How to understand that your baby has lactose intolerance. Symptoms of lactose deficiency in adults

As a doctor, I sometimes have to deal with lactase deficiency in adults. This is not to say that the disease is serious, but it gives patients a lot of anxiety. Based on my own experience and reliable sources, I will try to tell you as clearly as possible about milk intolerance and methods of treatment.

What is lactase deficiency

Lactose- from the Latin “lactis” - milk - sugar, which is found in free form in the milk of all species of mammals.

Lactase- an enzyme produced by cells of the inner mucous membrane small intestine and is involved in the digestion and breakdown of lactose.

Lactase deficiency- a condition in which the amount or activity of the enzyme that breaks down lactose - milk sugar - is reduced in the small intestine. As a result, the body does not fully digest foods containing lactose, mainly dairy, and it passes unchanged into the large intestine.

Lives in the large intestine great amount bacteria - different, “bad” and “good”. Normally, “good” ones dominate; they are involved in the digestion of food and the formation of immunity, which protects against infections, cancer and other diseases.

Unsplit milk sugar becomes an excellent source of nutrition for “bad” bacteria, which leads to their rapid proliferation and suppression of “good” microbes. A condition occurs that doctors call dysbiosis, or dysbiosis.

Digestion is normal and with lactose intolerance

By actively “eating” lactose, “bad” bacteria release large amounts of gas and various acids into the intestinal lumen, which irritate the mucous membrane and attract water. The process is similar to the fermentation of yeast dough. The contents of the intestine are filled with small gas bubbles and increase in volume many times over. All this provokes bloating, rumbling, abdominal pain and diarrhea.

Lactase deficiency is a lack of lactase

Who is at risk of lactase deficiency?

1. If your close relatives had or have lactase deficiency, the likelihood that you will continue the “traditions” of the family is extremely high. I'll tell you why a little later.
2. Lactose intolerance is rare among peoples who traditionally had cows on their farms and fresh milk on the table. Thus, among Europeans and Russians, only 6-16% have lactase deficiency. But among the peoples of Southeast Asia and North America this figure is 70-100%.
3. People over 60 years of age do not tolerate dairy products well. With age, the intestinal mucosa becomes thin and produces little of the enzyme that breaks down lactose.
4. Finally, all diseases that affect the small intestine are accompanied by lactase deficiency in every third case. So, for intestinal infections, food poisoning and inflammation small intestine It is recommended to exclude dairy products from the diet.

Congenital lactase deficiency is rare. But it has been noticed that almost all people with age do not tolerate dairy products well.

Why does lactase deficiency occur and what happens?

Lactose intolerance can be complete or incomplete:

• In the first case, there is no lactase at all; even tiny amounts of milk can cause bloating, rumbling in the stomach and diarrhea.
• In the second, when enzyme activity is reduced, you can consume dairy products in limited quantities, focusing on your well-being.

Congenital lactase deficiency - hereditary disease, which makes itself felt immediately after birth and requires a lifelong exclusion from the diet of foods containing lactose.

Adults are faced with another type of genetically determined lactose intolerance - constitutional lactase deficiency, which develops gradually. The cause of this disease is the “weakness” of the gene that encodes the activity of the lactase enzyme. If your father and mother passed this “weak” gene on to you, then the likelihood of the disease will be extremely high.

Doctors call both variants of lactase deficiency described above primary, that is, their appearance is not influenced by lifestyle, nutrition, or other diseases.

Secondary lactase deficiency appears against the background of intestinal diseases and disappears as soon as the body copes with the disease.

Congenital lactase deficiency is forever. Secondary lactase deficiency goes away on its own along with the disease that caused it

How does lactose intolerance manifest?

Symptoms of lactase deficiency They are somewhat reminiscent of an intestinal infection, with the difference that they occur 1-2 hours after consuming dairy or other products containing lactose.

• Bloating and rumbling of the abdomen, while gases are practically not released from the intestines;
• Abdominal pain that occurs here and there;
• Diarrhea up to 10-12 times a day;
• Feces are liquid, foamy, light yellow, with a sour odor;
• Possible nausea.

If you experience abdominal discomfort every time you drink a glass of milk, ice cream, or another lactose-containing product, consult your doctor.

What to do if you suspect lactase deficiency

On one's own

• Keep a food diary and each time, note in it exactly what product you ate and in what quantity, what you felt, how many times and how you went to the toilet.

Within a couple of weeks of keeping a diary, you will understand how much lactose your body tolerates

• Try to eliminate foods containing lactose as much as possible. and write down your feelings. Then add them to your diet and gradually increase the amount. Record the moment when abdominal discomfort and diarrhea appear. This way you can independently assess the degree of lactose intolerance.

What can a doctor do?

• Genetic analysis for congenital lactose intolerance. For research, a scraping is taken from the inner surface of the cheek or blood from a vein. There is no need to prepare for the study. The analysis will show whether you have a lactase “weakness” gene, whether it is active or “turned off.”

This is what a laboratory report confirming lactose intolerance looks like

• Lactose tolerance test. The analysis is done on an empty stomach. First, your blood is taken to determine baseline blood sugar. You then drink the lactose solution and the blood test is repeated. If the blood sugar level remains the same, it means that lactose has not been absorbed, and this indicates lactase deficiency.
• Hydrogen content test in the exhaled air. During the fermentation process in the intestines with lactase deficiency, a large amount of hydrogen is released. You are given a special lactose solution to drink. If after some time “labeled” hydrogen molecules are found in the exhaled air, it means that lactose is not broken down by enzymes, but is involved in fermentation.
• Stool acidity analysis reflects the body’s ability to digest carbohydrates in general and lactose in particular. An increase in acidity speaks in favor of lactase deficiency.

The diagnosis of “lactase deficiency” can only be made by a doctor after examination and exclusion of diseases of the intestines, pancreas and other digestive organs

How to treat lactase deficiency

The main thing is diet

For lactase deficiency, it is recommended to limit or completely eliminate foods that contain large amounts of lactose. In most cases, doctors allow the consumption of lactose-free and fermented milk products. Kefir and yogurt, natural yoghurts without additives and sour cream, cottage cheese and cheeses contain a minimal amount of lactose. It is broken down by lactic acid bacteria during the fermentation of milk and the preparation of these products.

