What kind of stool does a baby have when lactose intolerant? Lactase deficiency in newborns

Breast milk is the ideal food for infants. Hundreds of elements included in its composition help the child grow and develop normally, support his fragile immune system. Vitamins from mother's milk are more easily absorbed, and fats are better absorbed.

Milk changes its composition during the first months, throughout the day and even during one feeding. Not a single highly adapted mixture can exactly recreate such a “cocktail”, much less adapt to the changing needs of the baby.

But sometimes the body of young children, especially newborns, does not cope properly with the digestion of milk. Then they talk about lactase deficiency. What kind of disease is this? How to recognize it and treat it? Our article is devoted to revealing these issues.

Lactose and lactase: who is who?

Many people mistakenly call the disease “lactose deficiency.” In order not to be confused by these names (lactose, lactase), let's take a short tour of the physiology of our body with a chemical twist.

Lactose is milk sugar (we remember from chemistry course that sugars have the ending -ose: glucose, maltose, dextrose). This carbohydrate is of particular importance in the first months of life because, when broken down, it releases glucose and galactose. Glucose is the main energy source for infants. Galactose is involved in further development nervous system baby.

Simplified diagram of the breakdown of milk sugar

When lactose is well digested, the body normally absorbs other elements: calcium, zinc, magnesium. And if an adult is able to live without milk (he can get glucose and calcium from other foods), it is vital for a newborn, since in infancy he is not able to digest solid food.

Lactase is an enzyme, an enzyme (remember chemistry again - most enzymes have the suffix -ase: amylase, protease, lipase), formed in special cells - intestinal enterocytes. Each enzyme can only break down a specific element of food, just as a lock can only be opened with the right key. Digestive enzyme Lactase breaks down lactose - and only lactose - into glucose and galactose.

The enzyme set is not constant. It changes throughout life depending on the person’s eating style and age. Therefore, the intestines of infants contain an enzyme set that is suitable specifically for processing milk. But when there is not enough lactase or it is not produced at all, lactose, unable to be absorbed in the small intestine, enters the large intestine, where it is digested by “local” microorganisms. That's just side effects in the form of diarrhea, pain and flatulence are inevitable.

Lactase deficiency (LD) is a condition when lactase activity in the intestines is reduced, causing the body to be unable to digest milk sugar. Its other name is lactose intolerance. Due to similar symptoms, the disease is often confused with an allergic reaction to milk protein, but the causes of these two diseases are completely different, which means the treatment will be different.

Causes

Lack of the enzyme lactase can be either congenital or acquired.

Congenital LI(also called primary) occurs when the intestines of a newly born baby are not able to produce lactase. This form of the disease is quite rare. She explains herself genetic mutations. Can be inherited.

Acquired LN(temporary, secondary) appears as a result of a previous disease (intestinal infection, allergy to cow's milk), which caused inflammatory process in the intestines, causing damage to enterocytes. As soon as the pathology is cured, the enterocytes are “reborn”, and with them the ability to produce lactase is resumed.

About transient LI they say when the conversation turns to premature babies, whose intestines are not yet physiologically ready to process any food. In this situation, the problem is solved within several months, when all the digestive organs “ripen” and the child can easily absorb mother’s milk.

So, the main factors for the occurrence of LN are as follows:

• genetic predisposition;
• various diseases(allergy to certain foods, celiac disease, intestinal infections);
• lack of certain hormones;
• birth ahead of schedule.

Signs of lactase deficiency

Understanding that a baby is lactose intolerant is not that difficult. But symptoms indicating digestive problems do not always indicate low lactase production. Most of them are quite natural for infancy and individually have nothing to do with the disease under discussion.

Often the symptoms of one disease are disguised as the symptoms of another

Here are some signs that are common in young children, but do not always mean that the baby is lactose intolerant:

1. Intestinal colic . Almost all “healthy” children go through the colic stage, so on their own they have a right to exist. After 2-3 months, colic disappears, regardless of whether the woman stops breastfeeding or not. So there is no direct connection with the disease.
2. Frequent stool diarrhea-like. The baby eats liquid, easily digestible food. Therefore, it is normal if he poops frequently, the consistency is liquid, the color varies from mustard yellow to greenish, and there may be undigested milk lumps and a little mucus in the stool. In a newborn, such stool is not considered diarrhea, and certainly does not indicate problems with digestion.
3. False constipation. Infrequent bowel movements, provided that the stool is soft and the baby does not strain or blush during bowel movements, is quite acceptable. Breastfed babies may poop once every 2-3 days.
4. Regurgitation. They arise mainly due to dysfunction of the valve between the stomach and esophagus. Infrequent regurgitation is not considered a pathology and is not treated in any way.
5. Restless behavior during or after feeding. Digestion and breakdown of lactose begins about 20-30 minutes after feeding, so breast refusal or restless behavior cannot be affected in any way. Most likely, the baby’s moodiness is associated with irritation of the esophagus or stomach, but that’s another story.

