Everyone knows that babies need milk for nutrition. This is the main and only product on which the growth, development and health of the baby depends. Unfortunately, a small organism is not always able to process it correctly. Approximately twenty percent of newborns are diagnosed with lactase deficiency. This is the name given to a deficiency of the enzyme that breaks down milk sugar. And this, in turn, entails various unpleasant consequences.

The danger of lactase deficiency is due to the symptoms and consists of the following:

• diarrhea can quickly lead to dehydration;
• indigestion causes low weight gain or loss;
• lack of important and useful substances due to their improper absorption, it leads to an imbalance in metabolism and causes problems in the functioning of some organs;
• incompletely digested lactose provokes dysbiosis, fermentation and flatulence;
• in cases where the tactics of treating the disease require stopping breastfeeding, the child loses powerful natural protection in the form of vitamins, minerals, immunoglobulins and others valuable substances which he received through his mother's milk.

In order not to miss important signals from the infant body and to take adequate measures in time, it is important to “know the enemy by sight.”

Causes and types of disease

Regardless of the type of feeding, the lack of lactase in the body is provoked by the following factors:

• Genetic predisposition. If close relatives of the child suffer from this disease, a large share chances are it will manifest itself in him too.
• Organ diseases digestive system . In this case, lactase deficiency is one of the possible consequences transferred intestinal infections, helminthic infestation, enterocolitis or allergies.
• Low birth weight and prematurity- serious risk factors. If a child was born prematurely (or on time, but the organs and systems are not fully mature), in the first months of life he may also experience an inability to process milk sugar. Usually, as the gastrointestinal tract matures, the symptoms gradually disappear.

There are 2 types of lactase deficiency:

• alactasia (when the enzyme is completely absent);
• hypolactasia (when the enzyme is produced in small quantities or is characterized by reduced activity).

It can also be primary or secondary. In the first case, there are 3 forms:

1. Congenital(passed on by inheritance). The reason lies in gene mutation. It is quite rare. Both alactasia and hypolactasia are possible. Suspect the baby this form The disease can be caused by weight loss and the development of dehydration. The faster the diagnosis is made and implemented special food, the greater the chance that the child will survive and adapt to life without dairy products.

2. Transitional(or temporary) form of lactose intolerance - this is exactly what we talked about above. This is what is typical for low weight and premature babies. By the time they are born, the enzymatic system simply does not have time to fully develop, as a result of which the baby develops lactase deficiency. However, this is a passing phenomenon: as the body grows and develops, the disease will disappear. Therefore, as a rule, treatment is not necessary.

3. Functional a form that is recorded quite often. Its causes are not in pathology or immaturity of the digestive system, but in external factors:

• feeding defects, in particular overfeeding. This heavy load on a fragile organism: enzymes simply do not have time to break down the incoming lactose, there is too much of it.
• Low fat breast milk. As a result, it passes through the gastrointestinal tract too quickly, which also unnecessarily loads the digestive organs.

Reason secondary Lactase deficiency is damage to intestinal cells that can be caused by:

In case of secondary lactase deficiency, there is no need to interrupt natural feeding. Doctors usually recommend taking enzymes before feeding and a diet for the nursing mother.

Symptoms

Let's look at the main signs of lactase deficiency:

• The baby willingly takes the breast, but soon abandons it, starts crying and kicking its legs? Restlessness during or immediately after feeding, signals abdominal pain, intestinal colic. This is definitely worth paying attention to. In infants, colic is part of adaptation to the outside world, but it is also a constant companion to lactase deficiency.
• Flatulence and rumbling in the tummy, which is clearly audible.
• Regurgitation, vomiting.
• Changes in stool: This is usually frequent, loose, greenish stools, with or without foam. However, constipation is also possible. In general, the stool differs from normal: it is unstable, the consistency is uneven, there are lumps or impurities, the smell is predominantly sour.
• The child’s weight gain is insignificant or not at all. It even happens that the baby loses weight instead of systematically gaining it.
• A rash may appear on the skin.
• Diarrhea may cause dehydration.

Be that as it may, these symptoms should be considered comprehensively, since individually they are characteristic of many other diseases digestive tract. When making a diagnosis, one should take into account not only complaints and symptoms, but also the results of laboratory tests.

Diagnostics

Adults should not try to make a diagnosis on their own; lactase deficiency can easily be confused with something else. Correct tactics- contacting a local pediatrician (or gastroenterologist), who:

• will examine the baby, ask about complaints, find out how and what he eats;
• will conduct a test in which dairy products are excluded from the child’s diet completely or partially (if the problem is lactase deficiency, the symptoms will subside);
• will send you for a stool test to determine the amount of carbohydrates in it - a result of more than 0.25% at a pH less than 5.5 confirms the diagnosis.

These are the main examination methods. Genetic tests and other tests are carried out in cases of urgent need, not all of them are desirable for an infant.

On at the moment There is no method that will give 100% confirmation or refutation of the diagnosis if only one was used. This means that reliable result can only give comprehensive examination with the full range of symptoms. In addition, an important criterion for the correctness of the diagnosis is how quickly the baby recovers from the moment treatment begins.

How and how to help a child

Most difficult case- congenital alactasia, when the enzyme is not produced by the body at all. Complete removal of lactose from the baby’s diet is undesirable, because it is necessary for the formation of healthy microflora in the intestines. This move is justified only in severe cases of the disease.