In stores, look for shelves with lactose-free dairy products, they are more expensive, but do not cause digestive upset

Enzymes in tablets to replace the missing ones

Enzyme medications will definitely be selected and prescribed by a doctor if your body reacts to even minimal amounts of milk sugar. The enzymes in the tablets act in the same way as lactase and help the body digest lactose sugar. In case of congenital lactose intolerance, they will have to be taken for life.

For secondary lactase deficiency, diet is usually sufficient. Enzymes in tablets can supplement it while the body recovers from illness and restores lactose synthesis.

Treatment of symptoms

Symptomatic therapy treats not the disease itself, but its consequences. The need to take medications arises if unpleasant symptoms persist even while following a diet. For diarrhea, fixative medications are prescribed, for bloating and intestinal colic- drugs that relieve painful spasms and remove excess gases from the intestines in order to support “useful” microflora - drugs of lactic acid bacteria to avoid hypovitaminosis - vitamins.

Treatment of intestinal disease causing lactase deficiency

Treatment is always prescribed only by a doctor; amateur actions are unacceptable here. For example, when intestinal infection Prescribe antibiotics and drugs that adsorb and remove bacteria, viruses and toxic products from the body.

Treatment of lactase deficiency is based on diet therapy. It is selected individually for each patient, taking into account the nature of the disorders and the effect that the diet gives.

What not to eat if you are lactose intolerant

Everything is individual. The need to completely abandon dairy products, as the main carrier of lactose, arises very rarely. In most cases, it is enough to give up whole (sweet) milk, but you can freely eat fermented milk products, cream and butter. Sometimes the body is hostile to a large amount of “milk”, but 50-100 ml. milk a day does not react in any way. In such cases, you can safely add milk to your coffee and allow yourself one serving of ice cream once a week.

When choosing dairy products, focus on fat content. The fattier the product, the less lactose it contains. For example, everyone can eat butter. It contains a large amount of fat (up to 83%) and practically no protein or carbohydrates.

It is better to take butter with the highest fat content, it contains the least lactose

From fermented milk products choose those that contain live lactic acid bacteria - they will help restore normal acidity and “useful” intestinal microflora. Prefer mature hard varieties to soft young cheeses. The longer the cheese matures, the less lactose it contains.

Hard cheeses contain less lactose, and the Dzhugas cheese in the photo does not contain lactose at all

Most lactose is found in whole milk and its concentrates. Fermented milk products contain little lactose because it is broken down by lactic acid bacteria when the milk is fermented.

Carefully! Lactose is not only found in dairy products

Milk is added to bread, confectionery, sausages, pates, purees and ready-made sauces. When baked, milk sugar gives the product an appetizing golden color, and can even be found in French fries, chips, crackers and croquettes. What’s sad is that lactose is not always indicated on the label, so it’s better to avoid these “goodies” a priori.

Moreover, lactose is often used as a bulking agent, sweetener, flavor enhancer and flavoring agent in pharmaceutical preparations in tablets, pills, powders and syrups. Therefore, I recommend reading the annotations carefully.

Products that almost always contain milk sugar:

• Sausages and ham. Not only the “meat” itself, but also its packaging;

Powdered milk or whey is added to the sausage.

• Cheeseburgers, hamburgers, fast food;
• Dry semi-finished products: soups, cereals, purees, sauces, puddings;
• Cocoa powder, all types of chocolate, excluding extra-bitter chocolate;

If you can’t give up chocolate, give preference to extra-bitter chocolate, because milk contains several components containing lactose

• Nut butters;
• French fries, chips;
• Bakery products, pastries, confectionery;

Almost all bread contains milk, and therefore lactose.

• Dumplings, dumplings, croquettes;
• Saccharin tablets;
• Bulk spices with flavor enhancers. Often the manufacturer writes “flavor enhancer”, but does not indicate the substance; it could be lactose;

Pasta seasoning with flavor enhancer. Lactose is not listed on the label, but it may be there.

• Ready-made sauces: ketchup, mustard, mayonnaise;
• Nutritional supplements.

Milk sugar is not only found in dairy products. It is added to sausages, bakery products, confectionery products and even to some medications.

What can you eat without restrictions?

A large number of restrictions sometimes causes confusion in people with lactose intolerance. What is there? It's actually not that scary. A huge number of products do not contain milk sugar.

You can enjoy natural vegetables, fruits, nuts and unprocessed foods with confidence

If you have lactase deficiency, eat natural products, which by their nature are lactose-free. Read product labels, and when choosing semi-finished products, be sure to check their composition.

What about calcium?

By the way, milk is dangerous not only for patients with lactase deficiency, but also for completely healthy people. Back in 1997, Harvard Medical School published recommendations regarding milk consumption. Later in 2014, they were confirmed by the results of research by Swedish scientists.

As it turned out, the abuse of whole milk leads to “leaching” of calcium from the bones and increases the chances of atherosclerosis, and with it it is fatal dangerous diseases heart and blood vessels. 1 glass - 250 ml is recognized as safe for health. whole milk per day, which is equivalent to only 12 g of lactose.

Dairy products are one of the main sources of calcium, a microelement essential for human body. And in case of intolerance to dairy products, many people wonder where to get calcium, if not from milk.

Products rich in calcium and its amount in milligrams per 100 g of product

Sesame is the leader in calcium content

The body needs calcium for strong bones and teeth. It is involved in metabolism, muscle contraction, hormone formation and other important processes occurring in the body. While eliminating milk from your diet, you need to include other sources of calcium in your diet.

Memo

1. Some people are lactose intolerant from birth. But with age, it can develop in any person.
2. If you experience bloating, rumbling in the stomach and diarrhea every time after drinking a glass of milk, consult a doctor. He will conduct an examination, find the cause of your illness and prescribe treatment.
3. If you have lactase deficiency, you need to follow a diet. In the case of a congenital disease - throughout life. If lactase deficiency accompanies an intestinal disease - for the duration of treatment of this disease.
4. A diet for lactase deficiency involves excluding or limiting whole dairy products. Fermented milk products are allowed.
5. When buying products, carefully study their labels and choose only those that are lactose-free.
6. Some foods are best avoided because they may contain lactose, even if it is not listed on the label.
7. By eliminating milk from your diet, take care to provide your body with calcium.