Sometimes the only option for children with lactase deficiency is to stop drinking whole milk.

What can be concluded? Taken together, the listed symptoms may indicate a suspicion of lactase deficiency, but they must be considered as a whole. In addition, lactase deficiency is not an autonomous disease. It is only a consequence of other pathologies. Therefore, other signs may indirectly indicate lactose intolerance:

• skin rashes allergic nature;
• slow weight and height gain, developmental delays;
• Iron-deficiency anemia, not amenable to treatment;
• stools are too frequent (more than 9 times a day), watery;
• true constipation with dense feces and difficult evacuation.

Diagnostics

As you can see, signs of LI are skillfully disguised as other diseases: irritable bowel syndrome, allergic manifestations, celiac disease, Crohn's disease. Therefore for precise definition diseases are used differential diagnosis. Which one?

1. Analysis of stool for the presence of carbohydrates. The study allows us to see whether there is an increased content of carbohydrates in the stool of children in the first year of life. Normally, their existence is possible and varies from 1 to 0.25%. After a year there should be no carbohydrates in feces.
2. Stool acidity. Lactose intolerance is indicated by low acidity, where the pH is 5.5 or less. The accuracy of the results is directly related to the “freshness” of the sample, because if collected feces If it sits for several hours before analysis begins, it will oxidize on its own under the influence of bacteria.

Principles of treatment

The choice of treatment for young children will depend on the characteristics of the disease. For congenital lactase deficiency breast milk completely replaced by lactose-free formulas. If we are dealing with an acquired transient form, several options are possible:

Situation	Treatment tactics
The baby feels well and is gaining weight.	Breastfeeding or highly adapted milk formula continues without changes, despite the fact that the carbohydrate level in the analyzes remains slightly elevated.
The child is gaining weight well, but there are signs of intestinal dysbiosis.	Breastfeeding continues, but medications containing lactase are taken before feeding. The doctor selects the dose.
Weight gain is very low.	Dairy feeding is replaced completely or partially with special mixtures: Nan lactose-free, Nutrilak lactose-free, Nutrilon low-lactose.

For successful treatment LNs use lactase-based drugs or lactose-free mixtures

Thus, in most cases it is not at all necessary to give up breastfeeding. When the doctor additionally prescribes lactase (Lactase enzyme, Lactase baby), treatment cannot be interrupted throughout the entire course, which is about 4 weeks.

The withdrawal of the drug occurs gradually, one dose is removed every 4 days. If the symptoms of the disease make themselves felt again, return to the therapeutic dose and extend treatment for another 14 days. Sometimes taking lactase lasts for several months.

When artificial feeding The medicinal milk-free formula must also gradually be replaced with regular milk. It is administered initially one measuring spoon, and the dose increases every day.

As for the nutrition of a nursing mother, whole cow's milk is removed from the diet and the consumption of sweets is limited. The mother can eat fermented milk products, but with the introduction of complementary foods, the baby is also allowed to eat them. By the second half of the year, secondary lactase deficiency decreases, and in the future the child will most likely be able to consume dairy products without problems.

Congenital milk intolerance, to one degree or another, persists throughout life. Although even in this situation a small amount dairy product drinks without consequences. Another positive point: taking probiotics helps the body digest lactose in small quantities.

Lactase deficiency is a lack of the enzyme lactase, which is required to break down milk sugar (lactose). The main signs of FN: foamy and loose stool green, colic, bloating. As a rule, FN manifests itself in newborns and infants in the first year of life.

In infants, lactase deficiency is dangerous due to sudden dehydration body, weight loss and diarrhea. Also this state can lead to persistent disruption of the absorption of microelements that are required for the development and growth of the child. During lactase deficiency, the intestines suffer the most. Lactose negatively affects the formation of healthy intestinal microflora and leads to impaired peristalsis, the growth of pathogenic microorganisms, and fermentation. All these processes affect the functioning of the newborn’s immune system.

