Welcome to the definitive guide on milk allergy and dairy intolerance. In this guide you're going to find out everything you need to know about how to identify, diagnose and understand dairy intolerance or milk allergy and have all of your questions answered in one place.

When I started researching dairy intolerance for my baby nearly five years ago, I found that there was plenty of information on the internet, but there was nowhere that had all the information I needed, which meant hours of trawling through websites, articles and forums trying to find the answers to my questions.

Symptoms of Dairy Intolerance in Babies

So you're concerned that your baby or child may have a dairy intolerance or milk allergy? Maybe your baby or infant has one or more of the following symptoms:

• colicky
• showing signs of reflux
• is unsettled and unable to sleep
• prone to crying fits
• is not putting on weight
• has excessive wind
• stomach pain
• loose stools
• frequently vomits up whole feeds
• diarrhea
• runny, green stools
• raised red blotches on the skin (hives)

One or more of these symptoms can (but does not necessarily) indicate a dairy intolerance. Some of the more extreme symptoms may also indicate a milk allergy. Another common reaction to a dairy intolerance is eczema.

The symptoms above can be signs of one or more food intolerances. Remember that your baby may have a dairy intolerance in conjunction with intolerances or allergies to other foods. (One of my close friends' son has both a soya and dairy intolerance as well as an allergy to eggs.) The most common food intolerances are to dairy products, soya, and gluten.

In this article I'm going to focus on dairy intolerance or sensitivity and cover the following areas of concern that you may have.

• Why do babies & children develop food intolerances?
• The difference between an intolerance and an allergy
• Immediate vs delayed reactions
• Lactose or milk protein sensitivity?
• Diagnosis & testing of dairy intolerances
• Foods containing dairy products

• Foods with high calcium levels

Why do babies & children develop food intolerances?

Food intolerances are on the rise and affect between 6-8% of babies and children in western countries. There aren't any firm explanations of why this is happening but there are a few interesting theories. The first is that on the whole babies are born and brought up in very sterile environments in western countries, which means they have less exposure to dirt and germs. Because of the lack of "real" threats to fight against, the body turns on itself and starts attacking harmless proteins.

A second theory is that our bodies are so full of toxic and man made chemicals that we absorb through our every day environment, that the foetus in vitro becomes overloaded and is subsequently unable to cope with some natural chemicals such as proteins.

The third and final answer is that for some unknown reason babies bodies are simply not making enough of the enzymes needed to breakdown various foods.

The first thing I should explain is that a dairy intolerance is not the same as a milk allergy. Only 1-2% of babies and children will have a full blown allergy. These tend to be more serious and occur when the body sees the food substance, in this case milk, as harmful. The body creates antibodies to fight against the food molecules which results in allergic symptoms.

Milk allergy symptoms can range from vomiting, itchiness, hives, rashes, abdominal pain and diarrhea to asthma, swelling and anaphylaxis. Common foods that can cause an allergic reaction are milk, eggs, shellfish, peanuts and tree nuts. When an allergy causing food is eaten the reaction is usually fairly rapid (within an hour) and so they are quite easy to spot. If there is any shortness of breath or swelling then call your emergency services straight away.

Immediate & Delayed Reactions

Immediate reactions to dairy products occur from a few minutes to a couple of hours after the food has been ingested. These kinds of immediate reactions are more likely to be a milk allergy and are also far more obvious. If your baby continually vomits up all his milk within a hour of feeding, seems to have stomach pain (pulling legs up & very tense body) and is not putting on weight then this is likely to be an allergy and you should speak to your health professional as soon as possible.

Delayed reactions usually occur between 8 - 72 hours and possibly up to 4 days after the food has been eaten. These are more likely to be a dairy intolerance or sensitivity. It's this kind of intolerance that is harder to diagnose because of the long time frame involved. One way of telling the difference between a milk allergy or dairy intolerance is that your baby is likely to still be putting on weight with an intolerance even if they have reflux.

So you've identified that it's not a milk allergy but you still think you're baby may have a problem with dairy foods? There are two types of dairy intolerance. One is a problem with digesting lactose which is the sugar in the milk, and one is a difficulty digesting milk protein.

Lactose Intolerance

Some babies are intolerant to lactose (milk sugar), some to milk protein. Lactose intolerance is well understood by health professionals and is related to a lack of lactase in the small bowel which is what the body uses to break down lactose.

A baby born with lactose intolerance is likely to grow out of it within a few months as his body starts creating more lactase.

Frequent watery poos, green poos, flatulence, not gaining weight and stomach pain are the main symptoms of lactose intolerance. If your baby is born with this deficiency then he will be removed from a diet containing all lactose - human and cow's, and if you are bottle feeding will be given a cow's milk based, lactose free, formula. This will be done under the supervision of your health practitioner. Apart from simply removing lactose from the diet there are 3 main tests that can determine if your child is lactose intolerant.

Testing for Lactose intolerance

1. The Lactose Intolerance Test - The patient fasts before the test and then is given a lactose drink. Blood samples are then taken over a two hour period to measure the levels of glucose in the blood. This test determines whether the body is breaking down the lactose properly. (This test is not used for babies under 6 months old.)

2. The Hydrogen Breath Test - In this test the patient is given a lactose drink. The breath is then analysed to determine if there are higher than normal levels of hydrogen being exhaled. When lactose is not digested it ferments in the gut creating hydrogen. This then passes to the blood stream and is exhaled through the lungs. (This test is not used for babies under 6 months old.)

