Water bowel movements in lactase deficiency. Distinctive features of individual forms

The idea of lactase deficiency is inextricably linked with general information about lactose as a component of breast milk, the transformations that it undergoes in the child's body and its role for proper growth and development.

What is lactose and its role in the nutrition of a child

Lactose is a sweet-tasting carbohydrate found in milk. Therefore, it is often called milk sugar. The main role of lactose in the nutrition of an infant, like any carbohydrate, is to provide the body with energy, but due to its structure, lactose performs not only this role. Once in the small intestine, part of the lactose molecules under the action of the lactase enzyme breaks down into its constituent parts: a glucose molecule and a galactose molecule. The main function of glucose is energy, and galactose serves as a building material for the child's nervous system and the synthesis of mucopolysaccharides (hyaluronic acid). A small part of lactose molecules is not cleaved in the small intestine, but reaches the large intestine, where it serves as a nutrient medium for the development of bifidus and lactobacilli, which form a beneficial intestinal microflora. After two years, lactase activity begins to naturally decrease, but in countries where milk has been in the adult diet since ancient times, its complete extinction, as a rule, does not occur.

Lactase deficiency in infants and its types

Lactase deficiency is a condition associated with a decrease in the activity of the lactase enzyme (breaks down the carbohydrate lactose) or the complete absence of its activity. It should be noted that very often there is confusion in spelling - instead of the correct "lactase" they write "lactose", which does not reflect the meaning of this concept. After all, the lack is just not in the carbohydrate lactose, but in the enzyme that breaks it down. There are several types of lactase deficiency:

primary or congenital - lack of lactase enzyme activity (alactasia);
secondary, develops as a result of diseases of the small intestine mucosa - a partial decrease in the lactase enzyme (hypolactasia);
transient - occurs in premature babies and is associated with the immaturity of the digestive system.

Clinical symptoms

The absence or insufficient activity of lactase leads to the fact that lactose, having a high osmotic activity, promotes the release of water into the intestinal lumen, stimulating its peristalsis, and then enters the large intestine. Here, lactose is actively consumed by its microflora, resulting in the formation of organic acids, hydrogen, methane, water, carbon dioxide, which cause flatulence and diarrhea. Active formation of organic acids reduces the pH of the intestinal contents. All these violations of the chemical composition ultimately contribute to the development. Thus, lactase deficiency has the following symptoms:

frequent (8-10 times a day) liquid, frothy stools, forming a large water spot with a sour smell on a gauze diaper. It should be borne in mind that a water stain on a disposable diaper may not be noticeable due to its high absorbency;
bloating and rumbling (flatulence), colic;
detection of carbohydrates in feces (over 0.25 g%);
acid reaction of feces (pH less than 5.5);
against the background of frequent stools, symptoms of dehydration may develop (dry mucous membranes, skin, decreased urination, lethargy);
in exceptional cases, the development of malnutrition (protein-energy deficiency), which is expressed in poor weight gain, is possible.

The intensity of the manifestation of symptoms will depend on the degree of decrease in enzyme activity, the amount of lactose supplied with food, the characteristics of the intestinal microflora and its pain sensitivity to stretching under the influence of gases. The most common is secondary lactase deficiency, the symptoms of which begin to manifest themselves especially strongly by the 3-6th week of a child's life as a result of an increase in the amount of milk or mixture that the child eats. As a rule, lactase deficiency occurs more often in children who suffered from hypoxia in utero, or if the next of kin have its symptoms in adulthood. Sometimes there is a so-called "locking" form of lactase deficiency, when in the presence of liquid feces there is no independent stool. Most often, by the time of the introduction of complementary foods (5-6 months), all symptoms of secondary lactase deficiency disappear.

Sometimes symptoms of lactase deficiency can be found in children of "dairy" mothers. A large volume of milk leads to less breastfeeding and the production of mainly “forward” milk, especially rich in lactose, which leads to an overload of the body with it and the appearance of characteristic symptoms without reducing weight gain.

