– fermentopathy, characterized by the inability to break down milk sugar (lactose) due to decreased activity or absence of the lactase enzyme. Lactase deficiency in infants and young children is characterized by regurgitation, intestinal colic, flatulence, stool disorders (diarrhea, constipation), insufficient weight gain, changes in the central nervous system (irritability, excitability, sleep disturbance). To diagnose lactase deficiency, stool examination (for carbohydrates, pH), dietary diagnostics, and genotyping are performed. In case of lactase deficiency, breastfed children are given lactase replacement therapy; for artificial feeding, lactose-free and low-lactose mixtures are prescribed; For older children, a low-lactose diet is recommended.

General information

Lactase deficiency is a type of malabsorption syndrome caused by intolerance to the disaccharide lactose. Lactase deficiency in various regions affects from 10 to 80% of the population. Lactase deficiency is of particular importance for children in the first months of life who are breastfed, since lactose is contained in breast milk, which is the basis of nutrition for infants. Considering the importance and priority of natural feeding in the first year of life, the problem of prevention and treatment of lactase deficiency in children is an extremely urgent task in pediatrics and pediatric gastroenterology.

Causes of lactase deficiency

Normally, milk sugar (lactose) supplied with food is broken down in the small intestine by the enzyme lactase (lactazoflorizine hydrolase) to form glucose and galactose, which are then absorbed into the blood. Glucose serves as the body's main energy resource; galactose is part of galactolipids necessary for the development of the central nervous system. In case of lactase deficiency, undigested milk sugar enters unchanged into the large intestine, where it is fermented by microflora, causing a decrease in the pH of the intestinal contents, increased gas formation and water secretion.

Secondary lactase deficiency occurs when enterocytes are damaged due to diseases of the small intestine (enteritis, rotavirus infection, acute intestinal infections, giardiasis, etc.).

Classification

Thus, a distinction is made between primary (congenital) lactase deficiency (alactasia, hereditary intolerance to disaccharides); adult type hypolactasia; transient lactase deficiency of prematurity and secondary lactase deficiency associated with damage to enterocytes.

Based on the severity of enzyme deficiency, it is customary to speak of hypolactasia (partial decrease in enzyme activity) and alactasia (complete absence of the enzyme). The course of lactase deficiency can be transient or persistent.

Symptoms of lactase deficiency

Lactase deficiency is characterized by intolerance to dairy products, therefore all symptoms of digestive disorders develop against the background of consumption of foods rich in lactose, primarily whole milk.

The main clinical sign of lactase deficiency is fermentative diarrhea in the form of frequent, liquid, foamy stools with a sour odor. The frequency of bowel movements with lactase deficiency reaches 10-12 times a day; Less commonly, constipation is a manifestation of fermentopathy. Dyspeptic syndrome in newborns is usually accompanied by intestinal colic and other digestive disorders - regurgitation, flatulence, abdominal pain.

The consequences of diarrhea in young children are dehydration, insufficient weight gain and malnutrition. Excessive intake of undigested lactose into the large intestine causes quantitative and qualitative changes in the composition of microflora and the development of dysbiosis.

With lactase deficiency, changes in the central nervous system develop, which is explained by impaired nutritional status, deficiency of vitamins and minerals, and endogenous intoxication due to fermentation processes in the gastrointestinal tract. In this case, children may experience hyperexcitability, tearfulness, irritability, sleep disturbances, and a lag in psychomotor development from the age norm.

It has been noted that children with lactase deficiency are more likely to have muscle hypotonia, cramps, vitamin D deficiency rickets, and ADHD - attention deficit hyperactivity disorder.

Diagnostics

For a reliable diagnosis of lactase deficiency, characteristic clinical data must be confirmed by additional laboratory tests.

The so-called “diet diagnosis” is based on the disappearance of clinical signs of lactase deficiency (diarrhea, flatulence) when lactose is excluded from the diet and the appearance of symptoms when drinking milk. After a lactose load, the level of hydrogen and methane in the exhaled air also increases.

