The Map of Medicine on colic provided in the post “My Baby Cries All The Time” is an evidence-based document explaining the causes and treatment options for colic and it lists Transient Lactase Deficiency as one of the possible culprits. So what is Transient Lactase Deficiency and what can be done about it?
Lactase is the enzyme needed to break down lactose, the natural sugar found in milk, be it formula milk or breast milk. The theory is that due to gut immaturity some babies have insufficient levels of lactase enzyme in the small intestine. As a result, undigested lactose enters the large intestine where it undergoes bacterial fermentation and this process produces lactic acid and excess gases, which in turn causes abdominal pain and those dreaded colic-y symptoms.
So how do you know whether it is Transient Lactase Deficiency or something else causing your baby’s colic? Well, that’s something to discuss with your doctor but it is a difficult question to answer. One point to note is that Transient Lactase Deficiency won’t be accompanied by symptoms other than colic, whereas a Cow’s Milk Protein Allergy will likely be accompanied by other allergic signs such as a runny nose or congestion, wheeze, eczema, diarrhea or constipation, nappy rash, etc (head over to Is It Cow’s Milk Allergy for more info). If your baby has no other allergic symptoms your doctor may chose to manage it as Transient Lactase Deficiency initially. Hopefully the treatment will work and if not, you are still one step closer to working out the culprit through a process of elimination.
Management of Transient Lactase Deficiency
So how do you treat Transient Lactase Deficiency? Quite simply, by adding more lactase! Lactase drops are so safe that you can buy them over the counter, although ideally you will get them on prescription as you will be addressing your baby’s colic with your doctor. They are sold as Colief in th UK and Colief has a very informative website that you can read here.
It sounds like a straight-forward solution but unfortunately they are a bit of a faff to use. If you are bottle feeding you need to make up the bottle as usual, add 4 drops and then here’s the hard bit – wait 30 minutes before giving it to your baby! Hopefully you’ll know when your baby is likely to want fed but it obviously involves some planning and foresight. You can also make the bottles up in advance, adding just 2 drops and storing them in the back of the fridge. The World Health Organization states that it is best to make up each bottle as you need it but I think storing prepared bottles in the fridge would be the only way you could manage night feeds.
Now here’s an interesting thing if you are breast feeding and think your baby may have Transient Lactase Deficiency……breastfed babies can get colic symptoms if they are getting too much fore-milk which is packed full of lactose. This happens if there is a fore-milk/hind-milk imbalance or an oversupply issue. Tummy pain, gassiness and explosive green watery or foamy stools could indicate that this is the problem. As I’m writing this I’m acutely aware that I know very little about it! I do know that one solution is to ensure your baby is feeding long enough off one side to reach the fat-heavy hind-milk, and only offer the other side after 15-20 minutes and only if your baby is asking for it. This means they will fill up on fat-heavy hind-milk rather than the lactose-heavy fore-milk. If you suspect this may be the issue it would be worth getting in touch with a local breastfeeding councelor via your midwife, health visitor, children’s centre or NCT to talk it through with them before you trial the lactase drops.
I single-side fed our eldest and she was still having severe colic symptoms so we tried Colief for a while. If you are breast feeding you will need to express breast milk to give the drops in. The information leaflet that comes with the Colief casually suggests you express a ‘few tablespoons’ of breast milk, add 4 drops and give it on a spoon prior to breastfeeding. When we tried Colief this sounded straightforward. However, ‘a few tablespoons’ is actually an ounce, meaning that as our baby was having 6-8 feeds daily I needed to express 6-8 oz a day, which is a full bottle. And I challenge you to try and give a hungry baby milk off a spoon without it ending up everywhere other than in the baby’s hungry, and now angry, mouth! But we worked out a method that worked and used Colief for a few months, both day and night, so it is possible. Here’s the method that worked for us:
- Express in the morning and store in many sterilised bottles in the fridge, with an ounce in each bottle.
- Breast milk is safe to leave out the fridge for 6 hours so leave one bottle on the kitchen counter and when you’ve used it get the next one out of the fridge so there is always a bottle at room temperature.
- When your baby is asking to be fed, add the 4 drops to the bottle, give the bottle and then feed immediately.
It worked for us but requires your baby to take a bottle. We started the whole fiasco at 2 weeks old so she took a bottle quite happily but with an older baby you may need to try the spoon or a small cup, such as a medicine cup.
If the issue is a Transient Lactase Deficiency then lactase drops should make a significant difference and having a happy baby makes all the faff worthwhile. Make sure you keep a symptoms diary initially and if there is not, or very little, improvement you should go back to your doctor after a week to discuss other options.
Wow, that post felt like a hard slog! I’m sorry if it was heavy going. As usual, I hope it helps someone and if you have anything to add please comment below.