Symptoms of the disease

What symptoms of FN can be observed in a newborn child under one year of age? Which of them are dangerous to the life and health of the child? Are common symptoms lactase deficiency:

• constant rumbling in the intestines, colic;
• increased flatulence, bloating;
• crying, restlessness of the baby during feeding, with colic;
• regurgitation;
• greenish and foamy stools with a sour odor.

Dangerous symptoms:

The more milk sugar enters the body, the more severe the symptoms of lactase deficiency. The severity of FN is determined by the child's underweight and dehydration, and stool analysis determines an increased amount of sugar.

Types of LN

All types of LN can be divided into two main groups: primary and secondary. Both types of lactase deficiency can be detected in infants.

Explained by shortage enzyme lactase, but the newborn does not have disorders of enterocytes (intestinal epithelial cells). What are the forms of primary lactase deficiency?

Congenital lactose intolerance is a lack of the enzyme lactase, which is required to break down milk sugar (lactose). The main signs of FN: foamy, liquid green stools, colic, bloating. As a rule, FN appears in newborns and infants in the first year of life.

In infants, lactase deficiency is dangerous due to severe dehydration, weight loss and diarrhea. This condition can also lead to sustainable impaired absorption of microelements that are required for the development and growth of the child. During lactase deficiency, the intestines suffer the most. Lactose negatively affects the formation of healthy intestinal microflora and leads to impaired peristalsis, the growth of pathogenic microorganisms, and fermentation. All these processes affect the functioning of the newborn’s immune system.

Secondary lactose intolerance

Caused by a lack of lactose, but at the same time impaired functions and enterocyte production. Intestinal epithelial cells are affected by enteritis (diseases small intestine), rotavirus intestinal infections, giardiasis, radiation exposure, food allergies, gluten allergies. Also, during congenital short bowel or after removal of part of the intestine, disturbances in the formation of enterocytes may appear. During the process of inflammation of the intestinal mucosa, the formation of lactase is primarily disrupted. This is due to the fact that the enzyme is located directly on the surface of the epithelial villi. And when there is a malfunction in the intestinal tract, lactase is the first to suffer.

As the child ages activity lactase changes. Its deficiency may also be associated with dysfunction of the thyroid, pancreas, and pituitary gland. Active biological substances(acids, hormones) are important for the development of the baby’s enzyme system. When infant signs of a functional lactose system are noted, but he is developing normally and gaining weight well, then special treatment will not be required.

Diagnosis methods

Often, the diagnosis of FN is false positive results and complicated due to the age of the child. Which tests What can a doctor recommend if there is a suspicion of LN?

In the first days of life, newborns experience incomplete digestion of lactose, which is why hydrogen tests and lactose load tests often show positive results. Most often they only talk about normal FN.

Treatment options

Treatment of LN is complicated when a diagnosis of congenital hylactasia is made. During functional and transient LI, the picture is not so serious. What methods are used to treat the symptoms of LI?

Features of breastfeeding and nutrition of a nursing mother

Nursing mothers are not recommended to drink whole milk, but are not prohibited dairy products. Breastfeeding specialists do not give any special instructions regarding the mother’s nutrition in case of LF in the child. However, attention is paid to the peculiarities of feeding and latching the baby to the breast. Foremilk contains most of the lactose. When there is a very large amount of milk, the child quickly becomes saturated with milk enriched with lactose and cannot reach the “back”, the fattest part.

During LN, it is advised not to replace the breast at one feeding, but to slightly express the lactose-containing fore milk so that the baby consumes nutritious hind milk. In this case, food remains in the gastrointestinal tract much longer, and lactose in the intestines has time to break down. Symptoms of FN will go away over time.

Today, nursing mothers can hear this advice from doctors: stop breastfeeding and switch completely to lactose-free or low-lactose formula. This measure is used for severe and severe forms of LI. Most often, breastfeeding is not only possible to maintain, but simply necessary. In modern pediatrics, the diagnosis of “lactase deficiency” is so “hyped” and popular that most sensible mothers arouse distrust and suspicion.

In infants, lactase deficiency is treated comprehensively: to normalize the intestinal microflora, a course of probiotics, enzyme therapy, low-lactose diet. When, during functional LI, the baby has normal development and sufficient weight, then there is no need to look for a disease in the child. But with severe and congenital types of LI, a threat may arise to both the health and life of the baby. During persistent lactase deficiency, the nervous system begins to suffer, and developmental delays may occur.