Functional and temporary lactase deficiency requires limiting the consumption of milk sugar. The allowed amount is determined and subsequently adjusted based on the results of an analysis of sugar content in stool.

Interrupting natural feeding and transferring the baby to infant formula is not required in all cases, so do not rush into this. Mother's milk is an indispensable assistant in the formation of immunity and intestinal microflora, a storehouse of valuable substances necessary for full development little man. Therefore, if there is at least the slightest possibility Continue breastfeeding, it should be used. But it is necessary to give the child an additional enzyme.

The drugs “Lactazar”, “Baby-doc”, “Lactase Baby” and similar are prescribed. The enzyme is diluted in expressed breast milk and given to the baby immediately before feeding. The drugs are used until the child reaches 4–6 months, until independent lactase production is established.

If the symptoms are pronounced, you can resort to mixed feeding (alternating breast milk and lactose-free infant formula). However, the mother needs to be prepared for the fact that the introduction of formula over time may provoke the child to refuse the breast.

If the baby is artificial nutrition , it must be replaced with another one with low or zero lactose content (depending on the severity of the situation). It is worth keeping in mind that this option may have disadvantages. The first mixture chosen is not always suitable; an allergy to some of its components may occur. While the body adapts, changes in stool are likely. It is better to select the mixture taking into account the opinion of the pediatrician and individual characteristics child. And remember that it needs to be introduced gradually.

Another important point: you have to try do not overfeed the baby. It is better to reduce portions and feed more often. Sometimes this measure alone helps to get rid of the clinical manifestations of lactase deficiency. After all, the body produces exactly as much enzyme as is required to process a normal portion of milk.

We must not forget about proper nutrition nursing mother. Whole milk is excluded from her menu. The issue of consuming kefir and other fermented milk products is resolved individually with the pediatrician.

• If the mother has an excess of milk, it is better to express a little before each feeding. So the baby will get a little less foremilk, rich in lactose, and will quickly reach hindmilk, which is more nutritious and fatty. The latter takes longer to digest, and during this time the milk sugar has time to be processed.
• You should aim to feed only one breast at one feeding. This will also help your baby receive hindmilk regularly. You should not pump additionally after feedings.
• Babies with lactase deficiency are given complementary foods with caution, carefully monitoring the reaction. Give dairy-free porridges; it’s better to start with buckwheat, rice and corn grits.
• Children's kefir and yogurt are administered from at least 8 months, after consultation with a pediatrician. If adults notice that they are poorly absorbed, they should be excluded. Cottage cheese begins to be given in small portions from 12 months. The baby is not allowed whole milk, and neither is the mother (while she is breastfeeding).

When something bothers the baby, pediatrician appoints symptomatic treatment. In addition to enzymes, these can be:

• probiotics (Bifiform Baby, bifidumbacterin, linex) to bring the microflora into balance;
• dill water or simethicone preparations for increased gas formation;
• medicines for spasms (papaverine) for severe intestinal colic.

In case of secondary lactase deficiency all efforts should be aimed at combating the underlying disease that provoked hypolactasia.

Prevention

The congenital form cannot be corrected, preventive measures against it does not exist. However, in this case, adults usually assume in advance that this is possible, know how to help and what to do. Prevention for the secondary form of the disease is to avoid gastrointestinal infections. And for this it is necessary to follow the rules of sanitation and hygiene, avoid contact with sick people, and strictly monitor the quality of food that ends up on the family table.

So, if the doctor has concluded that the baby has lactase deficiency, parents should not panic and urgently stop breastfeeding. IN lately Unfortunately, this diagnosis has become very common and not always justified.

But even if your child does have a disease, keep in mind that only congenital complete absence enzyme poses a danger to his life and health. Other forms of pathology make it possible to cope with the problem by changing the diet of the nursing mother and baby, properly introducing complementary foods and using special drugs. These measures will help provide the baby with the substances necessary for harmonious growth and development. Parents are required to be vigilant in case of any manifestation of anxiety in combination with alarming symptoms Find out the cause together with your pediatrician.

Health to you and your children!

E. N. Preobrazhenskaya, Ph.D., will talk about what methods exist for testing a patient for lactose intolerance, in what cases it is necessary to prescribe treatment and what kind of nutrition an adult patient needs, as well as about the nutritional features of an infant with lactase deficiency. dietician of higher education qualification category(Northwestern State medical university them. I. I. Mechnikova, St. Petersburg).

Diagnosis of lactose intolerance

Lactose tolerance test

You should not eat anything before the test. On the day of the test, the patient drinks a liquid containing lactose, which can cause gas and abdominal pain. After this, the blood is checked every 30 minutes for 2 hours. If your blood sugar does not rise, it may indicate lactose intolerance. This test is not applicable to patients with diabetes mellitus, and babies.

Lactose intolerance in a child is determined by exclusion. For 2 weeks, milk and dairy products are excluded from the child’s diet. After the symptoms of dyspepsia disappear, milk is gradually reintroduced into the child’s diet in small portions. If symptoms of lactose intolerance occur 4 hours after your child drinks milk or formula, this means that the child does not have enough lactase enzyme.

Breath hydrogen test

This is the most accurate analysis lactose intolerance. Determining the hydrogen content in exhaled air makes it possible to identify the activity of microflora in digesting lactose. The concentration of gases is determined after a dosed load of regular or labeled lactose. The method is used to diagnose lactose intolerance in adults and older children.