Check to see if you have the right attitude towards food.

Enter your email and click the download button ↓

Breast milk is the natural and most desirable food for a newborn. But sometimes the child’s body refuses to assimilate one of the essential elements found in milk, called lactose. This disorder is called lactose deficiency, the symptoms of which appear quite early in children under one year of age. It will be useful for every parent to know the characteristic manifestations and methods of treatment.

Lactose is milk sugar that is found in all mammalian milk. The main task of this element is to provide the body with energy for normal growth and development. It also has a beneficial effect on intestinal function, as it is the main element for the formation and development of beneficial lactobacilli. Lactose - important trace element for brain development.

One more useful property milk sugar is to improve the body's ability to absorb calcium, which is important in the first months of life. Normal absorption of lactose, glucose and galactose in the baby’s body prevents the occurrence of dysbacteriosis.

Types of disorders and causes

Depending on how the symptoms of lactose intolerance manifest in children, this disorder has several forms. Each of them may have its own causes.

Lactose intolerance in infants

It exists in several forms, which differ in cause. Primary deficiency occurs when the enzyme is not absorbed well enough or is completely absent from the body. But the cells that form the surface of the intestine are not damaged. This type is the most common.

The congenital form is extremely rare and is very serious illness. It can lead to the most severe consequences, even death, if the necessary medical assistance is not provided in a timely manner.

The disease develops due to genetic mutations baby's body. The main symptoms of lactose deficiency in children under one year of age are rapid dehydration, noticeable underweight or sudden loss of body weight.

In children born with underweight or premature babies, a transient form of deficiency is sometimes diagnosed. This is explained by the fact that the formation of the enzyme system occurs at 12 weeks. After another period of time, it becomes more active and begins to process lactase.

So when the baby is born ahead of schedule, or has much less weight, the enzyme system does not have time to fully develop, which leads to enzyme deficiency.

One of the most common forms of lactose deficiency is functional. It does not appear due to any disturbances in the digestion system or intestinal function. The main reason for its occurrence may be ordinary overfeeding of infants. The body simply does not have time to process all the resulting material, which, without being properly digested, then enters the intestines and causes characteristic symptoms.

The secondary type of this disorder involves damage to the cells that are responsible for the production of lactase. It can disrupt normal bowel function and cause inflammatory process. The functioning and production of enterocytes is suspended.

The opposite state of the body occurs, which is characterized by an excessive amount of lactase enzyme. This happens when a large volume of milk accumulates in the breasts of a nursing mother. There is an overabundance in the child's body. Unlike cases with enzyme deficiency, there is no need to start treatment in this situation. To normalize the amount of lactose in a newborn’s body, it is enough to adjust the diet.

Sometimes babies are allergic to the carbohydrates the body needs. Its causes can be either congenital or acquired. The symptoms in this case do not differ from the main signs. The only thing that can indicate an allergic reaction in the body is a skin rash.

The danger of this disease

For children under one year old, this disease can be extremely dangerous. First of all, the disorder can cause disruption in the normal functioning of all organs. The upper layer of the intestinal walls is also damaged and the formation of enterocytes is stopped.

Undigested milk sugar provokes the appearance and contributes to the disruption of natural microflora gastrointestinal tract. Once in the baby's stomach, lactose provokes increased gas formation and becomes the cause of a fermentation reaction. As a result, the child becomes restless and irritable, refusing his favorite foods.

Refusal of a regular diet leads to sudden weight loss. This factor is very harmful in such early age, as it leads to disruption of the normal functioning of all organs. A weakened body becomes vulnerable to many harmful microelements. This also leads to complications in the form of dystrophy.

Due to the inability of the baby's stomach to cope with heavy food, the child develops bouts of diarrhea. This disease can unbalance an adult, and for a newborn it can be fatal. Because of frequent bowel movements Rapid dehydration occurs.

Characteristic symptoms of the disease

Depending on the cause, the symptoms characteristic of lactose intolerance in infants may vary. But regardless of the variety, there are several common features diseases. A disorder of the enzyme system can be determined due to the following features:

• Regardless of diet and the abundance of food, the child stops gaining the required weight. This state persists until a certain point. If no active measures have been taken, the baby begins to sharply lose weight, which leads to undesirable consequences;
• appears abnormally loose stool, sometimes accompanied by copious foam. Also, the stool may become greenish in color with a strong sour odor. This happens because lactation intolerance provokes diarrhea in infants;
• visible disruption of the functioning of the gastrointestinal tract, which manifests itself in bloating and characteristic uterine rumbling. Also serious symptom colic may occur. All this makes the newborn irritable and capricious, which should also attract attention;

• sometimes the disorder manifests itself in seemingly causeless regurgitation in the baby.

In any case, the child is at the age when the occurrence of any deviations from the norm should cause decisive and active action. This is the only way to eliminate unwanted consequences in a timely manner.

Diagnostic laboratory procedures

To make sure that the baby really suffers from lactose deficiency, doctors use many laboratory diagnostic methods. They are able to accurately determine the causes and type of disorder manifested in the baby. To do this, the doctor may resort to the following tests:

• A special diagnostic power mode is used. Milk sugar is excluded from the child's diet. If he was the cause of the disorder, then the baby’s condition immediately improves and the symptoms disappear;
• A laboratory blood test can reflect an insufficient increase in sugar. In the body of a newborn, this occurs in the case of lactase indigestibility;

• After a blood test, a sample of the baby’s exhaled air is taken for several hours to study the hydrogen concentration. This is also a fairly effective procedure for determining the condition;
• stool analysis. If the enzyme system is functioning normally, there should be no carbohydrates in the stool. In children in the first months of life, a small percentage of them are allowed to be present in the stool. But if the body refuses to digest lactose, the baby's stool will contain large amounts of carbohydrates;
• The most informative method for determining the disorder is a biopsy to study the activity of enzymes and enterocytes. It is capable of identifying the disease with great accuracy, but is used quite rarely;
• To determine the cause and subsequent classification, genetic studies may be needed for congenital abnormalities.

All these procedures are carried out in order to exclude errors in diagnosis. At an early age, there are a huge number of reasons that can cause diarrhea, stomach upset and other manifestations of impaired intestinal function. Similar symptoms make it difficult to determine the disease, so diagnostic procedures extremely important.

