Introduction
(0:00) I will never forget the confusion and worry I felt when my third child, Emily, was dealing with what I thought was lactose intolerance. In retrospect, was it a cow’s milk protein allergy or actually lactose intolerance? I was completely clueless about the difference and how to tell them apart.
(0:16) As a parent, it’s natural to feel overwhelmed when navigating the complex world of infant nutrition and allergies. That’s why I’m excited to share this podcast with you. Today, we’re diving into the latest insights on cow’s milk protein allergy and lactose intolerance with expert paediatric dietician Kath Megaw. She’ll guide us through the symptoms, diagnosis, and treatment options, providing step-by-step management tools to help you identify and manage these conditions.
(0:42) From my own experience, I know how frustrating it can be to deal with a fussy baby and not understand what’s causing their distress. But with the right information and support, you can breathe a sigh of relief and take steps to help your little one thrive.
(1:04) Welcome to Sense by Meg Faure, the podcast brought to you by Parent Sense—the app that takes the guesswork out of parenting. If you’re a new parent, you’re in good company. I’m Meg Faure, an occupational therapist, infant specialist, and author of eight parenting books. Each week, we talk with new parents like you about the wins, the challenges, and the questions of the moment.
(1:49) Welcome back, moms and dads! Today, we’re discussing one of the most critical topics in infant nutrition: allergy prevention. Joining me is paediatric dietitian Kath Megaw. Kath, as always, thank you for sharing your expertise with us today.
Understanding Lactose Intolerance vs. Cow’s Milk Protein Allergy
(2:31) Meg Faure: In this episode, we’ll address common questions and misconceptions about allergy prevention in infants. Many parents worry when their babies show signs of discomfort, like cramping and frothy stools. The immediate concern is often whether their baby is allergic to milk or lactose intolerant. Kath, could you explain the difference between these two conditions?
(3:23) Kath Megaw: Absolutely. Many parents and even healthcare professionals confuse lactose intolerance and cow’s milk protein allergy. Lactose is the sugar in milk, while cow’s milk protein is, as the name suggests, the protein.
(3:53) Lactose intolerance in babies is very rare. Newborns might temporarily struggle with lactose digestion because their gut enzymes are still developing. However, removing lactose isn’t usually helpful because lactose itself helps stimulate the production of the enzyme that digests it.
(4:45) Lactose in breast milk also plays a vital role in developing the baby’s gut microbiome, which is essential for long-term gut health. So, unless there’s a serious underlying issue, babies usually adjust and tolerate lactose over time.
(5:36) Meg Faure: That’s so interesting, Kath. Often, in the early days, babies are colicky and fussy. Parents want immediate solutions, leading to the use of medications or lactose-free formulas. What I’m hearing is that it’s often best to hold the line and allow the baby’s gut to mature naturally. Is that correct?
(6:58) Kath Megaw: Exactly. Most babies will adapt over time. True primary lactose intolerance is extremely rare and typically results in severe symptoms like weight loss and malnourishment.
Diagnosing and Managing Cow’s Milk Protein Allergy
(7:52) Meg Faure: For the mom wondering if her baby’s fussiness is serious, what signs should prompt a visit to a healthcare professional?
(8:09) Kath Megaw: Key signs include excessive frothy stools, the presence of reducing substances in the stool, and most importantly, weight loss. Babies with primary lactose intolerance cannot absorb essential nutrients and will lose weight despite eating frequently.
(9:05) Meg Faure: That’s fascinating. My daughter Emily was diagnosed with lactose intolerance years ago. In hindsight, I wonder if she had cow’s milk protein allergy instead. Could a misdiagnosis like this disrupt a child’s gut microbiome long-term?
(10:37) Kath Megaw: It’s quite possible. Blood in the stool is more indicative of cow’s milk protein allergy than lactose intolerance. Misdiagnosing and treating the wrong condition can impact the gut microbiome, especially when using proton pump inhibitors or eliminating important nutrients.
Exploring Treatment Options
(14:03) Meg Faure: Let’s dive deeper into cow’s milk protein allergy. Can you explain the difference between IgE and non-specific cow’s milk protein allergies?
(15:32) Kath Megaw: Sure. IgE-mediated allergies trigger an immediate immune response, like a peanut allergy. This can include vomiting, hives, or even anaphylaxis. In contrast, non-specific cow’s milk protein allergies cause delayed symptoms, such as reflux, constipation, diarrhoea, or bloody stools.
(17:40) While IgE-mediated allergies are rare with cow’s milk, they do occur. Non-specific reactions, however, are more common and harder to diagnose since they don’t show up in blood tests. Diagnosis typically involves symptom observation and elimination diets.
Practical Solutions for Parents
(22:35) Meg Faure: If a breastfeeding mother suspects her baby has a cow’s milk protein allergy, what’s the best course of action?
(22:53) Kath Megaw: First, eliminate cow’s milk protein from her diet while continuing to breastfeed. If symptoms persist, also remove soy. However, this can be challenging for some mothers, especially vegetarians. In extreme cases, specialized hypoallergenic formulas may be needed temporarily.
(25:43) Amino acid formulas can help confirm a diagnosis but should be used short-term. Ideally, once symptoms improve, the baby should return to breast milk or a partially hydrolyzed formula to support gut health.
Allergy Prevention Strategies
(27:18) Meg Faure: What can parents do to prevent allergies from developing in the first place?
(27:41) Kath Megaw: For IgE allergies, early exposure to allergens like dairy, eggs, and peanuts during pregnancy, breastfeeding, and weaning reduces risk. However, non-specific cow’s milk protein allergies are harder to prevent and are likely linked to gut health. Supporting a healthy gut microbiome through breastfeeding, skin-to-skin contact, and avoiding unnecessary antibiotics may help.
Conclusion
(3:43) Meg Faure: Wow, Kath—this has been an incredibly informative and niche discussion. Thank you for sharing your knowledge with us. If listeners want to connect with you, where can they find you?
(4:07) Kath Megaw: You can find me on Instagram @Nutri-Peds or visit our website at www.nutri-peds.co.za. Also, check out our book Allergy Sense for more in-depth information on navigating allergies.
(5:02) Meg Faure: Thank you so much, Kath! And to our listeners, we’ll see you next week. Until then, download the Parent Sense app and take the guesswork out of parenting.
Podcast