Many symptoms of lactase deficiency (colic, flatulence, frequent stools) are very similar to the symptoms of other neonatal diseases (intolerance to cow's milk protein, celiac disease, etc.), and in certain cases are a variant of the norm. Therefore, special attention should be paid to the presence of other less common symptoms (not just frequent stools, but its liquid, foamy character, signs of dehydration, malnutrition). However, even if all the symptoms are present, the final diagnosis is still very problematic, since the entire list of symptoms of lactase deficiency will be characteristic of carbohydrate intolerance in general, and not just lactose. Read more about intolerance to other carbohydrates below.

Important! The symptoms of lactase deficiency are the same as those of any other disease characterized by intolerance to one or more carbohydrates.

Dr. Komarovsky about lactase deficiency video

Tests for lactose intolerance

Biopsy of the small intestine. This is the most reliable method that, according to the state of the intestinal epithelium, allows you to assess the degree of lactase activity. It is clear that the method is associated with anesthesia, penetration into the intestines and is used extremely rarely.
Construction of lactose curve. The child is given a portion of lactose on an empty stomach and a blood test is done several times within an hour. In parallel, it is desirable to do a similar test with glucose to compare the obtained curves, but in practice, a comparison is simply made with an average glucose value. If the lactose curve is lower than the glucose curve, then there is a lactase deficiency. The method is more applicable to adult patients than to infants, since nothing but the accepted portion of lactose can be eaten for some time, and lactose causes an exacerbation of all symptoms of lactase deficiency.
Hydrogen test. Determination of the amount of hydrogen in the exhaled air after taking a portion of lactose. The method is again not applicable to infants for the same reasons as the lactose curve method and the lack of standards for young children.
Analysis of feces for carbohydrates. It is unreliable due to the insufficient development of carbohydrate norms in feces, although the generally accepted norm is 0.25%. The method does not allow assessing the type of carbohydrate in the feces and therefore making an accurate diagnosis. It is applicable only in conjunction with other methods and taking into account all clinical symptoms.
Determination of the pH of feces (). It is used in combination with other diagnostic methods (fecal analysis for carbohydrates). A fecal pH below 5.5 is one of the signs of lactase deficiency. It must be remembered that only fresh feces are suitable for this analysis, but if it is collected several hours ago, the results of the analysis may be distorted due to the development of microflora in it, which reduces the pH level. Additionally, an indicator of the presence of fatty acids is used - the more of them, the higher the likelihood of lactase deficiency.
genetic tests. They reveal congenital lactase deficiency and are not applicable for its other types.

None of the currently existing diagnostic methods allows, in the case of its only use, to give an accurate diagnosis. Only a comprehensive diagnosis, combined with the presence of a complete picture of the symptoms of lactase deficiency, will give a correct diagnosis. Also, an indicator of the correctness of the diagnosis is the rapid improvement in the child's condition during the first days of treatment.

With primary lactase deficiency (very rare), the child is immediately transferred to a lactose-free milk formula. In the future, a low-lactose diet is maintained throughout life. With secondary lactase deficiency, the situation is somewhat more complicated and depends on the type of feeding of the child.

Treatment with breastfeeding

In fact, the treatment of lactase deficiency in this case can be carried out in two stages.

Natural. Regulation of the intake of lactose in breast milk and allergens through knowledge of the mechanisms of breastfeeding and the composition of milk.
Artificial. The use of lactase preparations and specialized mixtures.

Natural regulation of lactose intake

Symptoms of lactase deficiency are quite common in healthy children and are not at all associated with insufficient activity of the lactase enzyme, but are due to improperly organized breastfeeding, when the child sucks out the “forward” milk, rich in lactose, and the “back”, rich in fat, remains in the breast.

