Lactose intolerance vs Cow’s Milk Protein Allergy vs Galactosemia
Lactose intolerance refers to the infant lacking the enzyme, lactase, required to break down lactose into glucose and galactose.
- Consequently, there is minimal breakdown and absorption of lactose in the small intestine
- The lactose then travels to the large intestine where it draws water in causing diarrhea and then is metabolized by colonic bacteria resulting in gas cramping pains
Cow’s milk protein allergy (CMPA) refers to the infant having an allergic reaction to a protein that is found within the cow’s milk
- Consequently, this can result in failure to thrive, and occult blood or gross blood in the stool
Galactosemia refers to an inborn error of the metabolism of galactose
- Remember that lactose breaks down into glucose and galactose
- Also recall that lactose is found in both breast milk and standard formulas
- There are 3 main types of galactosemia based on where in the galactose metabolism the enzyme is defective
- In classic galactosemia, deficiency of galactose-1-phopshate uridyltransferase can result in a severe presentation including failure to thrive, jaundice and cognitive impairment
Lactose intolerance, CMPA and galactosemia can occur during breastfeeding or during formula feeding using standard formula for healthy term infants.
What is Whey and Casein?
Whey and casein are the two proteins that are produced in mature milk at a ratio of 70:30 whey:casein. However, infant formulas are usually the opposite as they are more high in casein compared to whey milk protein.
What not unmodified cow’s milk?
Disrupts iron absorption, has insufficient iron and can lead to increased enteric blood loss in infants.
Cow’s Milk Based Standard Formula
- Enfamil A+ with Iron
- Similac Advanced with Iron
Specialty formulas
Lactose intolerance
- Lactose free formulas (do not use for galactosemia)
- Enfamil lactose free A+
- Similac Sensitive Lactose Free
- Low lactose formulas
- Enfamil Gentlease A+ with DHA and ARA
- Similac Partially Broken Down Protein with Omega 3 and 6
CMPA/infantile colic/constipation
- Partially hydrolyzed 100 % Whey Formulas (refractory constipation to PEG or digestive sensitivity to milk proteins)
- Nestle Good Start (variations include with probiotic, with DHA and ARA and with GOS)
- Extensively hydrolyzed Casein Formulas (mild to moderate CMPA)
- Similac Alimentum
- Nutramigen A+ with DHA and ARA
- Enfamil Pregestimil with DHA and ARA
- Amino Acid Based Formulas (severe CMPA)
- Enfamil PurAmino A+
- Nutricia Neocate
Galactosemia
- Soy based formula (avoid in preterm infants, congenital hypothyroidism, renal failure) (avoid until all hydrolysate formulas have been exhausted first as there is a high rate of coincident soy allergies)
- Earth’s Best Organic Soy with Omega 3 and 6
- Enfamil Soy A+ with DHA and ARA
- Good Start Alsoy with Omega 3 and 6
- Similac Isomil (also with Omega 3 and 6)
Reflux
- Nestle Goodstart
- Enfamil A+ for Babies who Spit Up