Tummy troubles. Irritability. Headaches, mouth ulcers, rashes and more — food intolerances can affect the whole body and they can be hard to diagnose, especially in children.
In this article, we’ll dive into what food intolerance is, give you some day-to-day tips, and what to do after your child’s medical team has confirmed they’re suffering from an intolerance and not an allergy.
How do I know if my child has a food allergy vs intolerance?
Food intolerance symptoms can come and go, and sometimes don’t seem related to each other at all. Or they can look like a food allergy.
Differences include:
- Symptoms caused by a food allergy usually occur immediately or very soon after eating. A food intolerance will occasionally cause symptoms immediately but usually takes up to 24 hours to develop.
- Food intolerance causes symptoms after consuming certain foods or food components, often due to the body's inability to properly digest or process them. Allergies cause symptoms because of an immune system reaction.
- Allergies can be triggered by a certain food, or they can be triggered by pollen, animal dander or dust mites. They can also include certain medications or insect bites. Food intolerances are less specific and cover a wide range of adverse food reactions which do not involve the immune system.
While intolerances can be uncomfortable and impact general health and wellbeing, they don’t cause life threatening reactions. Allergies can cause anaphylaxis.
What are the most common triggers of food intolerances in children?
Some components of foods which are associated with food intolerance in children:
- Lactose — The natural sugar in cow's milk and dairy products, especially milk. Note: lactose intolerance is more common in older children (it’s rare in babies and toddlers).
- Cow's milk protein — This is different to lactose intolerance although symptoms can be similar, and it’s often triggered by similar foods. A cow's milk protein intolerance is caused by an immune reaction to the protein in cow's milk, which may be due to difficulty digesting the A1 beta-casein in ordinary cow's milk.
- Gluten — Found in wheat, oats and barley as well as foods like bread, pasta and pastries.
- Food additives — Ingredients that food producers add to their recipes to enhance flavour and colour, or to prolong shelf life. Common culprits include artificial colours, and preservatives such as nitrates (in processed meats), propionates (in bread), benzonates (in soft drinks) and sulphides (in dried fruit).
- Caffeine — Usually passed through the breastmilk. High amounts of caffeine are found in coffee, tea and energy drinks, and chocolate to a lesser degree.
- Fructose — Soft drinks and lollies often contain concentrated amounts of fructose as a potent sweetener, but natural foods can have high levels too. Apples, grapes and bananas contain lots of fructose, as do onion, red capsicum and pumpkin.
- Naturally occurring food chemicals – These include salicylates (in certain fruits and vegetables), amines (found in fermented products, meat and certain fruits and vegetables) and glutamates (found in certain fruits and vegetables, and the additive MSG).
For some people the saying 'too much of a good thing' really is true – food chemical intolerance is typically dose related. For example, a couple of strawberries can be enjoyed but eating a punnet may result in skin rashes.
Lactose intolerance in children
Lactose intolerance is generally uncommon amongst babies. Breastmilk is naturally rich in lactose and, for this reason, physiologically, babies are born with the ability to digest lactose.
When everything is working right, an enzyme called lactase breaks down lactose in the digestive system. Some older children (and adults) don’t produce enough lactase to keep up with the amount of lactose they consume. This leaves undigested lactose molecules which can’t be absorbed into the body, and this causes symptoms of lactose intolerance. These symptoms can include:
- Loose stools and excessive gas, particularly after consuming dairy products
- Watery diarrhoea with gas
- Abdominal bloating, gas and feelings of nausea
- Abdominal pain and cramps
Research was published in 2019 which analysed the results of a clinical trial involving 75 Chinese children aged between 5 and 6 years with mild to moderate milk discomfort or lactose intolerance (confirmed via a urinary galactose test). The study reported that replacing conventional milk with a2 Milk® "reduced gastrointestinal symptoms associated with milk intolerance" in many subjects. More research is needed to understand the broader implications of these results.
a2 Milk® contains the same amount of lactose as found in conventional cow's milk. This means that if your child has lactose intolerance as confirmed by your healthcare professional, then it will be necessary to exercise the same precautions when introducing your child to a2 Milk® as you would in relation to any other cow's milk — or talk to your dietitian about introducing a2 Milk® Lactose Free milk instead.
NOTE: All cow's milk, including a2 Milk®, should be excluded from your child’s diet if your child has been diagnosed with a cow's milk allergy. These are different to lactose intolerance and A1 protein sensitivity, which we go into further below.
Understanding A1 protein intolerance
Cow's milk protein intolerance (or CMPI) is more serious than a lactose intolerance. It’s a very common condition and can affect 2-3% of babies younger than 1 year of age.