Proper organization of breastfeeding in children under one year means in this case:

lack of pumping after feeding, especially with an excess of breast milk;
feeding with one breast until it is completely empty, possibly using the breast compression method;
frequent feeding with the same breast;
correct grip on the breast by the child;
night breastfeeding for more milk production;
in the first 3-4 months, it is undesirable to tear the child from the breast until the end of her sucking.

Sometimes, to eliminate lactase deficiency, it helps to exclude dairy products containing cow's milk protein from the mother's diet for some time. This protein is a strong allergen and, in case of significant consumption, can pass into breast milk, causing an allergy, often accompanied by symptoms similar to lactase deficiency or provoking it.

It is also helpful to try pumping before feeding to prevent excess lactose-rich milk from entering the baby's body. However, it must be remembered that such actions are fraught with the occurrence of hyperlactation.

If symptoms of lactase deficiency persist, you should seek medical attention.

The use of lactase preparations and specialized mixtures.

Reducing the amount of milk is highly undesirable for the baby, so the first step that the doctor will most likely advise is the use of a lactase enzyme, for example "Lactase Baby"(USA) - 700 units. in a capsule, which is used one capsule per feeding. To do this, it is necessary to express 15-20 ml of breast milk, introduce the drug into it and leave for 5-10 minutes for fermentation. Before feeding, first give the baby milk with enzyme, and then breastfeed. The effectiveness of the enzyme increases when it processes the entire volume of milk. In the future, with the ineffectiveness of such treatment, the dosage of the enzyme is increased to 2-5 capsules per feeding. The analogue of "Lactase Baby" is the drug . Another lactase preparation is "Lactase Enzyme"(USA) - 3450 units. in a capsule. Start with 1/4 capsule for feeding with a possible increase in the dosage of the drug up to 5 capsules per day. Treatment with enzymes is carried out in courses and most often they try to cancel when the child reaches the age of 3-4 months, when his own lactase begins to be produced in sufficient quantities. It is important to choose the right dosage of the enzyme, since too low will be ineffective, and too high will contribute to the formation of plasticine-like stools with the likelihood of constipation.

Lactase Baby Lactase Enzyme
Lactazar

In case of ineffectiveness of the use of enzyme preparations (preservation of pronounced symptoms of lactase deficiency), they begin to use lactose-free milk mixtures before breastfeeding in an amount of 1/3 to 2/3 of the volume of milk that the child eats at a time. The introduction of a lactose-free mixture begins gradually, at each feeding, adjusting its consumed volume depending on the degree of manifestation of symptoms of lactase deficiency. On average, the volume of a lactose-free mixture is 30-60 ml per feeding.

Treatment with artificial feeding

In this case, a low-lactose mixture is used, with a lactose content that will be most easily tolerated by the child. The low-lactose mixture is introduced gradually into each feeding, gradually replacing the previous mixture with it in full or in part. It is not recommended to completely transfer a formula-fed baby to a lactose-free formula.

In the case of remission after 1-3 months, you can begin to enter the usual mixtures containing lactose, controlling the symptoms of lactase deficiency and excretion of lactose with feces. It is also recommended to carry out a course of treatment of dysbacteriosis in parallel with the treatment of lactase deficiency. Care should be taken with medications containing lactose as an excipient (Plantex, Bifidumbacterin), as manifestations of lactase deficiency may worsen.

Important! Attention should be paid to the presence of lactose in medicinal preparations, since the manifestations of lactase deficiency may worsen.

Treatment with the introduction of complementary foods

Complementary foods for lactase deficiency are prepared on the same mixtures (lactose-free or low-lactose) that the child received before. Complementary foods begin with fruit puree of industrial production at 4-4.5 months or a baked apple. Starting from 4.5-5 months, you can begin to introduce or puree from vegetables with coarse fiber (zucchini, cauliflower, carrots, pumpkin) with the addition of vegetable oil. With good tolerability of complementary foods, meat puree is introduced after two weeks. Fruit juices in the diet of children suffering from lactase deficiency are introduced in the second half of life, diluted with water in a ratio of 1:1. Dairy products also begin to be introduced in the second half of the year, initially using those where the lactose content is low (cottage cheese, butter, hard cheese).