Treatment procedures for lactase deficiency

Doctors use medications to treat this disorder. various actions. Most important task- influence as carefully as possible children's body excluding the use of strong medications. Depending on the symptoms manifested, the doctor selects the necessary course of treatment, which includes medications aimed at both restorative actions and elimination of symptoms and side complications such as diarrhea.

Drug correction is most effective only in premature babies. But if the child’s condition is critical, the doctor can still turn to the help of biocorrective drugs.

Now there is effective drugs, reviews and photos of which can be found on the Internet. But in no case should you use drugs without consulting a doctor, so as not to harm the baby’s health.

Recovery normal microflora intestines and removing the effect of dysbiosis, doctors actively use medicinal product called Bifidumbacterin. It has a beneficial effect on irritated intestinal cells and triggers the body's recovery processes. The drug can be used from birth.

Another proven method of therapy is feeding a mixture of already split enzymes with pre-expressed mother's milk. However, in case of severe disorder, complete abstinence from breast milk is recommended. In this case, at the discretion of the doctor, substitutes or specialized medical nutrition will be prescribed.

Drug intervention

The course of treatment may consist of a complex of corrective medications, or it may be only a small addition to the main diet. Here are the most common and proven drugs.

To help the baby's pancreas, medications are used that contain all the enzymes necessary for this. These include Festal, Mezim Forte, Pancreatin and other similar drugs.

In addition to Bifidumbacterin, probiotics Hilak Forte and Linex are used to restore microflora and normal intestinal function.

Anti-bloating, indigestion and anti-diarrhea medications may be used depending on the need to relieve symptomatic problems.

It is important to understand that the entire necessary course of treatment should be selected by a doctor with whom you can contact if necessary. But some proven videos on the Internet are also informative: Dr. Komarovsky is popular among young mothers. But this does not eliminate the need to contact your doctor.

Medical nutrition

In the case of a mild disorder in the baby, which occurs with not too pronounced symptoms, the attending physician may limit himself to a recommendation therapeutic nutrition. Such drugs are very careful fragile body newborn, and have virtually no contraindications.

The diet is aimed at completely eliminating the cause of the disorder from the baby’s body. Most drugs contain either an already split enzyme, which is absorbed directly, or its synthetic substitutes.

The following drugs are used for special nutrition of newborns:

• if doctors have prescribed the use of low-lactose products, then more often it is Nutrilak, Nutrilon or Humala;
• Lactose-free drugs include Mamex, Nutrilan lactose-free and Nan.

Sometimes, nutritional supplements that help a child's digestion can be extremely helpful. They become an indispensable help to a young mother if, due to an unpleasant disorder, the baby is forbidden to feed on breast milk, or he refuses it himself.

They have different clinical purposes, acceptable age and manufacturer. In order to choose a supplement, you should consult your doctor. The most common of them are Lactase Enzyme, Lactase Baby and Lactazar.

Complementary feeding of a baby can be no less beneficial, but it should be done with great care so as not to provoke even greater intestinal irritation. It is recommended to keep a diary describing foods to prevent recurrence of symptoms.

It is advisable to start complementary feeding with vegetables, giving one at a time for several days, gradually increasing the dosage to 150 g over 2 weeks. Then the baby is fed rice, corn or buckwheat porridge. The last product allowed for consumption by newborns is meat.

After 9-10 months, children are allowed to give small amounts of fermented milk products - natural yogurt or kefir. It is necessary to carefully monitor the body's reaction to the foods consumed.

Some foods, unlike others, may not cause irritation in children, even though they contain milk sugar. Therefore, when feeding, pay attention to:

• absence of obvious signs of indigestion - characteristic rumbling or bloating;
• no increased gas formation;
• unchanged stool during normal bowel movements;

Lactase deficiency in newborns is a serious disorder of the gastrointestinal tract, especially in the first years of a child’s life. It leads to many of the most undesirable factors and complications, sometimes exposing an already defenseless body to mortal danger.

And since the symptoms of a disorder of the enzyme system are quite common, it can be confused with ordinary indigestion. Therefore, if any symptoms appear, the baby should receive immediate medical attention.

Just a couple or three decades ago, young mothers ran enthusiastically to the dairy kitchen, and about scary words like "", "lactose intolerance" and "lactase deficiency" no one knew. Today they roll off the tongue of every second mother and rustle along the corridors of children's clinics, terrifying those around them. What is the meaning of the concept “lactase deficiency in infants” and how terrible is this diagnosis? Let's figure it out together.

IN Lately, the question of lactase deficiency arises more and more often.

Where it all begins

Probably not everyone knows what lactose is. Lactose is the sugar found in breast milk in mammals. The greater the amount of it present in milk, the greater intelligence (mind) a given person has. biological species. In humans, milk has the highest degree of lactose saturation.

Mother's milk has a beneficial effect on the development of the baby.

Sugar has a great influence on brain development and promotes energy production (mainly motor energy). In the baby's intestines, large lactose molecules are exposed to an enzyme with the similar name “lactase”. Lactose is broken down by lactase into 2 smaller and easier-to-digest molecules. The first - glucose - is used to produce energy, the second - galactose - is involved in the development of the central nervous system.

Lack of lactase affects the baby's quality of life.

If the activity of lactase (a digestive enzyme) is small or absent at all, then milk sugar is eaten by bacteria of the small and large intestines, as a result of which the protozoa multiply rapidly. The baby's stool becomes liquid. The baby's tummy is often and severely swollen. Gas formation is accompanied by pain in the stomach and intestines. The condition when the lactase enzyme refuses to work is called “lactase deficiency” in science. Ordinary people sometimes say not “lactase”, but “lactose deficiency”. This is not entirely correct, since in this case there is just enough lactose.

Some young parents are faced with the question: “” A well-designed routine will allow mothers to find free time for household chores and relaxation.

There is still debate about whether to give a newborn a drink of water. A variety of opinions on this issue are collected.

Flaw is dangerous

Lactase deficiency is a pretty serious thing, here's why:

• slows down baby's weight gain;
• interferes with the full absorption of lactose (sugar);
• the ability to absorb and digest other beneficial and nutrients, available in mother's milk.

Is it worth describing the consequences of such pathologies?

Why is activity decreasing?

What are the causes of low lactase activity in small intestine toddler?

