The breast feeding mother of an infant with lactose intolerance asks the nurse about dietary measures. The nurse tells the mother to avoid?

Appeared in: SJH Nursing Officer - 2019

Explanation

Hard cheese is a dairy product derived from milk and therefore contains lactose.
While the lactose content in hard, aged cheeses is lower than in fresh milk, it is still a source of both lactose and cow's milk protein.
In clinical practice, symptoms in a breastfed infant attributed to 'lactose intolerance' are often due to Cow's Milk Protein Allergy (CMPA).
The standard management for a breastfed infant with CMPA is for the mother to completely eliminate all dairy products, including cheese, from her diet.

Option B: Green leafy vegetables are plants and do not contain lactose, which is a sugar found in milk. They are a vital part of a healthy diet for a lactating mother.
Option C: Dried beans are legumes. They are a source of protein and fiber and do not contain lactose. They are a common cause of gas in both the mother and infant, but this is due to their fiber and oligosaccharide content, not lactose.
Option D: Egg yolk is a part of an egg and is a common allergen, but it is not a dairy product and contains no lactose.

Clinical Relevance

Nursing practice connection: Use the key finding related to Dietary management for a breastfeeding mother of an infant with milk-related intolerance to guide bedside assessment, documentation, and the next nursing action.
A key nursing responsibility is accurate parent education. It is vital to clarify that a mother's dietary lactose intake does not change the lactose in her breast milk. This prevents unnecessary and ineffective dietary restrictions.
Understanding the difference between CMPA and lactose intolerance is critical for providing correct guidance. Incorrect advice can lead to failure to resolve the infant's symptoms and potential nutritional deficiencies for the mother.
What if the infant has true congenital lactase deficiency? In this extremely rare case, the mother's diet is irrelevant. The infant would fail to thrive on breast milk and would require a specialized, completely lactose-free formula for survival.

How to Approach the Question

First, identify the key condition in the question: 'lactose intolerance' in a breastfed infant.
Next, analyze the core of the question: What food should the mother 'avoid'?
Scan the options to identify their food group and whether they contain lactose. A) Hard cheese (dairy), B) Green leafy vegetables (vegetable), C) Dried beans (legume), D) Egg yolk (egg).
Recognize that lactose is 'milk sugar'. The only milk-based product among the options is hard cheese.
Select 'Hard cheese' as it is the only logical option related to a milk-based intolerance.
Critically think about the clinical premise. While a mother's diet doesn't affect breast milk lactose, it does affect milk protein. The question likely uses 'lactose intolerance' as a common but imprecise term for a condition like Cow's Milk Protein Allergy, where avoiding dairy is the correct advice.

Concept Tested & Keywords

Concept Tested: Dietary management for a breastfeeding mother of an infant with milk-related intolerance.
Stem keywords: breast feeding mother, infant, lactose intolerance, dietary measures
Lead-in keywords: avoid
Clinical cues: The scenario involves a breastfeeding dyad, indicating that the mother's diet is the point of intervention.

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 315-317

Practise the full SJH Nursing Officer - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.