Intolerance to other carbohydrates

As noted above, the symptoms of lactase deficiency are also characteristic of other types of carbohydrate intolerance.

Congenital insufficiency of sucrase-isomaltase (practically does not occur in Europeans). It manifests itself in the first days of the introduction of complementary foods in the form of severe diarrhea with possible dehydration. Such a reaction can be observed after the appearance in the child's diet of sucrose (fruit juices, mashed potatoes, sweetened tea), less often starch and dextrins (cereals, mashed potatoes). As the child matures, the symptoms decrease, which is associated with an increase in the absorption surface area in the intestine. A decrease in the activity of sucrase-isomaltase can occur with any damage to the intestinal mucosa (giardiasis, cliac disease, infectious enteritis) and cause secondary enzyme deficiency, which is not as dangerous as the primary (congenital).
Starch intolerance. It can be observed in premature babies and children of the first half of the year. Therefore, starch should be avoided in mixtures for such children.
Congenital malabsorption of glucose-galactose. It is manifested by severe diarrhea and dehydration at the first feeding of the newborn.
Acquired monosaccharide intolerance. It is manifested by chronic diarrhea with a delay in physical development. May accompany severe intestinal infections, celiac disease, intolerance to cow's milk proteins, malnutrition. Characterized by a low pH in feces and a high concentration of glucose and galactose in it. Acquired monosaccharide intolerance is temporary.

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In our article we will talk about an extremely acute and controversial topic in modern pediatrics. Lactase deficiency is a diagnosis that was only read about in scientific articles a dozen years ago. Today, this term has become a kind of brand or fashionable diagnosis for which every third child is treated. Due to the growth in the number of young patients, the number of refusals to breastfeed and the number of sales of extremely expensive lactose-free formulas and lactase preparations are increasing. How does it really work?

Definition of the concept and clinic

Lactose intolerance is a permanent or temporary absence or decrease in the activity of a special enzyme in the small intestine, lactase. The main function of this enzyme is the breakdown of lactose milk sugar molecules into one glucose molecule and one galactose molecule. If there is no or little lactase in the small intestine, lactose remains undigested and undergoes fermentation processes. These processes are accompanied by the release of a large amount of gas and osmotically active substances that cause diarrhea. .

This implies the main symptoms and clinical manifestations of lactase deficiency:

Frequent loose stools.
Bloating.
Cramping pains.

The important thing is that these symptoms appear within 1-2 hours of taking the milk!

Relevance of the topic

Lactase deficiency is predominantly a disease of infants, that is, children under one year old. It is at this age that the main food of the child is breast milk or adapted milk formulas.

This condition also occurs in adults, but in this case it is more a variant of the physiological “growing up” of the body than a disease. In the wild, no mammal feeds on milk beyond childhood. So in humans, upon reaching 6-7 years, the activity of the lactase enzyme fades. It’s just that in some adults, symptoms of deficiency will appear from a couple of sips of whole milk, while in others after a liter.

So, there are several types of lactase deficiency:

Primary or congenital, when the enzyme is absent in the body in principle. This variant of the disease is extremely rare. According to recent studies, only a few dozen people with a complete genetically determined lack of lactase have been identified in the world.
Secondary or acquired insufficiency. This situation occurs much more often, but it is absolutely a passing phenomenon. Most often, secondary insufficiency develops as a result of damage to the walls of the small intestine. The reasons for this may be:

Intestinal infections, especially rotavirus.
Toxin poisoning.
Worm infestations.
Allergy or individual food intolerance. For example, an allergy to cow's milk protein or gluten intolerance is known as celiac disease.

With the elimination of these processes, lactase deficiency also disappears.

Also, the cause of the development of secondary lactase deficiency can be the banal overfeeding of the child, when there is an enzyme in the intestines, but its quantity is not enough for increased volumes of milk.