Lactase deficiency can be:

1. congenital as a consequence genetic disease(extremely rare occurrence);
2. observed in premature babies due to the immaturity of the intestines;

Premature babies may be susceptible to this diagnosis.

1. progressive (adult type) - manifests itself around the 12th month of a baby’s life and gains momentum throughout growing up and throughout subsequent life.

In this case, the cells of the small intestine remain undamaged, and the activity of the lactase enzyme is very low or zero. This deficiency is called primary.

Secondary lactase deficiency occurs due to damage to lactase-producing cells due to an intestinal infection suffered by the baby, an allergy to the protein contained in cow's milk, due to any chronic disease or inflammation of the intestines. Parents encounter secondary disabilities much more often than primary or imaginary ones.

Carefully monitor your baby's condition after he has suffered from intestinal diseases.

Imaginary lactase deficiency can occur due to improper breastfeeding. A baby who has sufficient lactase production suffers from symptoms of lactase deficiency due to excessive production of mother's milk.

The baby sucks only the front milk, rich in lactose, without reaching the rear milk, which is fattier (fats play important role in the digestion of crumbs). Foremilk is digested quickly and causes the same symptoms as true lactase deficiency.

Manifestations of the disease

What are the symptoms of lactase deficiency?

• Bloating and increased gas formation in the baby's tummy.
• The child behaves restlessly during and after feeding.

A child's whims when feeding are an unkind sign.

• The baby loses weight or disproportionately and gains it poorly.
• The feces excreted by the baby have a sharp sour odor, a liquid (or too thick) consistency and a foamy structure. Bowel movements can be very frequent (more than 10-12 times per day) or absent for several days (typical for infants who eat formula).
• Baby often and plentifully.

note

Signs of lactase deficiency are difficult to miss:

• The baby refuses the breast or abandons it during feeding.
• When feeding, you can hear rumbling and gurgling in the stomach.

Problems with the child’s stool should alert the mother.

• She cries and presses her legs to her tummy, jerking them randomly.
• There may be lumps or lumps of undigested milk in the feces. The stool is usually obvious. This is typical for secondary LN.

Differences between LN

It is quite difficult to suspect primary FN in the first weeks of life because the baby eats mother’s breast or bottle in small portions. It all starts with bloating in the abdomen, later pain appears, followed by problems with bowel movements.

In the first weeks of life, lactase deficiency is difficult to detect.

With imaginary LN, the baby eats well and gains weight, but suffers from pain in the tummy. Stool with a greenish tint and sour odor. In this case, the mother’s milk leaks in between feedings.

Dear mothers, it is impossible to say that your child has lactase deficiency based on the signs and symptoms listed above, since many of them fit perfectly into the clinical picture of many other diseases. Only a special analysis can show the presence of LN.

Diagnostic methods

Today, the presence or absence of LD can be determined in several ways:

1. The hydrogen test is carried out as follows: the baby is given lactose and they look at the numbers of hydrogen released after taking milk sugar on the exhale. Based on the indications, LN is determined. The procedure gives the baby a lot of weight discomfort due to the lactose consumed. This procedure is useless for children under 3 months of age, since hydrogen content standards have not been established for them.
2. Biopsy (removal of a small piece of tissue) from the small intestine. Analysis is painful. Must be performed under anesthesia. It is prescribed very rarely.
3. The most common, but not too common effective method- taking a stool test for carbohydrates. The limits for the content of carbohydrates in feces have not been clearly defined, and many experts now advocate dividing the standards by month for children in the first year of life. Another disadvantage of this method: it does not show the presence of a certain type of carbohydrate, which is important when diagnosing LI.

Stool analysis is the most painless method, but a 100% result is not guaranteed.

1. Within an hour after taking (on an empty stomach) lactose, the baby's blood is taken several times. Based on the indicators of blood components, a curved line is drawn depicting sugar fluctuations. This method is called the lactose curve.

The lactose curve will clearly show the presence of sugar in the baby’s body.

1. An analysis based on determining the acidity of a child's stool. It's called a coprogram. This diagnosis is carried out at the choice and recommendation of a doctor in combination with other described research methods. The acidity level is 5.5 pH. If the stool shows that the acid content in it is higher than normal (the lower the pH number, the greater the acidity), then this is a clear sign of LI.

- this is a real event for mom. However, there is no specific time when a baby should smile. It all depends on the individual characteristics of the baby.

We fight for peace

There is a disease, there are ways to identify it, which means there is a treatment. What is it, what are its features?

Nuances 2:

• LN type.
• Type of baby's nutrition (HW or IV).

Depending on the severity of these factors, based on tests and clinical picture, the doctor prescribes treatment. In case of acute primary LI, the baby is prescribed lactose-free formulas: Nutrilak, Nutrilon, Nan, Enfamil Lactofri, Humana. But mixtures are a last resort.

Basically, experts recommend maintaining natural feeding through proper organization of the process breastfeeding. In addition, a nursing mother must follow a certain diet. The diet is based on the exclusion of whole cow's milk from the diet. You can replace it with goat milk.

Mommy will have to endure a strict diet.

In rare cases, you have to give up beef, butter and all kinds of baked goods. If the situation is very acute, then you will have to give up all dairy products. The best way out will adhere to the usual diet of a nursing mother, unless the doctor recommends otherwise.

Add enzyme to milk, and the child’s condition will improve.

In case of secondary LN, getting rid of dysbacteriosis can be added to the treatment methods described above. “Dysbacteriosis is treated with drugs such as and/or. They contain lactose, so they cannot be used for treatment,” warns E. Komarovsky.

Early complementary feeding

Complementary feeding should be introduced for LI, but a little earlier than six months. From 4 months we begin to give and, later - juices, followed by dairy-free cereals.

Babies with LI need additional complementary feeding earlier.

Let's not let LN develop

Prevention of LF in infants is periodic stool testing for carbohydrates. Also, avoid taking medications and products containing lactose (fermented milk products may be an exception).

Carefully monitor the composition of the treats your child consumes.

The condition caused by a child's inability to digest lactose (milk sugar) is called lactose intolerance. Since the cause of this condition is a lack of the enzyme lactase in the body, its second name is “lactase deficiency.” What are the causes of this pathological condition and what should parents do if it is detected in their baby?