Biochemical examination of stool in children with lactase deficiency reveals a decrease in pH

Treatment of lactase deficiency

The approach to the treatment of lactase deficiency in children of different ages has its own characteristics. The basic principles are based on the organization of therapeutic nutrition, optimization of the breakdown of lactose, and prevention of the development of complications (hypotrophy, multivitamin and polymineral deficiency).

To preserve natural feeding, infants are prescribed replacement therapy with the enzyme lactase. Children receiving artificial feeding are transferred to low-lactose and lactose-free formulas or soy-based milk substitutes. When introducing complementary foods in the form of cereals and vegetable purees, lactose-free products should be used. Monitoring the correctness of diet therapy is carried out by determining the carbohydrate content in feces.

Whole and condensed milk, confectionery products containing milk fillers, some medications (probiotics), etc. are completely excluded from the diet of older children. With minor hypolactasia, the use of fermented milk products, yoghurts, and butter is allowed if they do not cause clinical symptoms of lactase deficiency. insufficiency.

Forecast

Children with primary congenital lactase deficiency require lifelong diet and enzyme replacement therapy. In premature infants with transient lactase deficiency, the maturation of enzyme systems allows a return to milk feeding by 3-4 months. Secondary lactase deficiency is eliminated as the underlying disease is relieved and lactase activity is restored.

Observation of a child with lactase deficiency is carried out by a pediatrician and pediatric gastroenterologist. The criteria for the effectiveness of treatment of lactase deficiency are the disappearance of dyspepsia syndrome, age-appropriate weight gain, normal rates of physical development, and a decrease in the level of carbohydrates in feces.

Reading time: 6 minutes. Views 392 Published 12/17/2017

Hello, dear readers.

Since most of you are mothers, wouldn’t you know that all parents dream of seeing their children healthy and active. But the reality is that children get sick: some more often, some less often. Even newborn babies often suffer from diseases that need to be diagnosed and treated on time. Today we will find out what lactase deficiency is in infants, the symptoms and specifics of this disease.

Difference between lactase and lactose

Two completely different concepts are often confused: lactose and lactase. The correct name for the disease that affects the absorption of milk sugar by the child’s body is lactase deficiency or hypolactasia.

The breast milk of women and animals contains a special substance - lactose. This is nothing more than milk sugar. And lactase is an enzyme produced in the small intestine. It is involved in the breakdown of milk sugar. Lack of lactase causes a disease called lactase deficiency.

Description of the pathology

Hypolactasia is a consequence of the characteristics of the digestive system of young children. Lack of lactase affects the breakdown and absorption of lactose contained in breast milk.

The child’s parents learn about the disease in the first six months of his life. The pathology is dangerous because there is a violation of the absorption in the intestines of substances necessary for full growth and development. In the baby’s intestines, undigested lactose provokes fermentation, the growth of pathogenic microorganisms, and disrupts the formation of normal microflora.

Due to this, the child experiences weight loss and the immune system suffers. Also, lactase deficiency in infants can cause dehydration, which is dangerous for the baby and leads to the development of serious complications.

Symptoms of the disease

If we talk about how lactase deficiency manifests itself in a baby, then it is not difficult to recognize it. There are general symptoms of lactase deficiency that can help determine the pathology. These include:

• severe regurgitation 15-20 minutes after drinking breast milk;
• bloating and increased gas formation;
• colic and rumbling in the baby's tummy;
• foamy stools with a sour odor and a green tint;
• tearfulness and anxiety during feeding.

If the pathology is not recognized in time and treatment is not started, then symptoms that pose a danger to the child’s life are added to the general symptoms. Namely:

• severe vomiting after the next feeding;
• diarrhea;
• baby's refusal to eat;
• weight loss;
• rapid dehydration of the body;
• Moodiness or, on the contrary, apathy.

