Lactose free weaning

Transcription

1 Lactose free weaning This booklet provides information and advice on how to follow a lactose free weaning diet. This booklet was given to you by: Name: Contact Tel No:

2 What is lactose intolerance? Lactose intolerance occurs when the body can t digest and absorb lactose allowing it to pass into the bowel causing gastrointestinal symptoms including colicky like symptoms and loose frothy diarrhoea in your baby. Congenital Lactase deficiency is very rare and usually present straight after birth with severe diarrhoea leading to dehydration and Malnutrition. The highest incidence is in the Finland population. Primary Lactase deficiency is very common in East and South East Asia-, Australian-, Africans- and Native American population. Lactase levels at birth are usually normally but decline to 5-10% during childhood and adolescence. Onset of symptoms usually starts after 3years of age depending on level of lactose in the diet. Secondary Disaccharides deficiency usually occurs after gastroenteritis. It is estimated that 30-50% of children with rotavirus will have secondary lactose intolerance that resolves after the infection. Lactose Intolerance can be managed by the temporary avoidance of lactose containing formula and food and can last between 2-4months. Some infants might need to be on a lactose free diet for a longer period. 2

3 What does a lactose free diet involve? Lactose is a milk sugar found in cows, sheep s, goats and human milk as well as manufactured products made with these milks. It s important that sources of lactose are excluded from your child s diet. Check the ingredient list on food labels containing the following: Butter Hydrolysed casein Rennet Butter fat Hydrolysed whey Skimmed milk powder Calcium caseinate Lactalbumin Sweet whey Casein concentrate Lactalbumin phosphate Whey Casein hydrolysate Lactoglobulin Whey protein Caseinates Lactose Whey solids Cream Malted milk Yoghurt Cultured buttermilk Milk (all types) Fromage frais depends on type Curds Milk protein Cheese * Delactosed whey Dry milk Ghee Milk solids Non-fat milk solids Protein hydrolysate 3

4 What suitable lactose free milk alternatives are available? Lactose free formulas are available for children under the age of 1 e.g. SMA LF and Enfamil Lactofree. These lactose-free formulas taste similar to ordinary formulas and are available form chemist to buy or available on prescription from your Gp. A soya formula can also be used if your baby is over the age of 6months e.g. Infasoy or Wysoy. It is important that your baby drinks at least 600ml (20oz) a day of lactose free- or soya formula to meet calcium requirements. For children over the age of I year a ready to drink lactose free milk can be used e.g. Lactofree (whole and semi skimmed versions available) or Alpro1 +. These can be used as a main drink as well as in cooking but always ensure that they are calcium enriched. Lactofree creams, cheese and yogurts are also available as is soya yogurts and -desserts from your local supermarket. 4

5 Introducing solids It is recommended that solids be introduced at around 6 months of age (but not before 17 weeks of age). All solids must be lactose free. First food should be smooth and lump free (see suggestions below). Starts with a small amount of food once a day and gradually increase the amount, texture and range of foods to 3 meals per day. Don t be alarmed if your baby refuses new foods in the beginning. Try the same food again on another day. Eggs, gluten, wheat and nuts* should not be introduced before 6 months of age. Meat should be introduced by 6 months of age to ensure sufficient Iron rich sources. Honey should not be given before 1year of age. Don t add any additional sugar and salt to your baby s food. It s recommended to offer your baby home made food rather than ready made baby foods as this is much cheaper and it allows baby to get used to family food. This will also help you to control what ingredients are added to the food. Whole nuts should not be given before 3years of age due to the risk of choking. 5

6 Suggested meal pattern at different stages weaning stages? Age/Stage Breakfast Lunch/Dinner Stage 1 (Around 6 months) Start with 1-2 teaspoons of smooth puree e.g. fruit, vegetables or milk free baby rice and increase the amount gradually Stage 2 (Around 7-8 months) Try mashing and grating food. Try to offer 2-3 solids a day with at least one serving of meat, fish or lentils, 2-3 servings of starchy food and 2 servings of fruit and vegetables Fruit puree or lactose free baby rice Lactose free cereals or porridge Vegetable puree e.g. carrots, potatoes, and courgette. Fruit puree e.g. apple, pear, and banana. Meat, fish or lentils puree. Lactose free yogurt. Mashed potatoes and vegetables Minced meat/ mashed lentils Mashed fruit Lactose free yogurt/ custard. Soya yoghurt or dessert 6

7 Age/Stage Breakfast Lunch/Dinner Snack Stage 3 (Around 9-12 months) Try lumpy texture and to encourage finger foods. Aim for 3 meals a day with 2 servings of meat, fish or lentils, at least 3 servings of starchy food and 3-4 servings of fruit and vegetables Lactose free cereals or porridge Toast/Bread with lactose free margarine Soft cooked potatoes and vegetables. Cooked rice and pasta Chopped meat/fish and cooked lentils Fruit, lactose free yogurt or custard. Soya yoghurt or dessert Soft cooked vegetable sticks e.g. carrot sticks Peeled fruit strips e.g. apple, pear, melon Plain rice cakes/ rice crackers Small finger of toast with lactose free margarine Small strips of cooked meat 7

8 Lactose and cheese Cheese normally contains lactose but due to the maturing process of hard cheeses, the lactose content has been reduced and is usually well tolerated. Look out for cheddar cheeses with the protected designation of origin seal in yellow and blue manufactured on mature and very mature West Country Farmhouse cheddar. Emmental and Gruyere cheeses are also suitable. Soft cheese e.g. cream cheese, cheese spread, mozzarella and feta is not manufactured the same way and will need to be avoided on a lactose free diet. 8

9 Other sources of lactose Lactose is not only found in food but can also be present in some medicine and tablets e.g.: Tablets/liquids and cough medicine Check with your Pharmacist Vitamin and Mineral supplements including some calcium supplements - check label Toothpastes and mouthwashes - check label Powdered / tablet artificial sweeteners check label Please note that this level of restriction is not necessary for all children especially if they remain symptom free after ingestion. Ask your Dietitian if unsure. 9

10 The following products don t need to be avoided on a lactose free diet as it doesn t contain any lactose: Lactic acid E270 Cocoa butter Stearoyl lactylates Sodium lactate E325 GLucona-delta-lactone Potassium lactate E325 Calcium lacteate E327 etc Will a lactose free diet always be necessary? No, most babies will outgrow lactose intolerance. A milk challenge will have to be done by giving a small amount of dairy products e.g. yogurt food containing milk or normal cow s milk formula. If baby experience loose frothy diarrhoea or colicky symptoms then stop lactose containing food and re-challenge in next couple of months. 10

11 Lactose Free Recipes Home-made rice pudding 30g (1oz)flaked rice or ground rice 150ml (5oz) milk substitute 1teaspoon sugar or golden syrup (optional) Place all of the ingredients in a saucepan and bring to the boil. Simmer for approximately 5 minutes. Stirring occasionally. Add a little more milk substitute if the consistency is too thick. Home-made custard 2 teaspoons of milk free custard powder 200ml (7oz) milk substitute 1-2 teaspoons of sugar or sweeten with pureed fruit Mix custard powder and sugar with 2 tablespoons of cold milk substitute to make a paste. Gently heat remaining milk substitute. Remove from heat and slowly add to the custard mixture and stir continuously. Pour mixture back into the pan and heat until thickened. Serve warm or cold. 11

12 Notes.. Created by Registered Dietitians Nutrition & Dietetics Department, The Great Western Hospital, Marlborough Road, Swindon, Wiltshire, SN3 6BB Tel.: Date Created: November 2012 Review Date: November