In newborns and infants

In newborns, lactase deficiency is usually genetically determined. To a greater extent, such congenital intolerance develops in carriers of Asian genes. Also, in children under 6 months of age, lactase deficiency may be associated with intestinal infection, allergies, or other diseases.

Lactase deficiency is often detected in premature babies, as a consequence of the immaturity of their digestive tract.

In older children

Most often, lactose intolerance develops in older children between the ages of 9 and 12. In babies who are no longer breastfed, the amount of lactase in the body gradually decreases. Although among Europeans there are many people whose bodies produce lactase normally until old age.

Among older children, many cannot tolerate milk sugar and do not suffer from it at all. They simply avoid dairy products to avoid symptoms of intolerance. But for small child this pathological condition can become a problem since milk is the staple food in early life.

Signs and symptoms

Hypolactasia (insufficient lactase) can be identified by the following symptoms:

• Stomach ache.
• Nausea.
• Flatulence, bloating, rumbling in the stomach.
• Diarrhea that appears one to two hours after eating dairy products.
• Restless behavior of the child after eating.

Classification

The following types of lactose intolerance are distinguished:

1. Congenital. A very rare condition in which the baby rapidly loses weight immediately after birth, suffers from dehydration and is at risk of death. To confirm the diagnosis, an intestinal biopsy is required, but it is rarely prescribed to newborns, most often simply by switching the baby to a lactose-free diet for 4-6 months, after which the baby is given lactose in small quantities.
2. Transitional. Occurs in babies who were born prematurely.
3. Primary. Develops after the end of breastfeeding. This form of lactose intolerance is very common. It is typical for people living in Asia, America, Australia, as well as on the African continent and islands in Pacific Ocean. This is due to the history of human nutrition, since in the past people mainly ate animal milk. European countries, in parts of Africa and India. Such lactase deficiency is manifested by bloating, nausea, belching, diarrhea, and vomiting. Symptoms may change throughout life. Some people react to small amounts of lactose, while others are able to absorb larger amounts.
4. Secondary. Appears as a result of intestinal damage due to infection, allergies or other reasons. For example, after gastroenteritis, the body takes several days or weeks (depending on age) to restore lactase production.
5. Functional. Appears at healthy child who is gaining weight, but suffers from gas, frequent watery stools with a greenish tint. Tests that detect lactase deficiency in such children will be false positive. The reason for this problem is the baby’s lack of hind (fat-rich) breast milk, as well as an immature enzymatic system.

Depending on the severity of the pathology, lactase deficiency can be complete or partial.

Causes

The cause of lactase deficiency in newborns (the primary form of deficiency) is often a genetic predisposition.

The following reasons lead to the development of a secondary form of this pathology, which is acquired:

• Inflammatory processes in the small intestine.
• Past infections.
• Surgical interventions on the stomach and intestines.
• Having celiac disease.
• Carrying out chemotherapy.
• Development of ulcerative colitis.
• Crohn's and Whipple's diseases.

Here are the processes that occur in the body in case of problems with digesting lactose:

• Undigested lactose enters the large intestine, where water also enters by osmosis.
• This milk sugar is processed by bacteria in the colon, resulting in the formation of gases.
• Undigested fatty acids appear in the stool, which are also formed as a result of bacterial activity.
• The lining of the intestine becomes irritated, leading to excess mucus production.
• Since stool passes through the intestines too quickly, its color becomes green.
• The result will be sour, foamy, greenish, liquid stool, tests of which will reveal sugar (undigested lactose).

Differences between lactose and lactase

The similarity of the name often leads to confusion between these two words:

• Lactose is an important carbohydrate for a child, represented by a combination of two molecules - galactose and glucose.
• In order for the body to break it down and digest it, it needs lactase. This is an enzyme produced in the small intestine.

If there is not enough lactase, then the breakdown of lactose does not occur, that is, it is not digested. That is why this condition can be called both lactase deficiency and lactose intolerance.

It's not a milk allergy

Lactase deficiency is often confused with the development of an allergy to dairy products. But these are completely different problems. Milk allergy is much less common than lactose intolerance and is a more serious condition with a risk of death.

If your baby is allergic to milk, then he is contraindicated to consume this product. Once in the body, even in small quantities, milk will cause the baby to develop rashes, itching, difficulty breathing and other allergy symptoms.

But with a lack of lactase, the body is able to process milk product in small quantities, for example, if you drink 100 ml of milk at one time or eat up to 50 grams of yogurt.

What to do?

If the baby's stool has a greenish tint, while it is liquid and foamy, the mother of the breastfed baby is recommended to:

• Make sure that the baby is attached correctly and that the breast is latched correctly.
• Try feeding for three to five hours from only one breast.
• Since in this case the mother often has a lot of milk, the second breast will have to be pumped a little at this time.

Treatment of lactose intolerance usually involves eliminating this disaccharide from the diet or using medications containing lactase. At the same time, symptoms are treated and the cause is eliminated (if lactase deficiency is secondary).

Breastfed children Lactase preparations are often prescribed, since it is undesirable to reduce the amount of human milk in the baby’s diet. If it is impossible to use such drugs, the child is transferred to a low-lactose formula (at first partially, keeping a maximum of breast milk in the baby’s diet, which will not cause symptoms of lactase deficiency).

When feeding your baby with formula select a product that will contain the maximum amount of lactose that does not cause clinical manifestations insufficiency. You can combine the regular mixture and lactose-free or transfer the baby to fermented milk mixture. If lactase deficiency is significant, the child is given only a low-lactose mixture.

When preparing complementary foods for a child with lactase deficiency, not milk, but a lactose-free formula is used, and after a year, dairy products are replaced with low-lactose analogues.

If hypolactasia is secondary, then a low-lactose diet is maintained during the period of treatment of the underlying pathology. Products containing lactose are introduced gradually over 1-3 months after recovery.

