By Dr Mike Marinus, dad to Megan and James plus a Chiropractor in Blairgowrie with a special interest in family practice and paediatric care. Click here to hear his podcast. This is the 6th in our series on babies by Dr Marinus. Find his other articles here.
Explosive, frothy, watery poos can be quite an experience and very unnerving for new parents especially when they are accompanied by tummy cramps, painful straining and very stinky gas. It is important to have these tummy troubles investigated by your doctor because there could be different causes for these symptoms.
Lactose intolerance has become a buzz word and unfortunately many moms stop breastfeeding unnecessarily or change to a Soy or Lactose free formula without exploring the alternatives.
Lactose is the sugar found in mammal breastmilk. It is too big to be absorbed whole so the body breaks it down into glucose and galactose, which are smaller and more easily absorbed. Your baby’s body uses an enzyme called Lactase to do this and if he doesn’t have enough of it he will develop Lactose Intolerance. Lactose is then not broken down properly and gets digested in the colon by bacteria. This process leaves baby’s colon full of acid and gas which ends up in acidic watery stools, tummy cramps and bad smelling wind.
Preemie babies (especially those born before 34 weeks) are very prone to this because they don’t have enough enzyme to start off with. This is called Developmental Lactose Intolerance and is temporary until their enzyme production catches up. It has been suggested that they use lactase drops to help breakdown lactose initially instead of being put onto lactose free formulae.
It is very rare for a baby to be born with no Lactase at all. For this to happen both parents would have to pass this trait on genetically. But it can happen, and when it does, it is called Congenital Lactose Intolerance and it is a medical emergency.
The Lactose Intolerance we generally see in babies is called Secondary or Temporary Lactose Intolerance and this happens after babies have had an allergic reaction, infection or inflammation of the small intestine where lactase is produced. These babies will often have a short time where they show signs of Lactose Intolerance like of bloating, diarrhoea and cramping because there is temporarily no enzyme to work on the lactose. When the gut lining has recovered everything goes back to normal again.
A much more common cause of these symptoms is Lactose Overload. This is when your baby has enough enzyme but is drinking too much milk. Too much lactose gets into the system and can’t be metabolized quickly enough. This then ends in excess Lactose in the colon. Because of its nature this condition is often misdiagnosed as Lactose Intolerance, Colic or even reflux. Babies might overfeed because mom has an oversupply of milk, they may be sick and want extra time on the breast to console themselves or their overfeeding may be linked to sleep issues. The answer with Lactose Overload is to figure out what is causing the overfeeding and manage that by changing your feeding method and habits and possibly lactase drops (which we talk about in the podcast) without necessarily changing baby’s diet.
Cow’s Milk Protein Sensitivity
Another culprit of these tummy troubles can be Cow’s Milk Protein Sensitivity. Whereas Lactose Intolerance and Overload are digestive issues, CMPS is an allergic reaction to cow’s milk protein in either breastmilk or formula that leaves your baby with inflammation in the intestines. This inflammation can stop the production of lactase enzyme and these babies often suffer Secondary Lactose Intolerance as a result of CMPS. As well as the tummy troubles these babies also have allergic symptoms like itchy red eyes, swollen faces and even blood in the stool.
The amount of dairy you eat as a nursing mother has no effect on the level of lactose in your breastmilk but it does change the amount of cow’s milk protein in your milk. Breastfeeding moms of CMPS babies can still breastfeed but need to eliminate cows milk from their diet completely.
Explosive Poos, Tummy Cramps and Stinky Gas are not reasons enough in themselves to stop breastfeeding or change to lactose free/soy formula’s. Check with your doctor, get the tests done and know what it is that’s causing your baby’s discomfort