Diagnosing milk allergy or lactose intolerance in infants—whether breastfed or formula-fed—is one of the most challenging issues mothers face in the first days after childbirth, especially for first-time mothers who lack experience in observing symptoms. Many babies experience discomfort after feeding, leaving mothers wondering: Is this normal, or does it indicate a real medical problem that requires urgent attention?
Dr. Wafaa El-Sawy, Professor of Obstetrics and Gynecology, provides a complete, science-based guide to help mothers detect milk allergy or lactose intolerance from the very first week, using simple steps and clear signs that are easy to observe.
Causes of Milk Allergy in Infants
Milk allergy may occur due to genetic or environmental factors, most commonly:
A family history of allergies, such as asthma or skin allergies
Delivery by cesarean section, which may affect the natural development of the immune system
The mother consuming cow’s milk during breastfeeding, allowing milk proteins to pass to the baby through breast milk and trigger an immune reaction
The Difference Between Milk Allergy and Lactose Intolerance
Milk allergy is an immune system reaction to milk proteins. The body treats these proteins as harmful invaders, causing rapid and sometimes severe symptoms that may become dangerous if not treated properly.
Lactose intolerance, on the other hand, is a digestive—not immune—problem. The infant lacks sufficient lactase enzyme needed to digest milk sugar (lactose), leading to digestive disturbances after feeding.
Early Signs of Milk Allergy (From the First Week)
1. Sudden Skin Rash
Red patches or swelling around the mouth, face, or body immediately after feeding are among the most dangerous signs. This rash results from an immune reaction to milk protein and may worsen rapidly if feeding continues.
2. Swelling of Lips or Eyelids
Facial swelling is a serious warning sign and should never be ignored. It may progress to breathing difficulties if not treated promptly.
3. Severe Vomiting After Feeding
Occasional spit-up is normal, but repeated, forceful vomiting immediately after feeding—especially if accompanied by diarrhea or lethargy—is a red flag.
4. Continuous Crying After Every Feeding
Persistent crying with legs drawn up toward the abdomen indicates severe abdominal pain caused by intestinal inflammation due to allergy. This pain does not improve with position changes.
5. Mucus or Blood in Stool
The presence of mucus or blood streaks in the baby’s stool is a critical sign of intestinal inflammation and requires immediate medical attention.
Signs of Lactose Intolerance in Infants
Although less dangerous than milk allergy, lactose intolerance can still be distressing for both baby and mother. Common signs include:
1. Severe Gas and Abdominal Bloating
Frequent gas and noticeable abdominal distension after feeding indicate poor digestion of lactose, often causing crying and sleep disturbances.
2. Recurrent Watery Diarrhea
Stools are watery with a strong odor and occur multiple times daily, increasing the risk of dehydration if not monitored.
3. Abdominal Pain with Legs Pulled Inward
Gas buildup causes pain that makes the baby repeatedly pull their legs toward the abdomen.
4. Poor Weight Gain
Babies with lactose intolerance may not absorb nutrients efficiently, leading to inadequate weight gain despite regular feeding.
Causes of Lactose Intolerance
There are three main types:
Temporary lactose intolerance following diarrhea or gastrointestinal infection, lasting a few weeks
Congenital (genetic) lactose intolerance, which is extremely rare and present from birth
Developmental intolerance, which usually appears later but may show early in infants with severe lactase deficiency
How Can a Mother Easily Tell the Difference?
By observing the timing and type of symptoms:
Milk allergy: Symptoms appear within minutes to two hours and include skin rashes, swelling, breathing issues, and severe vomiting.
Lactose intolerance: Symptoms appear hours later and are limited to digestive issues such as gas, bloating, and diarrhea—without skin or respiratory symptoms.
Can Milk Allergy Occur During Breastfeeding?
Yes. It is a common misconception that milk allergy occurs only with formula feeding. Milk allergy can appear even in breastfed babies if the mother consumes dairy products, as milk proteins can pass through breast milk.
In such cases, doctors may advise the mother to stop consuming dairy products for two weeks and observe whether the baby’s symptoms improve.
Formula feeding increases the risk because cow’s milk proteins are directly present, causing symptoms to appear faster.
How Doctors Diagnose Milk Allergy and Lactose Intolerance
Diagnosis may include:
Clinical examination of the baby’s skin, abdomen, breathing, and hydration status
Antibody tests to detect immune reactions to milk proteins
Milk elimination trial for two weeks to observe symptom improvement
Lactase level tests to confirm lactose intolerance
What Should a Mother Do If She Suspects Milk Allergy?
If severe symptoms appear—such as repeated vomiting, skin rash, or swelling—stop milk feeding immediately and seek medical care. Do not change formula types without consulting a doctor.
Treatment depends on the diagnosis:
Milk allergy: Special hypoallergenic or cow’s-milk–free formulas may be prescribed. Breastfeeding mothers may need to eliminate dairy from their diet temporarily.
Lactose intolerance: Temporary cases resolve within weeks; genetic cases require long-term lactose-free milk with close growth monitoring.
Will the Condition Improve Over Time?
Yes.
Milk allergy often resolves by the age of three in many children.
Lactose intolerance may improve as the digestive system matures.
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