Stool acidity analysis

Definition general content carbohydrates in stool, which reflects the body's ability to metabolize carbohydrates.

Treatment of lactase deficiency

Only those cases of lactose intolerance that are clinically manifest require treatment. The main principle of treatment is a differential approach to therapy depending on:

• depending on the age of the patient (term or premature newborn, infant, young, older, adult patient);
• degree of enzymatic deficiency (alactosia, hypolactosia);
• genesis of fermentopathy (primary or secondary).

The main treatment for patients with absolute lactase deficiency (alactasia) is a complete abstinence from consuming milk and dairy products. In parallel, therapy is carried out aimed at correcting intestinal dysbiosis, replacement therapy(use of lactase preparations: lactrase, thylactase, lactaid) and symptomatic treatment.

In secondary lactase deficiency, the focus is on treating the underlying disease. Reducing the amount of lactose in the diet is temporary until the mucous membrane is restored small intestine.

In patients with primary or secondary lactase deficiency, the degree of restriction in the consumption of milk and dairy products is strictly individual, since some patients cannot tolerate only milk, but are able to eat fermented milk products dream high content lactose. And patients with a slight degree of hypolactasia can consume even small amounts of fresh milk (up to 100-150 ml per day) without harm to health. In such cases, it is allowed to take milk not on an empty stomach, slowly, in small portions no more than 1-2 times a week. Restrictions are lifted when the patient's tolerance to dairy products increases.

Keep a food diary!

The patient needs to keep a food diary. Thanks to the recordings, you can get answers to two important questions:

• What particular product caused flatulence and diarrhea?
• How much lactase should be added to foods containing lactose?

In order to identify the patient's reaction to milk, it is recommended to carry out test loads of milk or lactose. Training of the corresponding enzyme systems is also shown by administering small amounts of fermented milk products with satisfactory condition sick child or adult patient. An indicator of an increase in the threshold of tolerance to milk is the absence of intestinal disorders.

Carefully!

IN food industry Lactose is used in the production of many food products. In addition to milk and dairy products, lactose is present in packaged sausages, packaged soups, ready-made sauces, chocolate, cocoa powder. It is used to increase the viscous properties of the product and ease of use. Lactose is 30-35% less sweet than sucrose; it is added in large quantities. When baked, milk sugar turns brown, so it is an invariable ingredient in French fries, croquettes, confectionery and baked goods.

Lactose is also widely used in the manufacture pharmaceuticals, is one of the main components of flavors, flavor enhancers, sweeteners, etc.

Read food and drug labels.

Amount of lactose in products

Using a special list of products, you can determine the amount of lactose present in the diet. Below are data from various authors.

• Dessert cream - 2.8-6.3.
• Coffee whitener - 10.0.
• Yogurt made from powdered milk - 4.7.
• Whole milk yogurt (3.5%) - 4.0.
• Milk yogurt (1.5%) - 4.1.
• Milk yogurt (3.5%) - 4.0.
• Natural yogurt - 3.2.
• Creamy yogurt - 3.7.
• Low-fat fruit yogurt - 3.1.
• Low-fat fruit yogurt - 3.0.
• Yogurt ice cream - 6.9.
• Creamy fruit yogurt - 3.2.
• Cocoa - 4.6.
• Mashed potatoes - 4.0.
• Semolina porridge - 6.3.
• Rice porridge with milk - 18.0.
• Kefir - 6.0.
• Low-fat kefir - 4.1.
• Sausages - 1.0-4.0.
• Margarine - 0.1.
• Butter - 0.6.
• Sour milk - 5.3.
• Low-fat milk - 4.9.
• Pasteurized milk (3.5%) - 4.8.
• Condensed milk (7.5%) - 9.2.
• Condensed milk (10%) - 12.5.
• Condensed milk with sugar - 10.2.
• Powdered milk - 51.5.
• Skimmed milk powder - 52.0.
• Whole milk (3.5%) - 4.8.
• Whole milk powder - 38.0.
• Milkshakes - 5.4.
• Milk chocolate - 9.5.
• Ice cream - 6.7.
• Milk ice cream - 1.9-7.0.
• Ice cream sundae - 1.9.
• Creamy ice cream - 5.1-6.9.
• Fruit ice cream - 5.1-6.9.
• Nougat - 25.0.
• Buttermilk - 3.5.
• Dry buttermilk – 3.5.
• Donuts - 4.5.
• Pudding - 2.8-6.3.
• Whipped cream (10%) - 4.8.
• Whipped cream (30%) - 3.3.
• Coffee creamer (10%) - 3.8.
• Pasteurized cream - 3.3.
• Pasteurized whole cream - 3.1.
• Sour cream (10%) - 2.5.
• Dry whey – 70.0.
• Gouda cheese (45%) - 2.0.
• Camembert cheese (45%) - 0.1-3.1.
• Mozzarella cheese - 0.1-3.1.
• Parmesan cheese - 0.05-3.2.
• Roquefort cheese - 2.0.
• Steppe cheese - 0.1.
• Cottage cheese (20%) - 2.7.
• Cottage cheese (40%) - 2.6.
• Low-fat cottage cheese - 3.2.