Transient lactase deficiency occurs in premature infants with immature intestines. However, as the child grows, lactase begins to be produced in the right quantities.
Adult lactase deficiency. As already mentioned, this is more a variant of the norm than pathology. Adults are not as dependent on milk in their diets and can easily limit their intake or opt for lactose-free milk as an alternative.

Diagnosis of lactase deficiency

In adults, the diagnosis of lactase deficiency is extremely simple and is based on clinical manifestations. If bloating, diarrhea, and pain occur within 2 hours of ingesting whole milk, this diagnosis can be safely suspected. Of course, this is not a reason to self-diagnose. With frequent repetition of such symptoms, you need to contact a gastroenterologist to exclude such serious diseases as Crohn's disease, ulcerative colitis, chronic intestinal infection, celiac disease, and so on.

Lactase deficiency in children of the first year of life is still a more significant and significant condition, because milk is the basis of their diet. This is where the main diagnostic difficulties arise.

Some guidelines cite the following clinical manifestations as the basis for a diagnosis, often completely unfounded:

Frequent loose stools.
Frequent vomiting.
Colic, bloating.
Restless behavior of the child during feeding.
The presence of lumps of undigested milk or mucus in the stool.
Constipation.

In contrast to these arguments, one can cite a quote from the World Health Organization's guidance on infant nutrition: "The stool of a breastfed child can be of absolutely any kind, frequency and regularity, provided that the child is in good health and develops normally!". That is, if a baby has loose stools with white lumps 10 times a day, but at the same time gains weight well, eats well, is happy and satisfied, this cannot be a sign of a particular disease!

Bloating and colic are an unpleasant, but absolutely physiological condition of children under 6 months old. This period of intestinal maturation just needs to be experienced.
The restless behavior of the child at the breast is more likely a sign of a short frenulum of the tongue, reflux disease, or inflammatory processes in the oral cavity in infants.

Of course, there are a number of laboratory tests to confirm lactase deficiency.

Analysis of feces for carbohydrates. It is believed that there should be little or no undigested carbohydrates in the feces of infants in older children. However, the assay does not specifically assess lactose content, so is not specific.
Analysis for pH (acidity) of feces. Undigested lactose residues can lower the acidity of the feces below 5.5, which may be indirect a sign of lactase deficiency.
Breath tests for the content of lactose breakdown products in the intestine in the exhaled air. With their reduced content, it can be assumed that lactose does not decompose in the intestine. Accordingly, there is a deficiency of the lactase enzyme.
Biopsy of the intestine. An invasive procedure that is absolutely not indicated for infants in order to diagnose lactase deficiency.
Genetic analysis that will show the presence or absence of genes responsible for lactase production. This is perhaps the most accurate diagnostic criterion. Unfortunately, such analysis is very expensive and not always available.
Test with the abolition of breast milk or formula for 2-3 days. Breastfeeding or milk formula is canceled, the child is transferred to a low-lactose or soy formula. This test can be considered as a diagnostic criterion, as well as a therapeutic moment, especially against the background of intestinal infections. However, as already mentioned, the vast majority of cases of lactase deficiency in infants is a secondary form and resolves on its own within a certain time.
Test with the addition of lactase preparations. In this case, there is no need to refuse breastfeeding or the usual mixture. With the relief of symptoms, lactase deficiency can be stated, which is also likely to be secondary and temporary!

Thus, it can be stated that there are no absolutely reliable and unambiguous tests for the diagnosis of lactase deficiency. The primary form of the disease is extremely rare, and the secondary goes away on its own after the elimination of intestinal problems or overfeeding.

Treatment

The most common and, unfortunately, absolutely wrong is the abolition of breastfeeding or milk formula and the transfer of infants to lactose-free soy formulas. This action does not make any sense in itself, except, perhaps, enrichment of the companies producing these mixtures.

