. The patient consumes a drink containing lactose and a stool sample is later collected and tested for lactic acid. Why Lactic Acid? When undigested lactose is fermented by bacteria in the colon, lactic acid is produced. This lactic acid passes through into the stool, indicating lactose intolerance.

2) Hydrogen breath test.

The patient consumes a drink containing lactose and the has their breath tested for Hydrogen over several hours. If hydrogen is present, lactose intolerance is indicated. Why? Undigested lactose is fermented in the colon producing hydrogen gas. The Hydrogen enters the blood systems and we breath it out.

3) Lactose Tolerance Test.

The patient will drink a liquid containing lactose and then have their blood tested for glucose 2 hours later. If glucose levels increase, lactose tolerance is indicated. Why? When Lactose is properly broken down in the small intestine it produces glucose which is then absorbed into the blood stream, increasing blood glucose levels. If lactose

Testing for Dairy Allergy

1) Skin Prick Test

A skin test is used to identify substances that cause an immediate allergic reaction. During a skin prick test you will be exposed to a small amount of cow milk proteins. An allergy is present, the body will initiate an immune response and the skin will be swollen and red at the contact site.

It can be Managed!

There is no one size fits all approach to managing dairy allergy and lactose intolerance. Each individual has a different level of tolerance and therefore must be assessed and managed on an individual basis. With proper management dairy will not be unnecessarily restricted.

Lactose Intolerance

For those with Lactose intolerance the lactose must be restricted, but not the protein. For some people, consumption of any lactose results in symptoms and excluding lactose is the best solution for these people. Others can tolerate some amount of lactose without symptoms. This level differs depending on the individual and can be determined by gradually building up lactose consumption until symptoms result. Dairy foods contain varying amounts of lactose and can therefore be tolerated differently. For example, hard cheese and yoghurt are much lower in lactose than soft cheeses or milk. Consuming lower lactose dairy products and small amounts of dairy at a time can also help manage symptoms.

There are many lactose free dairy products available on the market and these can be substituted for standard dairy products. Lactose free products have been treated with the lactose enzyme and are well tolerated.

Dairy Allergy

Individuals diagnosed with a Dairy Allergy need to restrict the dairy protein form their diet. For those who are highly allergic, total dairy restriction is required and dairy cannot be reintroduced until blood tests show the severe allergy has been outgrow. For those with a more mild allergy, varying amounts or types of dairy can be tolerated. For example, cooked dairy may be able to be tolerated (due to the heat changing the protein) but not raw dairy.

An elimination and reintroduction diet is a commonly used to determine what types of dairy foods can be tolerated in those with mild to moderate Dairy Allergy. Practitioners often work through the “Dairy Ladder”. This reintroduces dairy in a step-by-step manner, starting with the foods that are less likely to cause a reaction. A version of the Dairy Ladder can be accessed here. It is not recommended to commence this process without the guide of an accredited medical practitioner.

Many children outgrow their allergy to dairy. Infact, evidence suggests that 80% of children will have outgrown their allergy by the age of five years old. It is therefore important to keep monitoring the allergy

In summary, dairy restriction is a strategy to manage two different conditions- Dairy Allergy and Lactose Intolerance. As dairy is a key source of calcium and other essential vitamins and minerals we do not want to unnecessarily restrict it from the diet. If symptoms are present it is important that the condition is correctly diagnosed so that appropriate management strategies can be implemented. Once appropriately identified, strategies can be implemented to include dairy in the diet as appropriate. This can be a tricky process to work through and to manage, particularly in a childcare setting where different children will have different levels of tolerance. However, in the long term, appropriate management will ensure the best health outcomes for the children.

How does Yummies help Manage your Children?

We understand that it is difficult and stressful for parents and centres to manage dairy restriction and work through the reintroduction process. We want it to be as easy as possible for you to manage whilst ensuring that the best outcome for the children.

Yummies can work through the elimination and reintroduction process with you and are able to change dietary restrictions weekly as required. We can work with centres and parents to individualise restricted items. For example, we can provide:

- Dairy Free & Exclude items that “May traces of dairy”

- Dairy Free

- Cooked or Baked Dairy Only

- No Cheese

- No fresh dairy (no milk, yoghurt, custard, sour cream)

- No milk

Yummies also have a range of frozen dairy free meals that families can purchase to make it easier to manage at home!

For a quick infographic to share with Educators and Parents CLICK HERE or download below.

Copy Dairy infographic
Download PDF • 702KB


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