• Buckwheat groats - 0.03.
• Oatmeal - 0.05.
• Oatmeal - 0.02.
• Winter wheat - 0.05.
• Soft spring wheat - 0.02.
• Women's milk - 6.6-7.0 (cow's milk - 4.8, sterilized cow's milk - 4.7, mare's milk - 5.8, sheep's - 4.8, goat's - 4.5, camel's - 4.9, dry whole - 37.5, dry low-fat - 49.3).
• Full-fat kefir - 3.6.
• Yogurt - 4.1.
• Acidophilus - 3.8.
• Yogurt - 3.5.
• Kumis - 5.0.
• Pasteurized buttermilk - 4.7.
• Dry cream - 26.3.
• Sterilized cream (25%) - 3.3.
• Condensed milk with sugar - 12.5.
• Condensed milk without sugar - 9.5.
• Low-fat cottage cheese - 1.8.
• Fat cottage cheese - 2.8.
• Cream (10%) - 4.0.
• Cream (20%) - 3.7.
• Sour cream (30%) - 3.1.
• Cocoa with condensed milk and sugar - 11.4.
• Coffee with condensed milk and sugar - 9.0.
• Coffee with condensed cream and sugar - 9.0.
• Hard cheeses (the indicator depends on the fat content of the product) - 2.0-2.8.
• Cheese cheese - 2.9.
• Oil of traditional composition - 0.81 (“Peasant” - 1.35, “Buterbrodnoe” - 1.89).
• Creamy ice cream - 5.8.
• Low-lactose dry milk mixture, with rice flour - 0.36, with buckwheat flour - 0.36, with oatmeal - 0.36.

Products that almost always contain milk sugar:

• Milk and dairy products.
• Packaged sausages, including cooked ham.
• Soups in bags.
• Ready-made sauces.
• Bakery products.
• Nut butter.
• Ice cream.
• Breadcrumbs.
• Cakes and pies.
• Dumplings.
• Croquettes with cheese.
• Hamburgers.
• Cheeseburgers.
• Ham.
• Ketchup.
• Mustard.
• Mayonnaise.
• Flavor enhancers.
• Astringent component for making sauces.
• Sweeteners in prepared packaged foods.
• Condensed milk.
• Bulk spices.
• Chocolate bars, sweets such as candies, chocolate (with the exception of some varieties of dark chocolate).
• Cocoa powder.
• Nutritional supplements.
• Light sauces.
• Puddings, puree soups.
• Donuts and omelettes.
• Mashed potatoes.
• Saccharin tablets.

Products approved for use in lactase deficiency:

• Soy milk and soy drinks.
• Low lactose milk formulas.
• Raw meat, poultry, fish.
• Eggs.
• Lard.
• Vegetable oil.
• All fruits and vegetables.
• Potato.
• Cereals (rice, etc.).
• Legumes.
• Nuts.
• Jam, honey, syrups.
• Any type of sugar except milk (sorbitol, fructose).
• Liquid saccharin.
• Fruit and vegetable juices.
• Tea, coffee.
• Pasta from wheat flour no additives.
• Natural flour.
• Rye and wheat bread without whey and food additives.

Nutrition for lactase deficiency

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With primary (constitutional) lactase deficiency, the amount of lactose in the diet is reduced, up to its complete exclusion for life. You can reduce the amount of lactose in your diet by reducing or completely eliminating the consumption of lactose-containing products, primarily whole milk (see Table 1). This method is suitable for adults and older children with adult-type lactase deficiency.

It is important to note that neither in adults nor in children is there a correlation between the level of lactase activity and the severity of clinical symptoms. With the same degree of enzyme deficiency, there is great variability in symptoms (including diarrhea, flatulence and abdominal pain). However, for each individual patient clinical manifestations depend on the amount of lactose in the diet (dose-dependent effect).

In case of secondary lactase deficiency, the use of fermented milk products, butter, and hard cheeses is allowed. Pasteurized fermented milk yoghurts are absorbed worse by patients, since the microbiological effect of lactase is destroyed during heat treatment. You should buy products with live lactic acid bacteria because the bacteria in yogurt have already digested some of the lactose. It is advisable to eat yogurt, or acidophilus, or yogurt every day.

Cheeses are divided according to the degree of ripening: the longer the cheese ripens, the less milk sugar remains in it. Consequently, hard and semi-hard cheeses (Swiss, cheddar) lose most of the lactose.

Fats and half-fat cream contain less lactose than milk, so their consumption in small quantities is allowed in exceptional cases. The higher the fat content of a product, the less lactose it contains. A glass of milk contains 12 g of lactose. If necessary, milk and milk cheese can be replaced with soy milk and soy cheese.

It is advisable to combine dairy products, for example, with grain foods, bread products, pies, writes Edward Claflin in his book “ Home doctor for children" (1997).

A dairy-free diet may reduce calcium intake.

Infancy and lactase deficiency

IN infancy the problem of correcting the diet for lactase deficiency becomes more complex. If the child is breastfed, then reducing the amount of breast milk in the diet is undesirable. In this case the best option is the use of lactase preparations that are mixed with expressed breast milk and break down lactose without affecting the other properties of breast milk. If it is impossible to use lactase preparations, the issue of using low-lactose mixtures is resolved.

