What is lactose overload?

Lactose overload is a temporary problem that occurs in infants, and it is due to the gut being relatively immature. The baby has lactase enzymes, but it does not have enough to digest all the lactose in a large amount of milk. Approximately two-thirds of breastfed babies get lactose overload. It is rare after 3 – 5 months of age.

Lactose overload is caused by an imbalance between foremilk (which is lower in fat and passes through the gut quicker) and hindmilk (which is released at the end of breastfeeding). This is often because the mother might have an oversupply of milk and might switch breasts too soon. The lower fat foremilk might pass through the baby's gut too quickly for all the lactose to be digested. Lactose overload can also happen in babies who are formula fed from a bottle, as the baby might not be able to indicate when they have had enough and cannot control the flow of milk from an artificial nipple effectively.

Signs and symptoms include diarrhoea or explosive or frothy stools, offensive smelling stools, bloating, gas, cramping, or crying. The baby can also gain large amounts of weight, which is not the case with lactose intolerance.

Lactose overload can be easy to treat. For breastfeeding mothers, the key is to restore appropriate foremilk-hindmilk balance, and this can be achieved by making sure one breast is empty before switching sides. Spend more time on one side, and follow your baby's cues – you might be able to hear the baby's swallowing slow down or stop. You can also repeatedly feed from only one breast in more severe cases – this will mean the baby gets less milk but the milk will have a higher fat content, which will slow down the passage of milk in the baby's gut and also contribute to a feeling of fullness. For formula-fed babies, try to calculate exactly how much formula the baby needs. You can also space out feeds (try leaving a gap of 3 or 4 hours between feeds). You might have to resort to low-lactose formulas, but these should only be a temporary measure.

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