Necessary tests

There are several ways to determine if you have lactose intolerance:

1. Coprogram. The analysis determines the amount of fatty acids as well as the pH reaction. If you are lactose intolerant, the stool will be acidic and the concentration of fatty acids will increase.
2. Detection of carbohydrates in feces. Most often used to detect lactose intolerance, but often results in false negatives or false positives. The method detects carbohydrates, but cannot show for sure that it is milk sugar. Its results are taken into account only in conjunction with other tests and clinical manifestations.
3. Hydrogen breath test. A very common method involves using a special device that checks the air a person exhales after consuming glucose. The test is not used for children under 3 months.
4. Lactose curve. Blood is taken on an empty stomach in the morning, then lactose is consumed and a few hours later a blood test is performed again. Based on the results, a graph is constructed, which is called the lactose curve. The method is not very informative, and its use is infant comes with some difficulties.
5. Intestinal biopsy. This is very exact method to make a diagnosis of lactase deficiency. It involves taking small sections of the mucous membrane of the small intestine. Lactase activity is determined in these microscopic areas. The method is rarely used due to its traumatic nature and the need for general anesthesia.
6. Genetic research. Helps determine primary deficiency. The disadvantage of the method is its high cost.

How to live with this?

The prognosis for people with this pathological condition usually favorable. Most of those who are lactose intolerant do not consume dairy products by choice (without asking questions, they say that they simply do not like them).

There is no lactose in the following products:

• Vegetables;
• Vegetable oils;
• Pasta;
• Fruits;
• Raw fish;
• Eggs;
• Raw meat;
• Vegetable and fruit juices;
• Nuts;
• Cereals;
• Legumes;
• Soy drinks, soy meat and soy curd;

• You can find milk on sale that does not contain lactose. The sugar in this milk has already been broken down into galactose and glucose, so this milk product can be consumed if you have lactase deficiency.
• If you have lactose intolerance, you should consume more dairy products in which this carbohydrate is already fermented. Such products are hard cheeses, yoghurts and other fermented milk products.
• Chocolate milk is a good choice because cocoa has the ability to stimulate lactase production, which improves milk absorption.
• If you have lactase deficiency, it is recommended to drink milk with meals. It’s great if milk is combined with cereals. The volume of milk per serving should be up to 100 milliliters.
• Remember that skim milk contains milk sugar. This milk has the fat removed, not the lactose.
• Lactose is found not only in milk, but also in other products - products for diabetics, confectionery, sauces, bread, margarine, cream, condensed milk, chips and many others. Even if the list of ingredients does not say that the product contains lactose, the presence of this carbohydrate can be judged by other components - the presence of milk powder, whey or cottage cheese.
• You should also be aware that lactose is included in some medications. Milk sugar can be found in no-shpe, bifidumbacterin, motilium, cerucal, enap, contraceptives and other drugs.
• Lactose is one of the important components of nutrition for children. It must be added to milk formulas to bring their composition closer to human milk.

Lactase deficiency (LD)- this is a congenital or acquired circumstance when, due to a lack (or absence) of the lactase enzyme, the breakdown of milk sugar (lactose) occurs, that is, the body does not accept a product such as milk. Often this disease is common among young children, for whom milk is the main source of nutrition. But these manifestations can also be found in the adult population (about 15%).

• uncharacteristic green tint with foaming;
• bloating.

Symptoms of lactase deficiency are often noticeable in babies in the first 6 months of life.

Lactase deficiency in infants is extremely insidious. In addition to accompanying diarrhea, weight loss and dehydration, it can provoke persistent improper absorption of microelements, which are vital in the development of the baby. Lactase deficiency hits the intestines the hardest. The unsplit form of sugar negatively affects the formation of proper intestinal microflora. This affects peristalsis and leads to the accumulation and increase of pathogenic microorganisms and fermentation.

Lactase deficiency in infants has negative impact for immunity.

The main symptoms include:

• diarrhea (diarrhea);
• colic;
• palpable rumbling in the intestines;
• stools are frequent, liquefied, with a sour odor and foamy appearance;
• baby cry.

In addition to the main manifestations of lactase deficiency, dangerous symptoms which cause significant damage to health. Namely:

• frequent diarrhea;
• weight loss (or pronounced weight loss, according to age);
• loss of appetite, as well as complete refusal of food;
• dehydration;
• nervousness or obvious lethargy in the baby;
• vomiting accompanying every meal.

Lactase deficiency - symptoms

The more food containing lactose enters the body, the more severe the manifestations of lactase deficiency will develop. Dehydration and low body weight are the most severe indicators of LI. With this disease, stool is characterized by an increased amount of sugar in it.

Types of lactase deficiency

There are two types of lactase deficiency: primary and secondary. Lactase deficiency in infants can be present in one or another form.

Primary lactase deficiency

Occurs due to a lack of lactase enzyme, but the baby does not have any abnormalities associated with epithelial cells intestines.

Primary lactase deficiency is divided into:

1. Congenital. Congenital lactase deficiency is an abnormal process of lactase production, which is quite rare and can be explained by gene mutation. In the initial weeks of life, the baby has important during diagnosis of lactase deficiency. After all, if there is no enzyme at all or it is present in very small doses, then it is possible death. With this option, competent medical care is necessary. The main signs of congenital lactase deficiency in infants are:

• weight loss or underweight in accordance with age;
• dehydration that occurs quickly.

Babies suffering from lactase deficiency need a strict lactose-free diet. This regime must be followed for a long period.

Until the beginning of the twentieth century, babies with a similar illness were hopelessly doomed.

Nowadays, LN is effectively cured with a special diet that excludes lactose.

1. Transitional. It is found mainly in babies born prematurely (premature) or children with below normal weight. At the 12th week of pregnancy, the formation of the enzyme system occurs, and at the 24th week its activation begins. When a baby is born prematurely, the enzyme system has not yet formed in such a way as to be ready for high-quality processing of lactose found in breast milk. Most often, transient lactase deficiency does not require treatment and soon disappears.
2. Functional. This is the most common type of primary lactase deficiency. It has nothing to do with pathologies and disorders of lactase production. The factor often lies in the banal overfeeding of the baby. The large volume of incoming milk sugar simply does not have time to be processed by the enzyme. Another source of functional lactase deficiency in infants may be insufficient nutritional value of breast milk. Then, such milk penetrates the gastrointestinal tract too quickly, and lactose enters the large intestine in undigested form. This provokes manifestations of lactase deficiency.

Secondary lactase deficiency

This disease is also characterized by a lack of lactase, but with disturbances in the formation and functioning of enterocytes.