Children who are on artificial feeding, the mixture is selected from maximum number lactose, not causing the appearance clinical symptoms and increased carbohydrates in feces. If the child’s condition is not impaired, then you can start with a diet containing up to ⅔ carbohydrates in the form of lactose. This ratio can be achieved by combining a regular adapted formula with a low-lactose or lactose-free formula, or by prescribing a fermented milk mixture. If you use two mixtures, distribute them evenly throughout the day. For example: at each feeding - 40 ml of a low-lactose mixture and 80 ml of a standard one. After changing your diet, you should check the carbohydrate content in your stool. After 1 week, decide whether to further reduce the amount of lactose.

In cases of severe lactase deficiency and no effect when the amount of lactose is reduced by half, it is recommended to use low-lactose mixtures as the main food product.

There are several types of low-lactose products:

• milk formula with malt extract for feeding children during the first 2 months of life;
• milk mixture with flour (rice, buckwheat, oatmeal) or oatmeal for feeding children from 2 to 6 months;
• low-lactose milk for feeding children over 6 months and for preparing dishes instead of natural milk;
• You can prepare your own low-lactose mixture based on eggs with sugar, margarine and rice flour.

The ready-made low-lactose mixture is a powder, appearance and tastes like powdered milk. The composition of such mixtures includes corn oil and milk fats in a ratio of 25:75, sucrose, malt extract or dextrin-maltose, starch, flour for baby and dietary food, vitamins A, D, E, PP, C, group B, macro- and microelements (iron, sodium, potassium, calcium, phosphorus, magnesium).

Packages of lactose-free formulas are marked “SL” (sine lactose) or “LF” (lactose free). Soy-based mixtures that do not contain lactose can be used. Low-lactose mixtures can be developed based on casein, soy and milk protein hydrolysates.

Table 1. A set of foods that are allowed and excluded from the diet for lactase deficiency in children (A. I. Kliorin et al., 1980)

Products	Allowed	Excluded
Dairy	Low lactose dairy	Feminine and cow's milk, all types of milk powder, milk mixtures, cheeses, creams with added soy
Animal origin	Meat, poultry, fish	Liver, brains, pates, all types of sausages, ham
Fats	Vegetable oil, lard	Butter, fresh cream, margarine
Fruits	All	No restrictions
Vegetables	All	Peas, red beets, green beans, dried potatoes, lentils
Drinks	-	Factory-produced milk drinks
Flour	Natural, bread	Biscuit, cakes, bread with milk, soya products
Sweets	Regular sugar, glucose, fructose	Chocolate with milk, candies with milk (taffy), caramel with milk
Medicines	-	With added milk sugar

The first complementary food for a baby with lactase deficiency may be pureed vegetables. It contains pectin, vitamins, and mineral components. It is advisable to give preference to zucchini, potatoes, cauliflower, carrots, and pumpkin. Only one type of vegetable should be introduced and not mixed until all vegetables have been tried one by one. Monitor the child's well-being.

It is allowed to use baby kefir. It should be given to a child with lactase deficiency on the third day after preparation. You can use cottage cheese, well purified from whey.

Complementary feeding dishes (porridge, vegetable purees) for children of the first year of life with lactase deficiency are prepared not with milk, but with a low- or lactose-free product. You can use canned baby food. Fruit juices are introduced into children’s diets later, usually in the second half of life. Fruit purees industrial production prescribed from 3-4 months of age. Sick children over 1 year of age and adults usually tolerate fermented milk products (kefir, yogurt) well. Condensed and concentrated milk is excluded from the patient’s diet.

The duration of therapy is determined by the genesis of the disease.

In case of primary congenital lactase deficiency, a low-lactose diet is prescribed for life. With transient lactase deficiency in premature infants, usually by 3-4 months of life (by postconceptional age 36-40 weeks or more), children regain the ability to tolerate lactose. Full-term infants who are immature for gestational age require treatment for 1-2 months.

The indication for gradual withdrawal of therapy is the reduction of stools and their thickening in consistency.

With secondary hypolactasia, the symptoms of lactase deficiency are transient. Therefore, when the underlying disease resolves (reaches remission) after 1-3 months, the diet should be gradually expanded by introducing lactose-containing dairy products, under the control of clinical symptoms (diarrhea, flatulence) and excretion of carbohydrates in feces. If lactose intolerance persists, one should think about whether the patient has primary (constitutional) lactase deficiency.

Sample menu lactose-free

Breakfast

• Porridge made with water or soy milk, with the addition of fruits or dried fruits.
• Egg or scrambled eggs (without milk) in vegetable oil.
• Whole wheat bread.
• Tea with sugar or honey.

Snack

• Coffee without milk.
• Sandwich with boiled meat and herbs.
• Apple.

Dinner

• Vegetable soup.
• Fish (boiled or fried) or poultry (boiled or baked).
• Steamed vegetables with vegetable oil.
• Juice or compote from fruits (dried fruits).

Snack

• Yogurt.

Dinner

• Rice with vegetables or vermicelli with vegetables, vegetable oil.
• Canned tuna or salmon.
• Tea with jam.
• Fruits.

Metabolic disorders when following a lactose-free or low-lactose diet

Excluding milk and dairy products from the diet leads to a decrease in calcium intake, which is so necessary during the child’s growth period. Adults, especially women, need calcium to strengthen bones and reduce the risk of osteoporosis.