Mother's milk is an irreplaceable source of vitamins, minerals, amino acids, proteins, carbohydrates, the content of which is the most balanced for the full formation, growth and development of the child. It has a unique composition, as it is enriched with more than 400 elements. The highest quality artificial formulas are unable to replace breast milk. The main carbohydrate in human milk is lactose or milk sugar.

Lactose gives milk a pleasant, sweet and refreshing taste. However, this carbohydrate, essential for the body, can become the culprit of such an unpleasant disorder as lactase deficiency (LD) in infants. It can lead to serious consequences and health problems for the baby. To help the baby, it is necessary to recognize the signs of the disease in time, consult a doctor who will help determine the cause of the disease and choose effective treatment. According to statistics, lactase deficiency occurs in newborns in 6–10% of cases. Adults also suffer from this disease.

The beneficial carbohydrate lactose is present in the milk of all mammals, but the concentration of this substance varies and depends on the species. It is the woman's milk that contains more lactose than the milk of other mammals. The second place in lactose content is occupied by the female dolphin - the most “intelligent” animal in the world.

For infants, LN is more relevant, because in the first year of life, mother’s milk is the basis of their nutrition, and acidity gastric juice and enzymatic activity in children of the first year of life is very low. Gradually, after overcoming the age of six months, it increases and problems with the gastrointestinal tract leave the baby.
Lactose is needed for normal development brain In addition, it provides 40% of the baby's energy needs. The substance is broken down in the small intestine under the influence of the lactase enzyme. Because of this, one large molecule breaks down into two smaller ones - glucose and galactose.

The biological benefits and functions of lactose are difficult to overestimate. It is necessary for the normal absorption of calcium by the body. Another substance improves metabolic processes. Breast milk sugar is also used to feed and reproduce lactobacilli in the gastrointestinal tract, which, in turn, are responsible for normal stool and form immunity.

Lactose is found not only in the milk that a child receives during breastfeeding. The baby will receive the substance through the introduction of complementary foods such as cheese, cottage cheese, kefir and other fermented milk products.

Lactose molecules are necessary for the balanced and harmonious functioning of the central nervous system. Also, its constant synthesis in the body helps prevent diseases. of cardio-vascular system. The baby must eat mother's milk, because it is the main source for his growth, development, and energy.

The essence of lactase deficiency

If the lactase enzyme in the small intestine is not produced enough, undigested lactose moves further along the gastrointestinal tract. Lactose reaching the large intestine is a breeding ground for the development of lactic acid bacteria. At the same time, fermentation processes intensify, which manifest themselves in the form of colic and increased gas formation. The child has a tummy ache, he is capricious, often cries, and the mother cannot understand what caused the anxiety. In addition, lactose in the large intestine causes the accumulation of water in it, as a result of which the baby suffers from loose stools.

Lactase deficiency should be distinguished from lactose intolerance and lactose allergy.
Lactose intolerance is a condition when the body completely does not accept dairy products. In the case of LN, the body simply does not have enough of the necessary enzyme to break down lactose, and with proper treatment, the balance can be restored.

Intolerance can manifest itself in the form of diarrhea, constipation, pain and cramps in the intestines, and rash. The resulting acidic stool causes damage to the intestinal walls. They become irritated, which leads to absorption problems useful substances.

Another problem is allergic reactions when drinking milk. When a person has a lactose allergy, consuming dairy products may cause anaphylactic shock and even without timely medical care, cause death. It is important to identify allergies as early as possible. To do this you need to go through clinical tests and examination.

Types and causes of lactase deficiency

The pathogenesis (causes of occurrence) is quite wide. Children born prematurely are predisposed to the disease. This is due to the fact that the lactase enzyme begins to be produced in the fetus at 34 weeks. intrauterine development. Every month its quantity increases, production becomes more active.

Another reason for the development of LN is genetic predisposition. If the disease is provoked hereditary factor, the chances of completely curing it are minimal. Very rare.