Prescribing lactase preparations (Lactase Baby, Lactazar). This method of correcting temporary or transient lactase deficiency is more acceptable. In this case, the child remains on the usual formula or breast milk, which has no analogues. Usually, taking lactase supplements is a temporary measure until the intestines mature or the intestinal wall recovers.
The appointment of probiotics - preparations containing ready-made intestinal lactobacteria and bifidobacteria (Linex, BioGaia, Baktisubtil, Bioselak, Bioflor, Bifidumbacterin, etc.) can alleviate the symptoms of lactase deficiency and promote the development of intestinal enzyme systems in infants.
Adjust the frequency of feeding and portion size. This is especially true for formula-fed babies. When feeding with a mixture, it is important to observe the volume of the mixture and the frequency of feeding in order to prevent overfeeding. When breastfeeding, you need to consider the option of supplementing the baby with water, especially on hot days and the heating season.

It is very important to find a competent, adequate pediatrician who will treat the child’s condition with understanding and understand the true causes of his condition, and will not make unreasonable diagnoses and prescribe useless treatment.

Lactose is a disaccharide, a sugar made up of two simple molecules, glucose and galactose. In order for this sugar to be absorbed, it must be broken down into its simple components by the enzyme lactase. This enzyme "lives" in the folds of the mucous membrane of the small intestine.

In lactase-deficient children, the body cannot produce enough lactase, which means there is no way to digest and absorb the sugars found in milk and milk derivatives.

Since this sugar cannot be digested properly, it is exposed to the normal bacterial flora in the colon. This process of action, called fermentation, leads to symptoms that indicate a lactase deficiency in a child.

There are two types of lactase deficiency.

Various factors cause the lactase deficiency underlying each type.

primary lactase deficiency is an unusually rare diagnosis when babies have an absolute absence of the lactase enzyme from birth. Primary lactase deficiency in newborns manifests itself in the form of heavy feeding or the usual mixture, which requires the selection of special nutrition. This is a genetic disease inherited in a recessive way of inheritance. For lactase deficiency symptoms to develop, a child must receive one disease gene from each parent;
secondary lactase deficiency is a temporary intolerance. Because the enzyme lactase is produced in the villi of the small intestine, anything that damages the lining can cause a secondary lactase deficiency. Even slight damage to the mucosa can erase these villi and reduce enzyme production. In children, diarrhea is observed when consuming lactose-containing products, as well as nausea and vomiting. Rotavirus and - two infections associated with temporary lactase deficiency. However, any other viral and bacterial gastroenteritis can cause a lactase deficiency.

Celiac disease is a disease of the digestive system that causes damage to the small intestine when gluten (vegetable protein) is ingested, causing a temporary lactase deficiency. Children with lactose can only consume lactose-containing foods when the intestinal lining heals after following a strict gluten-free diet.

Crohn's disease is an inflammatory bowel disorder that also causes lactase deficiency. If the disease is adequately treated, then after that the condition improves.

Unfortunately, additional feeding speeds up peristalsis and leads to even more accumulation of gas and liquid.

Many mothers whose children have had this problem are advised to change their feeding routine.

This is usually only needed for a short time. The goal is to slow down the rate at which milk is delivered to the baby by "feeding" one breast per feed, or by "block feeding".

To block feeding, set a 4-hour breast change period and use the same breast each time the baby wants to feed during this period. Then use the other breast for the next 4 hours, and so on. Each time a baby returns to an already begun breast, he receives a smaller volume of milk with a higher level of fat.

This helps slow down the digestive system. During block feeding, make sure that the other breast is not crowded. When the child's symptoms disappear, the mother can return to her normal routine and give food as needed.

Symptoms

Fermentation of lactose in the large intestine by intestinal flora results in the formation of carbon dioxide and hydrogen, as well as some products that have a laxative effect.

Five symptoms to look out for:

loose stools and gas;
liquid diarrhea with gases;
bloating, flatulence, nausea;
skin rash and frequent colds;
abdominal pain and cramps.