Non-dairy foods containing calcium include:

• Broccoli (100 g - 90 mg), okra, brown cole, spinach, kale, turnip greens, lettuce (50 g - 10 mg).
• Canned sardines (100 g - 250 mg), tuna (100 g - 10 mg), salmon (100 g - 205 mg).
• Oranges (1 piece - 50 mg).
• Juices fortified with calcium - Orange juice(100 g - 308-344 mg).
• Enriched with calcium soy products, cereals.
• Beans (50 g - 40 mg).
• Almond.

To absorb calcium, the body needs vitamin D, which is found in soy milk, butter, margarine, egg yolks, liver.

Main criteria for treatment effectiveness

1. Clinical signs: normalization of stool, reduction and disappearance of flatulence and abdominal pain.
2. In children: age-appropriate rates of weight gain, normal indicators physical and motor development.
3. Reducing and normalizing the excretion of carbohydrates (lactose) in feces.

Addressing patients

If you feel persistent discomfort after drinking a glass of milk, ice cream, or other dairy product, this may indicate lactose intolerance. Sometimes symptoms appear or worsen with age. If you think you may be lactose intolerant, consult your doctor.

Lactase deficiency in children is a type of malabsorption syndrome that develops due to intolerance to the disaccharide lactose (milk sugar). In babies of the first year of life, its signs are detected very often, but correct treatment helps get rid of pathology.

Lactase deficiency - main types and characteristics

What lactase deficiency is is not difficult to understand. To digest lactose, the human body produces an enzyme - lactase. When there is a shortage of it, the same condition occurs when the baby’s gastrointestinal tract is unable to process dairy products.

Lactase deficiency can be primary or secondary.

The primary type is rare and presents with the most severe symptoms. This is a genetic pathology in which lactase synthesis is impaired or does not occur at all.

Secondary deficiency is much more common. Its signs are less obvious, sometimes smoothed out and go away on their own with age. Due to immaturity enzyme system it is observed in most premature babies. Also reasons may be:

Among other things, symptoms of this type of lactase deficiency appear when you are allergic to milk. In some cases, lactase deficiency persists even into adulthood.

Symptoms in children under one year of age

Usually, parents begin to notice strange signs in their child’s digestion at the age of 3-6 months. The main symptom is the appearance loose stool with foam, which has an unpleasant sour smell. Typically, this type of bowel movement occurs soon after drinking the mother's breast milk. In severe cases, even after a single feeding in the morning, stool disorders are present all day.

Others important signs problems:

Colic in an infant can become literally debilitating, occurring at night and during the day. The baby screams, because the pain from distension of the colon against the background of gas formation is quite strong. Painful spasms are also observed, during such periods the child may “roll away” from pain. The process of excreting feces itself is also difficult - the child cries, but after emptying he feels some relief.

What else indicates illness in children?

The so-called fermentative diarrhea in babies with lactase deficiency can occur 10-12 times a day. Often there are streaks of blood and mucus in the stool - this means damage to the intestinal mucosa or the development of an inflammatory process.

In a 9-12 month old child, undigested food particles can be visually seen in the stool.

For some children, the picture is different - diarrhea alternates with constipation due to impaired enzyme production. There are other symptoms that complement the clinical picture:

All of these signs often force a mother to give up breastfeeding. Long absence treatment of pathology causes serious problems with the child's health. He may lag behind in development (physical, mental). If you continue to feed your baby incorrectly, severe dysbiosis develops, convulsions, rickets, and deficiency of vitamins and minerals may appear.

Diagnosis and treatment basics

It is possible to identify the problem by eye, but it is difficult to diagnose its type and severity on your own. Please contact pediatric gastroenterologist and conduct an examination and take tests. Diagnostics may include the following methods:

Also, the primary type of pathology is determined when genetic analysis- lactase genotyping.

At congenital pathology you have to completely and for life exclude any dairy products from the baby’s diet. In all other cases, they try to limit them without completely eliminating them, using a special diet and medications.

All about therapeutic nutrition

How much milk sugar can be left in the diet depends on biochemical analysis feces Complete exclusion of lactose is carried out in the most severe cases and only as a temporary measure. Lactase is a natural probiotic, and without it it will be extremely difficult for a child to live.

For breastfed babies, special dietary supplements are added to mother's milk.

The mother's diet should not contain such products - whole milk, beef, allergens and large quantity Sahara.

For children who consume formula milk, a lactose-free complex is selected (in monotherapy or in combination with a regular formula). The child's reaction is checked empirically, sometimes you have to try several different mixtures. A number of patients tolerate goat milk formulas well.

What to do if your baby cannot tolerate breast milk? Should I really give up breastfeeding? Or is there still a way out?

Lactase deficiency (lactose intolerance) is a disease whose main symptom is impaired absorption of dairy products. The disease is diagnosed from the first months of life, because at this age breast milk is the main food product of the child. It must be remembered that the severity of symptoms increases as the amount of milk consumed increases. Lactose intolerance can also occur among adults.

Lactase is an enzyme synthesized by enterocyte cells of the intestine. The main function of this enzyme is the breakdown of lactose, the main constituent of any milk. Lactase, breaking down lactose, converts it into simpler sugars: glucose and galactose, which are then absorbed through the intestinal wall. If there is not enough lactase, or there is none at all, then lactose is not broken down in the intestines. It promotes the accumulation of water in it and the development of diarrhea - loose stools.

Lactase deficiency can be primary or secondary.