Babies who are sensitive to cow's milk protein often show symptoms within the first week of introducing cow's milk into their diet. Most infants with cow's milk protein intolerance (CMPI) experience symptoms that mostly affect their gastrointestinal system:
- Presence of blood or mucus in the stool
- Frequent loose stools
- Vomiting
- Signs of abdominal discomfort
- Irritability
- Difficulty with growth and weight gain
A1 vs A2-type beta-casein proteins
Research suggests that a common form of cow's milk beta-casein protein (called A1) could be the culprit. Another type of protein in cow's milk, A2-type beta-casein protein, isn't associated with these adverse effects.
A1 and A2 are beta-casein proteins found in cow's milk. The difference between them lies in how they are digested. When broken down, the A1 protein can release a peptide called BCM-7. Some children may have difficulty with BCM-7 and it could lead to intolerance symptoms.
A2-type protein does not break down into BCM-7.
Years of research demonstrates that some adults and children experience digestive discomfort when drinking conventional cow's milk but find a2 Milk® easier on digestion*.
The A1 beta-casein protein that is found in ordinary milk is digested differently to A2-type beta-casein protein. There is evidence that supports the unique benefits of consuming milk from cows that naturally produce only the A2-type beta-casein protein that is naturally A1 protein free, like a2 Milk®.
*a2 Milk® is naturally A1 protein free, so it may be easier on digestion than ordinary milk for some milk intolerant individuals, when consumed as part of a healthy varied diet.
How do you know if your baby has a food intolerance?
Food intolerances are notoriously tricky to diagnose. There are a few things to keep in mind:
- Seeing a health practitioner is essential. They can help you distinguish an allergy from an intolerance and assist you in finding out what your child might be intolerant to.
- Waiting period. Symptoms can present immediately or up to 24 hours after your child has consumed the culprit food, so keep an eye on your little one and note any changes.
- Keep a diary. When your child has symptoms, note down the time and review what they’ve eaten (and how much) in the previous 24 hours. If you are giving them breastmilk, note what you’ve been eating and drinking, too.
- Diagnosing a food intolerance does not require a blood test, so be cautious of online test kits promising insights from your child’s blood, urine or hair to determine food intolerances.
Your healthcare professional may want to rule out an allergy first with some tests and refer you to an Accredited Practising Dietitian. Your dietitian can then assist you further in understanding what your child’s trigger foods are and at what amounts your child can tolerate them.
How can you manage a food intolerance in babies & children?
- Identify the food: The first step is to see your health practitioner and a dietitian. Getting to the bottom of a food intolerance usually involves cutting the suspected offending food out of your child’s diet, and then systematically reintroducing it. This is known as an elimination diet followed by “a challenge”. It should be done under the guidance of a professional so that you can confidently determine your child’s “threshold” — how much they can eat of a particular food or food component – before experiencing symptoms.
The elimination and challenge diets can be tough, but they’re not long-term. They’re a short test for you and your dietitian to identify and understand your child’s intolerances and what you can do about them. - Portion control: The great news is that you may be able to include the offending foods in your child’s regular diet — just in small amounts.
With a lactose intolerance, for example, your child may be able to consume certain types of dairy foods in limited quantities. Research has shown that many lactose intolerant individuals can tolerate up to 250mL of lactose-containing milk per day when consumed with other foods and spread over the day. There are also lactose free milks available. - Watch for signs of allergy: If your child has a reaction immediately or shortly after eating a food, they could have an allergy.
If your child shows any signs of anaphylaxis, call for an ambulance immediately. Anaphylaxis signs can include: - Swelling of tongue or throat
- Difficult or noisy breathing, or wheezing
- Persistent cough
- Difficulty talking or hoarse voice
- Dizziness or collapse
- Pale and floppy (young children)
What are some tips for managing food intolerance in children?
- Learn the language of labels: Ingredients labels can be confusing, to say the least. Some foods and components are listed under different names or numbers.
Work with your dietitian, download an app, and seek info from online communities for help navigating food packaging. - Don’t restrict: Cutting out a food — or a food group — long-term can lead to nutritional deficiencies. Switch out the offending food for something similar that doesn’t cause food intolerance symptoms. For example, if your dietitian approves, swap ordinary cows’ milk for a2 Milk® to support your child’s calcium levels.
- Educate family, caregivers, and teachers: Everybody responsible for your child needs to be aware of your child's food intolerance and understand the importance of avoiding trigger foods. Provide them with necessary information, including a list of safe and unsafe foods.
- Meal plans: Plan meals and snacks in advance to ensure your child's diet is well-balanced, nutritious and free from trigger foods. Home-cooked meals give you better control over ingredients.
- Encourage open communication: Teach your child to communicate about their food intolerance and ask questions about ingredients or food preparation when dining outside of home.
- Pack safe snacks: When your child is away from home, pack safe snacks to prevent accidental consumption of trigger foods. This is especially important for school lunches, outings, or events.
- Be kind to yourself: Food intolerance symptoms can flare up, even when you’re doing your best. There can be unexpected changes in the amount of food that your child can tolerate. Don’t be hard on yourself. The symptoms will resolve within a short period of time and, unlike allergies, intolerances don’t usually cause damage.
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