3. Stool Acidity Test - This is the most common test performed for babies under 6 months old. Lactose that is undigested creates lactic acid that will be present in the stool and can be detected by testing.

Milk protein intolerance is less well understood and is somewhat harder to test for. There are some tests available to buy on the internet or your doctor may decide to carry them out, but the main way to diagnose it is to eliminate all dairy from your child's diet for two weeks (and yours too if you are breastfeeding) and see what difference it makes. If you are bottle feeding see your doctor, health visitor or midwife before trying a soya formula.

In the UK you can get soya, lactose free and hydrolyzed formulas free on prescription. In the US they may be covered by your health insurance.

If removing dairy from the diet doesn't make a difference then it may be that your baby is suffering from normal colic which is due to an immature bowel and will right itself in time. (I know it's hard going coping with a colicky baby but there are some good mediciines on the market and certain types of baby massage that can be really helpful too!) It's also possible that your baby is intolerant to other foods in addition to, or instead of, dairy. 35% of babies who have a dairy intolerance will also have a soya intolerance. In these cases, if you are bottle feeding you will need a hydrolyzed or predigested baby forumla which your doctor will prescribe for your baby.

Do be careful about eliminating foods from yours and your infants diet. Make sure you know what vitamins and minerals are in each food and research alternative sources (there is a list of calcium rich foods below). If you are worried or unsure about anything relating to your child's health it's always best to seek medical advice.

Testing for Milk Protein Intolerance

1. Allergy Skin Test - These can be carried out through your doctor or you can buy them on the market to do at home. The test involves pricking the skin with a small pin loaded with milk protein. If a wheal develops this shows that the body is reacting to milk protein.

2. Milk Allergy Test - Another test available also involves taking a very small amount of blood through a pin prick. The levels of IgE (allergy antibodies) are determined and can tell you if there is a sensitivity to milk.

WARNING! There are lots of companies out there saying they can diagnose milk protein and lactose intolerances who show very flimsy or no proof of their reliability - be particularly wary of ones that offer energy scanning.

The York Test is probably the best test available. The initial yes/no test is only £20 but further testing is quite expensive.

So you've finally found out the problem and discovered your baby or child has a dairy intolerance or milk allergy. Your weekly grocery shop will never be the same! You will become intimately acquainted with every single food that contains a milk product and you will be surprised at how many there are! Ones that were a shock to me included crisps, gravy, stock cubes, bread crumbed food, cereals, sweets and processed meats,

The best way to cope with buying and cooking food for your child is to make everything fresh and cut out processed foods. I have noticed that most processed foods have some kind of milk product in them as it's used as a flavour enhancer. Look out especially for whey and casein which are both derived from cow's milk. Replace cow's milk with soya or rice milk (which can both be used in cooking). Dairy free margarines, yogurts, ice-cream and cheese are available in the majority of supermarkets and most of them contain added calcium and other vitamins. Goat's milk is also an alternative for some dairy free children and worth a try.

There are now an array of FREE FROM foods so your child will still be able to have treats. The hardest times for our little one (and us) are children's birthday parties. There are so many things she can't eat at them, including the cake, that I always take some treats with us so that she doesn't feel left out. And if we are going to meet with friends I make her food and bring it with us just in case.

Calcium rich foods include wholewheat bread, green vegetables, sesame seeds, oily fish such as mackerel, salmon and halibut, tofu, rhubarb and oranges. Most soya alternatives and cereals are also fortified with calcium.

The hardest thing about dairy intolerance is diagnosing it (and sometimes getting your doctor to listen). But once you know what the problem is it's easy enough to avoid foods containing dairy and your child will come to know what they can and can't eat too.

Don't take the advice of well meaning friends and relatives who tell you to keep feeding your baby or child dairy because that will "help them grow out of it". This is not true. It will actually make things worse and could lead onto a full blown milk allergy. Your child may grow out of their dairy intolerance in time or they may not, whatever the outcome they will still grow up to be healthy and strong and that's the main thing.

I've been learning all about dairy intolerance for the last 4 years because, as you may have guessed, I have a child who has it. Coming from a family where we don't even get hayfever it was quite a shock to find out what was wrong with my beautiful, breast fed baby.

There was no denying it - my baby was unhappy. She cried all the time, her little legs would constantly be pulling up to her tummy, her body was tense, her sleep pattern was disrupted, she passed wind continuously (100 times a day or more!) and every time she did so she screamed in pain. My first born had been colicky but this was something different, so I talked to my midwife.

First off she suggested that I eat lots of natural yogurt to help with my babies wind. That didn't help my little one at all. Then she surprised me by suggesting that I cut out dairy from my diet altogether (remember I was breast feeding so it was me that had to change my diet!). Desperate for a solution and a contented baby I did so.

It took about 4 days for it all to get out of her system and, "hey presto" - it was like I had a completely different child! She was relaxed, happy, content and having decent amounts of sleep. It was like someone had waved a magic wand! Since then she has eaten a dairy free diet. Occasionally, we try her on something containing dairy, but it always causes stomach cramps and wind and it still takes about 4 days to leave her system.

Whether it's a milk allergy, a diary intolerance or another food sensitivity that your baby or child has to live with, diagnosing it is the hardest part. From then on you as a parent can just get on with dealing with it.

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