In primary deficiency, lactase is secreted in sufficient quantities by healthy intestinal cells, but the activity of the enzyme is reduced, so lactose remains undigested. Primary lactase deficiency, in which production enzyme, is very rare. There is a so-called transient lactase deficiency. It is typical for premature and full-term but immature babies. This is explained by the fact that high enzyme activity is needed only at the time of birth, therefore, starting to increase from 34 weeks of pregnancy, lactase activity reaches a maximum at 37-39 weeks. It is for this reason premature baby may have lactose intolerance, which, being transient, goes away after some time.

Secondary lactase deficiency occurs when enterocytes are damaged, which is characterized by impaired lactase secretion. Most often, cell dysfunction is caused by various kinds inflammation in the intestines (including allergic).

Symptoms of lactase deficiency

1. Liquid, yellowish, foamy, with sour smell stool, which can be either frequent (up to 8-10 times a day) or rare. The chair looks like yeast dough. After settling in a glass container, the stool separates into two fractions: liquid and dense. Remember: when using diapers, the liquid part is absorbed, and bowel movements can be overlooked!
2. The child is restless during or after feeding.
3. Bloating, colic.
4. The child does not gain weight well or even loses it.

A child with lactase deficiency usually has good appetite. Often, he begins to suck greedily, but after a while he drops the breast, tightens his legs and stomach, and begins to cry.

Since the symptoms of lactose intolerance increase as the amount of milk consumed increases, the disease may not manifest itself in the first weeks of life. Then there is bloating and increased gas formation, then - abdominal pain and, finally, loose stools.

The symptoms described above are characteristic of primary lactase deficiency. With secondary lactose intolerance, these signs are complemented by the presence of a large amount of mucus, greens in the stool, and there may be undigested lumps of food.

Diagnosis of lactase deficiency

1. Determination of the amount of carbohydrates in feces. This is the most accessible, fastest and cheapest method for determining carbohydrates in feces. But this analysis is nonspecific, since it does not talk about the causes of the disease, and based on the results of this research method, it is not even possible to say which carbohydrate is not tolerated by the child. But since little children who are this study, most often consume only breast milk, we can say with a high degree of confidence that they are lactose intolerant. The normal carbohydrate content in feces for a child under 1 year of age is 0 – 0.25%. Deviations from the norm are considered insignificant if the carbohydrate content ranges from 0.3 - 0.5%, average 0.6 - 1.0%, significant - more than 1%.
2. Determination of lactase activity in a fragment of the small intestinal mucosa (biopsy) is the “gold standard” for diagnosing lactose intolerance. However, this method is carried out more for differential diagnosis with other diseases than as a routine research method.
3. Examination of stool for dysbacteriosis.
4. If an allergy is suspected, a blood test for specific antibodies.

Principles of treatment

Lactose intolerance is not a reason to stop breastfeeding. You can continue to breastfeed your baby, and lactase enzyme preparations (for example, Lactase Enzyme, Lactase Baby) will help him cope with lactose, which should be taken approx. Take at every feeding. The dosage of the drug is selected by the doctor individually in each case. Gradually, as the baby’s enzymatic systems mature, the dosage decreases. Here are the basic rules for using lactase enzyme preparations:

1. Express 10-15 ml of milk.
2. Pour the doctor prescribed amount of Lactase Baby (or Lactase Enzyme) into the expressed milk. Lactase Baby dissolves easily, but Lactase Enzyme is more difficult.
3. Leave for 3-5 minutes to ferment. At this time, all carbohydrates contained in the foremilk are broken down.
4. Start feeding with this part of the milk fermented with Lactase Baby (or Lactase Enzyme).
5. Continue feeding as usual.
6. Use at every feeding.

Every mother cares about the health of her child. Therefore, it is so important for her to carefully watch the baby in order to detect primary symptoms possible pathologies and start treating them on time. Quite rare, but considered a dangerous condition for the child - congenital intolerance lactose, when the baby cannot digest mother's milk. Children with this condition need special dietary food. Because they cannot consume dairy products, they need to ensure that the fragile body absorbs vitamins D and calcium in sufficient quantities. possible ways.

Lactose deficiency will be discussed in detail in this article.

Description of the pathology

Lactose intolerance is a pathology that results in children's body unable to independently absorb the protein contained in milk. This diagnosis is made in the first months of the baby’s life, since the baby is fed only breast milk during this period. You need to know that the signs become more pronounced, it all depends on the amount of milk - if there is a lot of it, then the consequences of such nutrition are more difficult to bear. Lactose deficiency can continue into adulthood.

What is lactase, lactose and its intolerance? Lactase is a special enzyme that is produced by intestinal cells. It is he who can break down lactose, which is the main ingredient in milk of various origins. Lactase must break down complex sugars into simple ones so that they are more quickly absorbed into the baby’s intestinal walls. These are the so-called galactose and glucose. Sugar is very important for our body - it is one of the main sources of energy. When very little lactose is produced in the intestines or its synthesis has stopped altogether, then such undigested milk ultimately leads to diarrhea. In such a dairy environment, bacteria always appear, which, producing waste products, form gases - main reason bloating and colic.

How is lactose intolerance classified?

By type, lactose deficiency is divided into primary and secondary.

First view

In this case, lactase is produced in the intestines, its quantity is ok, but its effectiveness is limited. reduced level, this is the main reason why milk is not absorbed by the body. There are very rare cases when such an enzyme is not produced at all.