Intestinal epithelial cells (enterocytes) can be damaged by various diseases (enteritis, rotavirus infections), as well as allergic reactions to gluten or any food. Radiation exposure also leads to disturbances in the functioning of enterocytes. Removal of a segment of intestine or congenital pathology short intestines provoke disturbances in the formation enterocytes .

It is possible that the disease developed as a result of a disruption in the formation of lactase. This can happen with any inflammation of the small intestinal mucosa. This is due to the fact that the enzyme is located at the top of the epithelial villi. If there is any interruption in bowel function, initial stage lactase suffers. As the baby grows up, the dynamics of lactase also changes. Its deficiency may also indicate dysfunction of the pituitary gland, pancreas, thyroid gland. If a baby has indicators of functional LI, but is gaining weight well and developing well, then, as a rule, treatment is not carried out.

Diagnosis of lactase deficiency

Due to the age of the patient (patients are usually less than a year old), diagnosing lactase deficiency is very difficult. And survey results can often be false.

Examinations prescribed by a doctor if LN is suspected:

1. Biopsy of the small intestine. It is performed extremely rarely and only in cases where there is a suspicion of congenital LN. This is a rather expensive method of examination, but the most accurate. However, this method may cause complications in the form of bleeding or the probe getting stuck in the duodenum.
2. Dietary diagnostic method. The method is based on a complete (temporary) refusal of food containing milk sugar.

If the manifestations of FN decrease or disappear, then the conclusions about the disease are proven.

Diet diagnostics- the method is accessible and the right way identifying the disease. But this method is not without its disadvantages. So, children may be capricious and refuse to accept a new milk formula.

1. Analysis for acidity and sugar content in stool. When the pH jumps to an acidic environment (less than 5.5), as well as when there are more than 0.25% carbohydrates in the feces, you can begin to suspect lactase deficiency. But often these indicators can indicate other intestinal problems.
2. Hydrogen breath test. Due to the separate requirements of this analysis, its methodology is more applicable to older children. If lactulose fermentation begins in the intestines, hydrogen will inevitably be produced. Hydrogen is well absorbed by the blood and leaves the body with exhaled air. When the lactulose content is too high, there will be much more hydrogen. This may indicate a lack of lactase.

A blood test is taken from the child to check glucose levels
The test is carried out in several stages:

1. The blood is tested for glucose levels. The main condition is to conduct the analysis on an empty stomach, that is, before taking blood, food is excluded.
2. The patient is offered a lactose solution, and after a couple of hours, blood is taken again for analysis.

In infants in the first weeks of life, this test can almost always show positive result. Indeed, at this stage, children only partially digest lactose. Often such tests only indicate functional disability.

Lactase deficiency in infants: treatment

If transient or functional LI is easily curable, then the diagnosis of the disease as “congenital LI” indicates difficulties in treatment.

What methods are used to combat the manifestations of LD?

1. Changes in diet.

Absolutely avoiding foods containing milk sugar will not solve problems in newborns. After all, lactose is a natural probiotic. It is very important for the development of intestinal microflora. Therefore, it should not be completely excluded.

It is worthwhile to completely give up lactose only in the case of very acute forms of lactase deficiency and during peak periods. This does not apply to functional LN (incoming lactose is only reduced, but not completely eliminated). The dose of lactose that is acceptable in the body is changed by testing sugar in stool.

1. Natural and artificial feeding.

You can find many on sale that offer a product with low or no lactose content. But is it always necessary to reject natural feeding and take up artificial feeding? There is no need to eliminate breastfeeding. Doctors recommend supplements of special enzymes for breastfed babies. To do this, an enzyme is added to pre-expressed milk and offered to the newborn before feeding.

If the baby is fed an artificial formula, then it is necessary to change it to low-lactose or lactose-free.

A mixed feeding method is also encouraged. This is especially true during periods when symptoms are acutely identified.

1. Features of complementary feeding in children with manifestations of LI

It is necessary to introduce complementary foods for such children with extreme caution and be sure to record the effect on the body of each product. Complementary feeding begins with vegetable purees. Porridges are diluted strictly with water. The priority is porridge made from rice, buckwheat and corn. Low-fat fermented milk products are allowed only after 8 months, and then only in small doses. The child should have no symptoms such as colic, excessive regurgitation, diarrhea, or discomfort. prohibited. Cottage cheese can be given after a year.

1. Amount of food consumed

When identifying lactase deficiency, the main criterion is not to overfeed the child. The best option There will be frequent feedings, but in small portions. Then the child will begin to form as much lactase as needed, but the enzymes will not be able to cope with increased doses of lactose. Often, by reducing the amount of food (provided that the child weighs at a normal weight appropriate for his age), the problem of LI is solved.

1. A course of medications. The doctor will most likely recommend taking a course of medications containing enzymes for the pancreas (““), which facilitate the activity of the intestinal tract.
2. Probiotics. They are necessary for the good functioning of the microflora in the intestines. But medicines must exclude lactose in their composition.
3. Symptomatic treatment. At frequent diarrhea and discomfort, the specialist prescribes medications for diarrhea and antispasmodic medications.

Functional LN can be eliminated quite well with the help of a well-chosen diet (regular milk formulas containing lactose or breast milk with artificial lactose-free mixtures).

Nutrition of a nursing mother and features of breastfeeding

Doctors advise women who are breastfeeding to completely avoid whole milk. This ban does not apply to fermented milk products. There are no specific instructions or advice, but doctors strongly recommend paying attention to feeding habits. This is due to the fact that "front" Breast milk is rich in lactose. If there is a lot of milk, then "front" The milk must be expressed, and the baby must be put to the breast after incomplete milk, with the so-called “hind” fattier milk. It is not recommended to change breasts during one feeding.

Among experts, one can come across the opinion that if a baby has lactose deficiency, the mother should abandon breastfeeding in favor of dry milk formulas. But the mixture must strictly be low in lactose or completely lactose-free. This method is practiced for acute forms of LN. But often, breastfeeding is not only possible, but also necessary.

For quick and effective results, treatment must be carried out comprehensively. Namely: combine a low-lactose diet with enzymes and the addition of a course of probiotics.

Dr. Komarovsky: Lactase and lactose (video):

There is no need to look out for illness in a baby if its weight and development are normal. However, congenital or aggravated forms can cause damage to the health and even life of the child. With persistent LI, the nervous system is affected and developmental delays may develop.