Ingestion of large amounts of milk sugar worsens the child’s condition. If there is a suspicion of lactase deficiency, the child should be shown to a pediatrician. The pathology is diagnosed based on stool analysis, in which the sugar content will be increased. The doctor also relies on an external examination, identifying symptoms of dehydration and insufficient body weight gain, according to established standards.

Types of lactase deficiency

This disease is divided into two groups: primary and secondary lactase deficiency in infants. In children, both types of pathology can be observed.

Primary hypolactasia

With this type of pathology, the child’s body suffers from a lack of lactase, but enterocytes, the epithelial cells of the intestine, do not have pathology. Primary hypothalasia is: congenital, transient and functional.

Functional form

Is the most common. At the same time, the baby has no violations. Its development is provoked by overfeeding the baby, as well as the reduced fat content of mother's milk. In the first case, the body simply does not have time to break down a large amount of lactose, in the second, milk quickly passes through the gastrointestinal tract, and lactose, undigested, enters the intestines. All this provokes symptoms of hypolactasia.

Congenital hypothalasia

It occurs less frequently, but is the most dangerous. It is caused by gene mutations and poses a threat to the baby’s life if treatment is not started on time.

Transitional form

Does not require treatment. It is diagnosed in children born prematurely and is caused by immaturity of the digestive tract. After some time, the disease goes away on its own.

Secondary lactase deficiency in infants

It is caused by a lack of lactase, as well as pathology of the production and functioning of enterocytes. Secondary hypolactasia develops after the child suffers from diseases that affect the functioning of the small intestine: rotavirus, giardiasis, food allergies. This pathology is also possible after surgery to remove part of the intestine.

The production of lactase is also affected by disturbances in the functioning of the thyroid gland, pituitary gland, and pancreas.

Treatment

Treatment of lactase deficiency includes several methods.

Adjusting your child's diet

Lactase is a probiotic that promotes the formation of beneficial intestinal microflora. Therefore, it is impossible to completely exclude milk sugar from a child’s diet; it is only necessary to adjust the amount of sugar entering the baby’s body. Severe forms of the disease require complete abolition of milk sugar.

Enzymes

The pediatrician may prescribe a course of enzyme therapy to improve the functioning of the pancreas.

Probiotics

They are prescribed to infants to form beneficial intestinal microflora.

Feeding

In case of lactase deficiency, it is recommended to stop breastfeeding only if the disease is severe. In other cases, extreme measures are not required, but doctors prescribe enzyme supplements. When artificial feeding, lactose-free or low-lactose mixtures are used. Also, the mother may be offered a combined type of feeding the baby.

Lure

Lactase deficiency in infants affects the complementary feeding schedule. Each new product is introduced with extreme caution. Whole milk is excluded from the child’s diet, while cottage cheese is allowed, but only after the baby reaches 1 year.

Amount of food consumed by the child

It is important not to overfeed the baby so that the incoming milk sugar has time to be absorbed by the body. It is necessary to feed often, but in small portions.

Relieving symptoms
In case of colic or severe diarrhea, the child is prescribed symptomatic treatment aimed at eliminating problems of the gastrointestinal tract.

Breastfeeding women should eliminate whole milk from their diet. However, fermented milk products are allowed for consumption. It is also not recommended for a breastfeeding woman to eat canned foods, spices and sweets.

Before starting feeding, it is necessary to express a small amount of foremilk, which is rich in milk sugar. It is better if the child consumes hind milk. It has a high percentage of fat and nutritional content, lingers in the child’s gastrointestinal tract and saturates the body with essential microelements. Due to the increase in the time dairy food spends in the digestive system, milk sugar has time to be broken down and absorbed.

Let's sum it up

Lactase deficiency in infants is a common disease. Mom should know the symptoms of this pathology in order to recognize it in time and begin treatment. Remember that this diagnosis is not an indication to interrupt breastfeeding. The exception is severe forms of the disease.