The primary type of lactose deficiency has one subtype - transient. Quite often observed in premature babies and may be the reason that lactase begins to be produced only at 37 weeks, and at 34 weeks such an enzyme is just beginning to be produced by the body. The transient type of deficiency often quickly goes away within a couple of weeks after birth, when the baby grows and gets stronger.

What other types of lactose deficiency are there?

Secondary type of deficiency

With this type of lactase deficiency, enterocytes are affected, and it is because of this that the production of the enzyme is disrupted. Very often the cause of this type of disease is allergic reactions in the intestines, as well as various inflammatory processes. A timely approach to treatment and diagnosis can effectively cope with this disease.

Symptoms of lactose deficiency

How does the disease manifest itself? Possible following signs:

Contrary to the above symptoms, lactose deficiency in children has almost no adverse effect on appetite. The baby may throw himself at the breast with great zeal, but after a while he will begin to cry and press his legs towards his stomach.

In the first days, lactose deficiency almost does not manifest itself at all - the symptoms are cumulative in nature and arise progressively. First of all, bloating makes itself felt, then the baby begins to feel pain in the tummy, and at the final stage, bowel movements are disturbed. All parents should know the symptoms of lactose deficiency in children under one year of age.

It is extremely important: almost all of the listed symptoms are characteristic primarily during primary lactose intolerance. Secondary failure in addition to these signs, it is expressed primarily in the presence of green stool, mucus and lumps in stool.

Diagnosis of the disease

Signs of illness alone are not enough to accurately diagnose the disease. For a correct diagnosis and prescription suitable treatment various laboratory tests. Usually the doctor provides referrals for necessary tests.

• Carbohydrate analysis of stool.

Needed to determine the concentration of carbohydrates. This is the fastest, easiest and cheapest way to find out how much carbohydrates are in stool. Based on these results, it is possible to determine how well lactose is digested. The normal carbohydrate content in children under one year of age is no more than 0.25. Minor deviations of 0.5% are normal, but if this number exceeds 1%, then this will be a serious case. There are also disadvantages to this analysis - the results can reveal the presence of lactose intolerance, but it is impossible to find out the cause of this pathology.

• Biopsy of the small intestinal mucosa.

This analysis will determine how active lactase is in the digestive tract. This is a simple method for detecting milk protein intolerance.

• Analysis of stool for dysbacteriosis.

If an allergic origin of the child’s disease is suspected, he may be referred for another blood test.

Dr. Komarovsky conducted statistics, during which he found out that 18% of the total number of newborns suffer from lactose intolerance. This is almost every fifth baby born in our country. At this disease Adults can easily tolerate this disease, since they do not need to consume milk alone, and they have the opportunity to go on a diet that excludes lactose. This method will not work with small children, because mother’s milk is the basis of nutrition for them. So, it is better to detect the disease and then use everything necessary methods as early as possible so that the child has time to adapt.

Genetic test for lactose intolerance

Molecular genetic testing for predisposition to lactase deficiency is important in diagnosis. The analysis will help in differential diagnosis the causes of lactose malabsorption and the selection of an appropriate diet.

Treatment

If the baby’s diagnosis is nevertheless confirmed, this does not mean that it is necessary to refuse mother's milk in his diet. The mother can also safely continue to breastfeed the baby, while giving him medications that contain lactase before starting feeding (“Lactase Enzyme” and “Lactase Baby”). Such a disease must be treated as quickly as possible, in this way it will be possible to protect against complications in the future.

The doses prescribed by the doctor are strictly individual. As the baby's enzymatic system begins to develop, the doses of the medicine will gradually decrease. What needs to be done to prepare medicinal mixture before starting feeding:

Features of complementary feeding

For children with altered stool due to lactose deficiency, complementary foods are introduced a little earlier. It is necessary to ensure that the diet is varied and balanced according to nutrients.

What can you feed your baby?

It is very important to prepare porridges and pureed vegetables without milk, and use diluted lactose-free mixtures for this.

Juices from fruits and berries can be given as early as 6 months, but it is also important to monitor possible appearance allergic reaction. Little by little you can add various dairy products, such as cheese, live yoghurts.

Milk and other dairy products in the diet of a child over one year old should be replaced with low-lactose foods. If you cannot purchase them, you can give your baby lactase in capsules.

If you have milk protein intolerance, your child should not eat any food that contains condensed milk or other milk fillers. And you will have to forget about many sweets.

Treatment of lactose deficiency should only be carried out under the supervision of a physician.

What else should be excluded from the diet?

It is necessary to reduce consumption to a minimum or completely eliminate:

• caffeine. Do not drink tea and coffee, they contain this substance;
• sugar;
• baking;
• do not drink alcohol in any form or strength;
• you need to carefully read the labels on products in stores, do not eat products with dyes and preservatives (this will be extremely difficult to do, since the main assortment of stores contains these substances);
• food with a high content of hot spices, pickles - cucumbers, mushrooms and others;
• no matter how bland it may be to eat dishes without seasoning - but this is necessary during breastfeeding;
• do not eat anything that can cause allergies in a child, for example, various exotic fruits or berries, and you should not eat red vegetables;
• You should not eat yeast bread;
• legumes;
• grape.

Diet for lactose intolerance is very important.

What can you eat?

Products for lactose intolerance must be carefully selected.

Successful recovery largely depends on the nutrition of the child and mother, as well as on the intake medicines, which contain required quantity lactase.