By Hope Sande
Six weeks after my son was born, he developed a facial rash, abdominal discomfort and high temperature. All the tests carried out were negative, but a paediatrician, nonetheless, prescribed an ointment for the rash.
However, the medication did not help. A paediatrician suspected he was reacting to a certain chemical, possibly in his food.
Since I was breastfeeding my son exclusively, the paediatrician advised that I stop breastfeeding for two days and introduce formula milk, as I monitored him. Unfortunately, the rash persisted and I was advised to try soya milk.
Within a day of introducing the soya milk, the rash started fading. The paediatrician concluded that he was intolerant to lactose.
Breastfeeding exclusively for the first six months has shown to significantly lessen the risk and severity of food allergies and eczema in families with a strong history of them, experts say.
Breastfeeding a newborn is also a bonding opportunity for both the mother and child. But for various reasons, some mothers are not allowed to share in this joy, which is disheartening and may affect the baby’s growth.
Sabrina Kitaka, the president of the Uganda Paediatrician’s Association, says: “Lactose-intolerance is a condition where someone reacts to lactose, one of the sugars found in milk, due to lack of the enzyme, lactase. Breast milk contains lactose, which makes it possible for a child to be allergic to breast milk.”
When a baby is intolerant to lactose, he presents with loose stool, profuse diarrhoea, oral sores, a rash and, as a result of not feeding well, weight loss.
Other symptoms are abdominal discomfort, colic and difficulty in breathing that lasts up to several hours after breastfeeding.
The allergy can be confirmed after doing tests on the baby’s stool. If a paediatrician finds out that the baby is lactose-intolerant, he may recommend a special diet for him.
Other reasons why a baby’s body may reject breast milk
Dr. Daniel Tumwine, a paediatrician at Mulago Hospital, says a baby’s body may reject breast milk as a result of a genetic disease known as methylmalonic academia. With this condition, a baby is unable to break down protein, so the protein in the milk poisons the body.
The babies are usually healthy at birth, but within the first one to two weeks, they feed poorly, vomit and show signs of extreme tiredness, among other symptoms.
Methylmalonic academia is a serious condition and can result into death if breastfeeding continues. It affects about one in every 50,000 children globally.
Jane Achan, a paediatrician at Mulago Hospital, says breast milk allergy is a rare occurrence. Although there may be some reports of allergies, usually with closer evaluation and questions, it can be said that the cause of any such allergies is not really the breast milk itself, but some components of the mother’s diet that have been secreted in the breast milk.
“It is possible that the child reacts to components in the food the mother eats, especially, cow milk protein,” Tumwine says.
Babies whose mothers produce a lot of milk frequently also have bowel problems because the baby is getting more foremilk (the lower fat fast milk) than hind milk (higher fat milk) that comes with constant feeding.
This, therefore, allows some of the lactose to get into the bowel undigested, creating an irritation that often leads to gassiness. This further inhibits the bowels ability to manage the lactose, creating a situation that often gets worse.
Unlike what many people believe, lactose-intolerance, which is lack of the enzyme lactase, is rare. It is a genetic condition that is incompatible with normal life, unless there is medical intervention.
A truly lactose-intolerant baby would fail to thrive from birth, may not even gain weight and become dehydrated. This is considered a medical emergency and the baby would need a special diet soon after birth.
How it comes about
The enzyme, lactase, is produced in the tips of the microscopic folds of the intestine. Anything, therefore, that damages the gut lining can cause secondary lactose-intolerance.
Even subtle damage to the gut may wipe off these tips and reduce enzyme production, the paediatricians explain. The condition may also be caused by parasitic infections, intolerance to the gluten in wheat and some other grain products. Bowel surgery can trigger the condition because the procedure may remove the gut with its enzymes.
Jessica Nsumbwa, the assistant commissioner of Child Health Services, says: “Breast milk allergy is not as common as cow milk allergy and diagnosis should be made primarily on clinical grounds”
Can it be controlled?
Tumwine suggests elimination of cow milk products from the mother’s diet for at least two weeks to allow bowel time to heal. Avoid milk, cheese and all the packaged milk products. If symptoms persist, despite the mother eliminating the food, this may point to colic.
When the cause of the damage to the gut is eliminated, for example, by taking the food to which a breastfed baby is allergic out of the mother’s diet, the gut will heal, even if the baby is still fed breast milk.
One who is lactose-intolerant and is not showing signs of severe dehydration and starvation should continue being breastfed. Only when you suspect primary or true lactose-intolerance should you halt breastfeeding.
Doctors only recommend the use of lactose-free artificial baby milk if the baby is artificially-fed and is malnourished and/or losing weight. However, a mother’s milk remains the best food and will assist with gut healing.