If you suspect that your child has this pathology, be sure to show him to the doctor. He will determine the type of lactase deficiency, prescribe treatment and give recommendations to the mother on how to alleviate the baby’s condition. In most cases, hypolactasia can be successfully treated, or, in mild forms, goes away on its own as the child grows older.

Feed your baby breast milk, but do not overfeed. You cannot forcefully offer the breast to a baby if he refuses. A simple adjustment of a nursing mother’s diet can help eliminate a mild form of hypolactasia in an infant.

Dear readers, share the link to the article with your friends on social networks and leave your comments. Tell other mothers if you have ever encountered lactase deficiency in your infant and what treatment methods you used.

Update: December 2018

Lactase deficiency is a syndrome that occurs due to impaired digestion of lactose and is characterized by watery diarrhea. Pathology appears when the intestines lack the enzyme lactase, which can digest milk sugar (lactose). Therefore, it should be understood that the term lactose intolerance does not exist, this is a mistake. Lactose is milk sugar, and the lack of the enzyme to break it down (lactase) is called lactase deficiency.

There are several signs that indicate lactase deficiency in children and which should immediately alert the young mother:

• baby age 3-6 months
• liquefied, foamy stool
• stool has a sour smell
• bloating

Surprisingly, this pathology is most common among the Vietnamese and indigenous Indians, but the Dutch and Swedes practically do not suffer from it. In Russia, up to half of the population has a deficiency of this enzyme to one degree or another, and lactase deficiency can periodically appear and disappear.

Children suffer the most from lactase deficiency, of course. It is one of the common causes of exhausting intestinal colic (see) and is a frequent reason for stopping breastfeeding. Milk sugar in a child’s diet covers up to 40% of energy needs.

Types of enzyme deficiency

Primary lactase deficiency- This is an enzyme deficiency syndrome in intact intestinal enterocytes. This includes:

• congenital LI – very rare, occurs due to a genetic mutation
• transient LN - appears in newborns born before the 34th-36th week: enzyme activity is insufficient
• lactase deficiency in adults is not a pathology, but reflects the natural process of decreasing lactase activity with age.

In the same Swedes and Dutch and other northern Europeans, lactase remains highly active throughout life, which cannot be said about the inhabitants of Asia.

Secondary lactase deficiency is an enzyme deficiency that occurs as a result of damage to intestinal cells. It is lactase deficiency that is the most common form of intestinal enzyme deficiency, since the structural feature of the intestinal villi is such that lactase is located closest to the lumen and is the first to be hit by unfavorable factors.

Why is lactase deficiency dangerous?

• Develops as a result of diarrhea, this is especially dangerous in infants
• Absorption of calcium and other beneficial minerals is impaired
• The growth of beneficial microflora is disrupted due to the lack of nutrients obtained from the breakdown of milk sugar
• Putrefactive microflora multiplies
• The regulation of intestinal motility is disrupted
• Immunity suffers

Reasons

Lactase activity may vary. In addition to the main factors, the enzyme is influenced by numerous biologically active substances: thyroid and pancreatic hormones, pituitary hormones, nucleotides, fatty acids and amino acids located in the intestinal lumen, glucocorticosteroid hormones.

Symptoms

Symptoms of lactase deficiency, both primary and secondary, are usually similar. The only difference is that with primary LN, pathological manifestations are observed within a few minutes, their severity depends on the amount of lactose consumed. Secondary LN reveals itself when consuming even a small amount of milk sugar, since the lack of its breakdown is combined with some kind of intestinal pathology.

Common signs of lactase deficiency are:

• diarrhea, characterized by watery, foamy stools with a green and sour odor, a lot of gas
• pain, rumbling in the stomach, vomiting
• bloating, decreased appetite
• ), attacks of intestinal colic, anxiety, decreased weight gain, crying during feeding are characteristic of lactase deficiency in infants.