Signs of lactase deficiency may be similar to those of other conditions and depend on the amount of lactose consumed. The more lactose a child consumes, the more severe the symptoms will be.

Aside from the symptoms and discomfort associated with the condition, lactase deficiency in children is not a life-threatening disorder with long-term complications – it simply suggests a lifestyle change.

If the child has symptoms of a lactase deficiency, the doctor will recommend switching to a lactose-free diet to see if the symptoms disappear. If the symptoms go away, then the child is lactase deficient.

A stool sample is taken to confirm the diagnosis. High levels of acetate and other fatty acids in the stool are signs of a lactase deficiency.

The specific treatment for lactase deficiency will be determined by the doctor. based:

the child's age, general health and medical history;
the degree of the disease;
the child's tolerance for specific drugs, therapies, or procedures.

Although there is no treatment to improve the body's ability to produce lactase, the symptoms caused by a deficiency in this enzyme are controlled through diet. In addition, a doctor may suggest lactase enzymes available without a prescription.

If you want to avoid dairy and other products containing lactose, read the labels on the products you buy. Some seemingly safe foods — processed meats, baked goods, breakfast cereals, confectionery — contain milk. Check food labels on products such as whey, cottage cheese, milk by-products, powdered and skimmed milk.

By law, products containing dairy ingredients (or other common allergens) must be clearly labeled as such. This should make your job easier.

Watch how your child reacts. Some lactase-deficient babies can digest some milk, while others are very sensitive to even minimal amounts.

For example, some cheeses have less lactose than others, making them easier to digest. And live culture yogurt is generally easier to digest than milk because the healthy bacteria in fermented milk helps the body produce lactase.

Stopping breastfeeding infants in favor of lactose-free formula is not a solution. The solution for an infant with secondary lactase deficiency is not to stop breastfeeding or switch to lactose-free formula.

These formulas should only be recommended if the baby is already formula-fed or if there are concerns about growth. The way out is to find out what caused the secondary lactase deficiency and deal with it. Breast milk will help the intestines to heal.

Therefore, if there is a factor that irritates the intestines, breastfeeding is recommended to continue. When the cause of the deficiency is identified and corrected, the bowel heals and the deficiency disappears.

For example, if the cause of secondary lactase deficiency in exclusive breastfeeding is an allergy to cow's milk protein and the mother eliminates it from her diet, the infant's symptoms resolve.

A lactose-free formula may reduce symptoms, but it won't actually heal the gut because the lactose-free formula still contains cow's milk protein. In severe cases, a highly hydrolyzed special mixture is prescribed.

If the child is very sensitive, all sources of lactose should be excluded from the diet. If not, you can give him a small amount of selected dairy products. It will be easier to carry them if the baby eats such food along with other foods.

Make sure that all nutritional needs of the child are met. If you find yourself needing to eliminate dairy entirely from your child's diet, you need to be sure your child has other sources of calcium to help keep bones and teeth strong. Non-dairy sources of calcium: sesame seeds, leafy greens, fortified juices, soy milk and cheese, broccoli, salmon, sardines, oranges.

Other nutrients to worry about are vitamins A and D, riboflavin and phosphorus. Lactose-free dairy products are now available at many grocery stores. They have all the nutrients of regular dairy products.

Lactase deficiency has been recognized as a common problem in many children around the world. And although it is rarely life-threatening, the symptoms of lactase deficiency lead to significant discomfort, a decrease in the quality of life. Treatment is relatively simple and aims to reduce or eliminate the offending agent.

This can be done by eliminating lactose from the diet or by pre-treating with the enzyme lactose. Calcium should be provided by non-dairy dietary alternatives or taken as a dietary supplement.

Lactose deficiency is a common and incorrect name lactase insufficiency. In the following text, the correct name of the disease will be used.

