Dietary Modifications for Lactose Intolerance

Cheese is usually tolerated because it contains little or no lactose. Yogurt may also be well tolerated, especially if it contains live and active cultures. Yogurt cultures digest lactose within the gastrointestinal tract after it is eaten. If milk solids are listed on the label, then the yogurt will contain additional lactose.

Lactose-reduced milk may also be an option. Children may like the slightly sweeter taste. Calcium-fortified orange juice and soy beverages are other sources of calcium, but these foods do not have the same nutrients as dairy foods. Soy beverages are fortified with calcium. Generally, the calcium in fortified soy beverages is absorbed 25% less efficiently than it is from milk.

Children diagnosed with lactose intolerance should be encouraged to eat cheese, yogurt, and small amounts of milk with meals as tolerated and as allowed by the diet prescription from the physician. CACFP has a special form for this prescription.

Lactose Intolerance or Milk Allergy

Lactose intolerance and a milk allergy are not the same. Symptoms of lactose intolerance are limited to the stomach and intestines, while symptoms of a milk allergy involve the immune system. Lactose intolerance tends to develop later in childhood or in adolescence and will not be outgrown.

With a milk allergy, the immune system reacts inappropriately to the protein in milk, whereas, with lactose intolerance, the body is unable to completely digest the lactose, or milk sugar. Most milk allergy begins in infancy and is outgrown by 3-4 years of age. Children who are allergic to cow's milk may or may not be allergic to soy beverages. A child with a true milk allergy must eliminate all dairy foods from the diet, since they all contain some dairy protein. Eliminating dairy foods increases the possibility that the allergy will be outgrown. Child nutrition professionals should check all food labels if a child in their care has a milk allergy.

Symptoms of lactose intolerance: Gas, abdominal pain or cramping , nausea, diarrhea
Symptoms of milk allergy: Itchy red rash, eczema, hives, swelling of the lips, mouth, tongue, face or throat, abdominal pain or cramping, gas, diarrhea, vomiting, wheezing

Good Communication is Key

Talk with the child and the parents to learn what milk products and how much of these products are tolerated and what other sources of calcium are being consumed at home. Document this information to help staff remember what a child may and may not be served, especially since it may vary from one child to another. Give the parent the Food Program Allergy Physician Statement for completion if applicable. Keep all diet prescriptions on file along with all other diet-related documentation. Be sure that your staff, including new staff, is kept informed.