Distinctive features of individual forms

Congenital LI is a rare but severe type of enzyme deficiency, dangerous due to dehydration and severe toxicosis. A mother can understand this from the first days of a child’s life, when breastfeeding leads to vomiting and unstoppable diarrhea. The only thing that helps is stopping breastfeeding and consuming lactose-free formulas.

Primary LN appears only after drinking a large amount of milk. At an early age, it can masquerade as normal intestinal colic, which worries most babies. As the child grows, the microflora can adapt to milk sugar through the proliferation of appropriate bacteria. Over time, symptoms appear only with excessive milk consumption. At the same time, fermented milk products are well tolerated, as they support the growth of bacteria that break down milk sugar.

Secondary LN can appear at any age due to any disease. Specific symptoms of lactase deficiency manifest themselves poorly, since the main role is played by the underlying intestinal pathology. However, a dairy-free diet helps improve the condition slightly.

How can you determine for yourself that it is lactase deficiency? The symptoms are very persistent, there is no effect of treatment. Pathological manifestations disappear only when following a diet excluding lactose.

Tests for lactase deficiency

• Lactose loading test: determine the increase in blood sugar by plotting a curve. With an enzyme deficiency, a flattened type of curve is visible on the graph, that is, there is no normal increase due to the lack of sugar absorption.
• Stool analysis: stool for lactase deficiency is taken to determine the carbohydrate content. Normally, there should be no carbohydrates, 0.25% is allowed in infants, its pH is also assessed - with FN the level drops below 5.5.
• Hydrogen breath test. Along with the stress test, you need to take an analysis to determine the concentration of hydrogen in the exhaled air: a sample is taken every 30 minutes for three hours after loading with lactose.
• Determination of enzyme activity from a biopsy or washout from the intestinal mucosa. This is the most informative method for determining LN, but its use is not always justified due to the complexity of taking an analysis.
• Genetic research to identify mutations in certain genes responsible for lactase activity.
• Diagnostic (elimination) diet with the exception of milk sugar in the presence of lactase deficiency, the condition of the intestines improves, the symptoms of the disease disappear.

If lactase deficiency is suspected, other possible causes of diarrhea, which can be quite serious, must be excluded (see).

Treatment of lactase deficiency

It includes several stages:

• Medical nutrition, taking the nutritional supplement Lactase Baby (370-400 rubles), Lactase Enzyme (560-600 rubles), Lactazar for children (380 rubles), Lactazar for adults (550 rubles).
• Help the pancreas (enzymes: pancreatin, mezim forte, festal, creon and others)
• Correction of intestinal dysbiosis (prebiotics and probiotics: bifidumbacterin, linex, hilak forte, etc. see)
• Symptomatic treatment:
  • Medicines for bloating - Espumisan, Subsimplex, Bobotik
  • Diarrhea - see
  • For pain - antispasmodics.

Medical nutrition

A diet for lactose intolerance involves completely eliminating lactose or limiting it in the diet in accordance with the level of carbohydrates in the feces. Complete exclusion of lactose is a temporary and necessary measure in case of a child’s serious condition (dehydration, persistent diarrhea, severe abdominal pain).

There is no need to avoid consuming lactose at all, as it is a natural prebiotic. Therefore, the main task at this stage is to individually, step by step, select a diet with such an amount of lactose that does not cause digestive disorders and does not provoke the release of carbohydrates in feces.

How to treat lactase deficiency if the child is breastfed? Modern standards do not imply a complete cessation of breastfeeding. For such children, enzyme replacement therapy is used: the drug is added to expressed milk, and after fifteen minutes the child is fed mother’s milk. To do this, use the food supplement Lactase Baby (price 370 rubles): one capsule is enough for one hundred milliliters of milk. After feeding with expressed milk, the baby is given the breast.

For bottle-fed or mixed-fed children, the optimal combination of lactose-free formula and regular formula is selected. The ratio of mixtures for lactase deficiency can be different: 2 to 1, 1 to 1, and so on (depending on the child’s reaction). If lactase deficiency is severe, only low- or lactose-free mixtures are used.