Signs of lactase deficiency in children of different ages are very different. So, in infants, the signs of lactase deficiency are some symptoms, and in children over 6-7 years old, they are completely different. Since lactase deficiency leads to intolerance to milk, which is the main food for infants in the first year of life, the importance of identifying and treating the disease in infants is understandable.

So, in infants, all the symptoms of lactase deficiency are detected depending on the manifestations of digestive disorders, which indirectly indicate the indigestibility of milk in the intestine. Currently, most of the classic guides and articles give the following signs of lactase deficiency in young children:

Colic;

Bloating

Frequent and loose stools (up to 8 - 10 times a day);

Sour-smelling and green-colored stools;

The presence of lumps of undigested milk in the stool;

Constipation (lack of independent stool in a child without additional stimulation);

Crying and arching of the child in the process of feeding.

The above signs do develop in children with lactase deficiency. However, these symptoms are not specific, therefore, when they appear, it is impossible to unambiguously and immediately diagnose a child with lactase deficiency. In addition to simply knowing the possible symptoms of lactase deficiency, it is necessary to understand in what situations their appearance is really caused by the disease, and when they are simply the physiological characteristics of the child.

Colic and bloating occurs in almost all healthy babies, and are a variant of the norm up to six months. Therefore, only the appearance of colic and bloated abdomen in a child during the first 6 months of life is not a sign of lactase deficiency.

Frequent, liquid, frothy green stools with lumps of undigested milk may also be a manifestation of the norm. The green color of the stool is given by the components of bile, which constantly enters the intestines of the child. Foam is a trace of the presence of a large amount of gases. And undigested lumps of milk in semi-liquid contents are normal, since the child removes the milk protein casein from the body, which he is unable to absorb. Normally, a child can have stools up to 10 times a day. Thus, the presence of frequent, liquid greenish and frothy stools can be in a perfectly healthy child. If a baby with a similar stool is gaining weight and developing normally, then he definitely does not have lactase deficiency, and a similar type of feces for this particular child is a variant of the norm.

Constipation. By constipation, most parents understand the absence of a chair in a child for several days. However, if the child feels well, then he does not have constipation, but a physiological retention of stool, which can last up to 5-6 days in infants. Constipation is considered only the appearance of a dense and shaped (in the form of a sausage) stool in an infant. Therefore, stool retention against the background of the child's well-being is also not a sign of lactase deficiency.

Restless behavior of the child during feeding, when he cries, stops suckling, arches, etc. Most often, this behavior of the baby is due to gastroesophageal reflux, which is normally observed in most children up to 8 months. Remember that lactase deficiency is manifested in milk intolerance, and symptoms of indigestion occur only 0.5 - 1 hour after eating any dairy products. Therefore, the anxiety of the child in the process of feeding may be a sign of other diseases, but not lactase deficiency. The same goes for spitting up.

Thus, none of the above symptoms is a characteristic sign of lactase deficiency. However, they may be present in lactase deficiency. But at the same time, with lactase deficiency in a child, in addition to these symptoms, there is always a developmental delay and other signs of various digestive disorders. Therefore, lactase deficiency is manifested by the above symptoms, which must necessarily be combined with the following violations of the general well-being of the child:

Developmental delay of the child (low weight gain, insufficient increase in height);

Frequent watery stools in combination with developmental delay;

Allergic skin rashes;

Iron deficiency anemia, not amenable to therapy;

True constipation (the appearance of dense feces in a child).

The listed violations in combination with the above symptoms are reliable signs of lactase deficiency in infants. And the separate appearance of developmental disorders or symptoms of lactase deficiency does not indicate the development of this disease.

In children older than 6 years and adults, lactase deficiency manifests itself quite typically and is not difficult to diagnose. So, typical signs of lactase deficiency in non-babies and adults are the following symptoms that appear 1 to 2 hours after taking milk or dairy products:

Bloating

Flatulence;

The severity, duration and intensity of symptoms depend on the amount of milk consumed, as well as on the degree of lactase deficiency.