Depending on the root cause of the decrease in enzyme activity, LN can be primary or secondary. In the first case, the cells of the small intestine (enterocytes) are not damaged, but lactase activity is reduced or completely absent. Primary or congenital deficiency is often associated with a congenital gene mutation and may be a sign of a genetic disorder. Congenital defects are divided into types:

• Transitional. Typical for babies born prematurely. Premature babies are more susceptible to lactase deficiency. It is associated with underdevelopment of the infant's intestines. This type often develops in children born at 30, 34 weeks of pregnancy, when the concentration of lactase in the fetal gastrointestinal tract is reduced. Transient lactase deficiency is temporary and goes away after some time.
• Functional. The enzyme is produced in normal quantities, but other dietary features lead to the fact that food quickly enters the large intestine and lactase does not have time to act.

Secondary LN develops when enterocytes are damaged. It is because of malfunctions in their work that the necessary enzyme is not produced. The disease is acquired in nature, that is, it develops against the background of another disease. Cell damage can occur under the influence of immune and infectious diseases, as well as inflammatory processes.

Only an experienced doctor can detect the disorder, its causes and the type of disease. If the baby has become restless, cries a lot, or has problems with the intestines, you should consult a pediatrician to learn more about diagnostic methods.

Many medicines contain the lactose component. Therefore, it is very important for children with lactase deficiency to replace them with alternative pharmacological agents. Parents need to carefully study the composition of all medications and food products used.

Symptoms

Symptoms of FN are similar to those of other gastrointestinal diseases. Pronounced signs of pathology are:

• with foam and mucus;
• during or after feeding, the baby becomes restless;
• the child has bloating;
• he is not gaining weight;
• he has increased gas formation;
• stool analysis shows high acidity and high sugar content.

The appearance of these signs is a reason to consult a doctor and not self-medicate. Symptoms of gastrointestinal diseases in infants are very similar to each other. Only a competent specialist can make a diagnosis.

Lactose overload

Sometimes LN symptoms are caused by lactose overload. It is associated with the fact that the mother has an excess amount of milk (hypergalactia). Lactose is found in large quantities in foremilk, which is 90% water, so it passes easily and very quickly into the intestines. Even if the enterocytes are not damaged and work at full capacity, they do not have time to cope with the resulting volume of carbohydrate. It turns out that the child is healthy, but lactose does not have time to break down. This is what causes the symptoms of LN.

This condition can also occur when a nursing mother offers her baby both breasts at one feeding. The baby receives only lactose-rich foremilk. In this case, the baby may experience a deficiency of proteins and fats, which hind milk is rich in.

You can get rid of the problem if you stick to simple recommendations. Main principle- this is to establish processes breastfeeding. You should not allow your child to overeat. It is necessary to feed him with one breast, making sure that the baby completely empties the mammary gland.

The required interval between feedings should be maintained, taking into account the baby’s age. Usually the feeding process lasts no more than 20 minutes, but this criterion is relative and depends on individual characteristics crumbs.

Diagnostics

LN can become a serious problem. Your pediatrician will tell you whether it is necessary to stop lactation based on the severity of your symptoms. The specialist draws conclusions and prescribes treatment only after testing. Unfortunately, there is no single test that can be used to make a diagnosis. Many tests are quite unpleasant and painful. Most often, the following studies are used to diagnose LN:

• Biopsy of the small intestine. Several cells will be taken using a special probe for research to determine the level of the lactase enzyme. The technique is rarely used due to its traumatic nature and the need to use general anesthesia and penetration into the infant's intestines, high cost.
• Lactose curve. The test consists of giving the child a portion of milk on an empty stomach. Then blood is drawn within an hour. Based on the results of changes in indicators, the doctor can conclude that there is an enzyme deficiency. Some experts say there are false positive results from this test. Therefore, it is better to conduct it in conjunction with another type of research.
• Hydrogen test. This method is to ensure that the child receives the required portion of protein. Then, using special equipment, the healthcare worker determines the level of hydrogen in the exhaled air. The negative point is the high cost of the equipment and procedure. In addition, the minimum limit for indicators in children has not been established.
• Stool analysis for carbohydrates. The technique is not the most reliable, but remains popular. The presence of false positive results is associated with the lack of uniform carbon standards. Also, the method does not answer which carbohydrates are found in feces. Correctly deciphering the data can only be done in conjunction with data from other studies and after collecting an anamnesis.
• Coprogram. It is used to determine the acidity of a child's stool. The method is used in combination with other diagnostic measures. The pH norm is 5.5 and above.

Examining a baby is not easy. Many procedures and tests are painful or require extensive intervention in the body. It is worth considering that if the problems are truly caused by LN, taking lactose for tests may provoke additional painful sensations, increased other symptoms.