• Low-lactose mixtures: Nutrilon low-lactose, Nutrilak low-lactose, Humana LP + MCT.
• Lactose-free mixtures: Nan lactose-free, Mamex lactose-free, Nutrilak lactose-free.

Introduction of complementary foods

If you have lactase deficiency, you should especially carefully keep a diary of the introduction of complementary foods, since some foods can cause the same pathological reaction: bloating, diarrhea.

Start complementary feeding with vegetables, using one vegetable at a time for several days. Their quantity is increased to 150 grams within 14 days. Then water-based porridge with a low gluten content (rice, buckwheat, corn) is added to the diet, also increasing the amount of complementary foods eaten. The next step is to give the baby meat.

After 8-9 months, you can give some fermented milk products (kefir, yogurt), carefully monitoring the reaction. But cottage cheese is not recommended for sick children under one year of age (see).

Further nutrition

The further diet of a child, as well as an adult with enzyme deficiency, is selected individually, based on the body’s reaction. What signs indicate that the product can be consumed, even if it contains milk sugar:

• normal stool - formed, without pathological impurities and sour odor
• no increased gas formation
• absence of rumbling and other uncomfortable sensations in the stomach

Initially, the diet should contain many foods that do not contain lactose: fruits, vegetables, rice, pasta, meat and fish, eggs, legumes, nuts, tea, coffee, buckwheat, corn.

Then you need to add products with lactose to the diet, but monitor the reaction to the product and its quantity:

• dairy products - milk, cheese, yogurt, cottage cheese, sour cream, butter, ice cream (see).
• other products in which lactose is added as an additional component - bread, sausages, cookies, cocoa, ketchup, mayonnaise, chocolate and many others

Sour cream, cream, low-lactose milk, three-day kefir, and hard cheese are considered low-lactose.

It must be remembered that the diet alleviates the condition of patients with LI, but also deprives them of the main source of calcium, so the issue of replenishing this microelement should definitely be resolved with the attending physician.

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 child nutrition?

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 component 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 broken down in the small intestine, but reaches the large intestine, where it serves as a breeding ground for the development of bifidobacteria and lactobacilli, which form beneficial intestinal microflora. After two years, lactase activity begins to naturally decrease, however, in countries where milk has remained in the human diet since ancient times into adulthood, 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 enzyme lactase (breaks down the carbohydrate lactose) or a complete absence of its activity. It is necessary to note that very often there is confusion in the spelling - instead of the correct “lactase” they write “lactose”, which does not reflect the meaning of this concept. After all, the deficiency is 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 activity of the lactase enzyme (alactasia);
• secondary, develops as a result of diseases of the small intestinal mucosa - partial decrease in the lactase enzyme (hypolactasia);
• transient - occurs in premature babies and is associated with immaturity of the digestive system.

Clinical symptoms

The absence or insufficient activity of lactase leads to the fact that lactose, having 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 disturbances in the chemical composition ultimately contribute to the development of lactase deficiency. Thus, lactase deficiency has the following symptoms:

• frequent (8-10 times a day) liquid, foamy stools, forming a large water spot with a sour odor on the gauze diaper. Please note 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 0.25g%);
• acidic stool reaction (pH less than 5.5);
• against the background of frequent bowel movements, symptoms of dehydration may develop (dry mucous membranes, skin, decreased number of urinations, lethargy);
• in exceptional cases, malnutrition (protein-energy deficiency) may develop, which is expressed in poor weight gain.

The intensity of symptoms will depend on the degree of reduction 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 formula that the child eats. As a rule, lactase deficiency occurs more often in children who suffered from hypoxia in utero, or if immediate relatives have its symptoms in adulthood. Sometimes a so-called “constipated” form of lactase deficiency occurs, when in the presence of liquid stool there is no independent stool. Most often, by the time complementary foods are introduced (5-6 months), all symptoms of secondary lactase deficiency disappear.

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

Many symptoms of lactase deficiency (colic, flatulence, frequent bowel movements) are very similar to the symptoms of other diseases of newborns (cow's milk protein intolerance, celiac disease, etc.), and in certain cases they are a variant of the norm. Therefore, special attention should be paid to the presence of other less common symptoms (not just frequent stool, but its liquid, foamy nature, 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 below about intolerance to other carbohydrates.

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

Doctor Komarovsky about lactase deficiency video

Tests for lactase deficiency

1. Biopsy of the small intestine. This is the most reliable method, which allows one to assess the degree of lactase activity based on the state of the intestinal epithelium. It is clear that the method involves anesthesia, penetration into the intestines and is used extremely rarely.
2. Construction of a 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 advisable to do a similar test with glucose to compare the obtained curves, but in practice, a comparison is simply made with the average for glucose. If the lactose curve is lower than the glucose curve, then lactase deficiency occurs. The method is more applicable to adult patients than to infants, since nothing other than the accepted portion of lactose can be eaten for some time, and lactose causes an exacerbation of all symptoms of lactase deficiency.
3. Hydrogen test. Determination of the amount of hydrogen in 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 due to the lack of standards for young children.
4. Stool analysis 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 one to assess the type of carbohydrate in the stool and therefore make an accurate diagnosis. It is applicable only in conjunction with other methods and taking into account all clinical symptoms.
5. Determination of fecal pH (). It is used in combination with other diagnostic methods (stool analysis for carbohydrates). A stool pH value below 5.5 is one of the signs of lactase deficiency. It must be remembered that only fresh feces are suitable for this analysis; if it was 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 there are, the higher the likelihood of lactase deficiency.
6. Genetic tests. They detect congenital lactase deficiency and are not applicable for other types.

None of the diagnostic methods existing today allows us to give an accurate diagnosis when used only. Only a comprehensive diagnosis combined with 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.

In case of primary lactase deficiency (very rare), the child is immediately transferred to a lactose-free milk formula. Subsequently, the low-lactose diet continues 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

As a matter of fact, treatment of lactase deficiency in this case can be carried out in two stages.

• Natural. Regulating the amount 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.

Regulating lactose intake using natural methods

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 caused by improperly organized breastfeeding, when the child sucks out the “front” milk, rich in lactose, and the “hind” milk, 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 if there is an excess of breast milk;
• feeding with one breast until it is completely empty, possibly using the breast compression method;
• frequent feeding from the same breast;
• correct latching on the breast by the baby;
• night breastfeeding for greater milk production;
• In the first 3-4 months, it is undesirable to tear the baby off the breast until the end of 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, if consumed significantly, can pass into breast milk, causing an allergy, often accompanied by symptoms similar to lactase deficiency or provoking it.

It will also be useful to try expressing before feeding to prevent excess lactose-rich milk from entering the baby's body. However, we must remember that such actions are fraught with the occurrence of hyperlactation.

If symptoms of lactase deficiency persist, you should seek help from a doctor.

The use of lactase preparations and specialized mixtures.

A decrease in the amount of milk is extremely undesirable for the baby, so the first step, which the doctor will most likely advise, will be the use of the lactase enzyme, for example "Lactase Baby"(USA) – 700 units. in a capsule, which is used one capsule per feeding. To do this, you need to express 15-20 ml of breast milk, inject the drug into it and leave it 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, if such treatment is ineffective, the dosage of the enzyme is increased to 2-5 capsules per feeding. An analogue of "Lactase Baby" is the drug . Another lactase drug is "Lactase Enzyme"(USA) – 3450 units. in a capsule. Start with 1/4 capsule per feeding with a possible increase in the dosage of the drug to 5 capsules per day. Treatment with enzymes is carried out in courses and most often they try to stop it when the child reaches the age of 3-4 months, when its 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

If the use of enzyme preparations is ineffective (severe symptoms of lactase deficiency persist), lactose-free milk formulas begin to be used before breastfeeding in an amount of 1/3 to 2/3 of the volume of milk that the child eats at a time. The administration of a lactose-free formula begins gradually, at each feeding, adjusting its consumed volume depending on the degree of manifestation of lactase deficiency symptoms. On average, the volume of 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 in full or in part. It is not recommended to completely switch a formula-fed baby to a lactose-free formula.

In case of remission, after 1-3 months you can begin to introduce regular mixtures containing lactose, monitoring the symptoms of lactase deficiency and the excretion of lactose in feces. It is also recommended, in parallel with the treatment of lactase deficiency, to carry out a course of treatment for dysbiosis. You should approach medications containing lactose as an excipient (Plantex, Bifidumbacterin) with caution, as manifestations of lactase deficiency may worsen.

Important! You should pay attention to the presence of lactose in medications, as manifestations of lactase deficiency may worsen.

Treatment during the introduction of complementary foods

Complementary feeding dishes for lactase deficiency are prepared using the same mixtures (lactose-free or low-lactose) that the child received before. Complementary feeding begins with industrially produced fruit puree at 4-4.5 months or a baked apple. Starting from 4.5-5 months, you can begin to introduce pureed vegetables with coarse fiber (zucchini, cauliflower, carrots, pumpkin) with the addition of vegetable oil. If complementary feeding is well tolerated, 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 1:1 ratio. Dairy products also begin to be introduced in the second half of the year, using initially those with low lactose content (cottage cheese, butter, hard cheese).

Intolerance to other carbohydrates

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

1. Congenital deficiency of sucrase-isomaltase (practically not found in Europeans). It manifests itself in the first days of introducing complementary foods in the form of severe diarrhea with possible dehydration. Such a reaction can be observed after the appearance of sucrose in the child’s diet (fruit juices, purees, sweetened tea), less often starch and dextrins (porridge, mashed potatoes). As the child gets older, 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, celiac disease, infectious enteritis) and cause secondary enzyme deficiency, which is not as dangerous as primary (congenital).

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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;
• a lack of important and beneficial substances due to their improper absorption leads to an imbalance of metabolism and causes problems in the functioning of some organs;
• incompletely digested lactose provokes dysbacteriosis, fermentation and flatulence;
• in cases where the treatment tactics for the disease require cessation of breastfeeding, the child loses powerful natural protection in the form of vitamins, minerals, immunoglobulins and other valuable substances that he received from 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 a child suffer from this disease, there is a high probability that it will manifest itself in him.
• Diseases of the digestive system. In this case, lactase deficiency is one of the possible consequences of previous intestinal infections, helminthic infestations, 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. This form of the disease can be suspected in an infant by weight loss and the development of dehydration. The sooner a diagnosis is made and special nutrition is introduced, 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 birth 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 is a serious burden on the fragile body: the 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 and 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 of the 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. The correct tactic is to contact 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.

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 only a comprehensive examination in the presence of a full range of symptoms can give a reliable result. 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

The most difficult case is 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 permitted 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 the full development of a little person. Therefore, if there is even the slightest opportunity to maintain breastfeeding, it should be taken advantage of. 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 on 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 the individual characteristics of the child. And remember that it needs to be introduced gradually.

Another important point: you need 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 for a 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. This way, the baby will receive a little less foremilk, which is 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, the pediatrician prescribes 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; there are no preventive measures against it. 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. Recently, unfortunately, this diagnosis has begun to be made very often and not always justified.

But even if your child really has the disease, keep in mind that only congenital complete absence of the 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 medications. These measures will help provide the baby with the substances necessary for harmonious growth and development. Parents are required to be vigilant and, with any manifestation of anxiety in combination with alarming symptoms, find out the cause together with the pediatrician.

Health to you and your children!





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