Dr. Komarovsky notes that congenital lactase deficiency is extremely rare. In most cases, LN, as a diagnosis, is made in the case of a transient form, i.e. the baby has the enzyme, but there is much more food and lactose than he can digest. Sometimes LN develops against the background of viral intestinal infections. The way out of this situation is simple - limit the amount of food you eat, switch to lactose-free formulas, or take the lactase enzyme prescribed by your doctor.

Treatment

Therapy for lactase deficiency is a set of measures that also includes diet therapy, the use pharmacological agents. It is important to understand that there is no single panacea for this problem.

Catering

The following recommendations will help you get rid of the disease:

• Compliance with breastfeeding regimen. Catering is included correct schedule, baby's position, breast latch, normalization of milk quantity. Experts insist that after feeding you should not express your breasts, because healthy fatty milk is simply poured out or frozen, and the baby receives watery first milk, which does not have time to be digested due to the rapid progress. It is better to feed from one breast; you can change it only if the baby has completely emptied the first. Never take your baby away from sucking; let him eat as much as he needs. It is recommended to continue night feedings.
• Another step towards treating LI is hypoallergenic diet. Dairy products should be excluded from the mother's diet. How long diet therapy lasts depends on the success of its use (disappearance or weakening of the child’s symptoms) and is regulated medical specialist. In addition, along with medical worker It is better to create a diet for a young mother taking into account the replenishment of the deficiency of substances that she will lose if she excludes dairy products. As prescribed by a doctor, a woman can take vitamin and mineral complexes that contain calcium.
• If unpleasant symptoms appeared in the baby due to overeating, the mother is recommended to express breast milk before feeding, so the baby will receive hind milk, which is more useful. However, the technique should be used with caution, after consulting with a breastfeeding expert.
• Fermentation of breast milk allows you to continue breastfeeding with LI. In this case, the enzyme deficiency is compensated by adding its synthetic analogue to expressed breast milk. The use of this method involves the use of finger feeding, through a syringe, from a cup, or a spoon. The use of bottles with a nipple is not recommended due to the increased risk from the breast when full contact breastfeeding is restored.
• The use of low-lactose and lactose-free mixtures. This therapeutic baby food made from protein hydrolysates using triglycerides. Most often, these artificial mixtures are recommended for severe forms of diarrhea, when readily available sources of energy are needed.
• Application of products for therapeutic nutrition based on soy protein isolate.

Drug therapy

• Preparations with lactase enzymes. Prescribed only by a medical specialist, name, dose, how long the course of using the funds will last. Special attention the young mother must pay attention to precision when dosing. It is important to understand that this remedy only acts to alleviate the symptoms of the disease without affecting the cause of the disease.
• It is very important to restore the intestinal microflora. For this, the baby may be prescribed prebiotics. This medications, which contain active lacto- and bifidobacteria. Having adjusted intestinal function and restored damaged tissue and cells, manifestations of LN can be eliminated.
• Symptomatic treatment is reduced to the use of drugs to relieve infant colic (Espumizan, Bobotik), antidiarrheals (Loperamide, Smecta), vitamin-mineral complexes, antispasmodics.

If in general state of the gastrointestinal tract will be positive, and the child has been diagnosed with primary LN; after a few months, the disease may go away on its own as soon as the enterocytes start working on their own. Therapy is mixed. It is important to influence the disease on several levels at once. Only an attentive and responsible approach will help eliminate unpleasant symptoms and save the child from problems in the future.

Lactase deficiency is a syndrome that occurs due to impaired digestion of lactose and is characterized by watery diarrhea. Manifestations of pathology are typical for those cases when there is a lack of lactase in the intestines, which can digest milk sugar (lactose). Therefore, it should be understood that the very definition of the term lactase deficiency is erroneous. Lactose is the name given to milk sugar, and lactase deficiency is the name given to the lack of the enzyme in the body that breaks it down.

The following main causes of lactase deficiency in infants can be identified:

1. Premature birth. Lactose begins to be actively produced while the baby is in the mother’s womb, around the seventh month of pregnancy. Before the baby is born, the amount of this enzyme only increases. If the production of the enzyme does not stop by the time the baby is born, the baby may be born premature.
2. Hereditary factors. Lactose deficiency in the body can be genetically determined. If one of the baby's closest relatives experiences an aversion to dairy products, the child may develop lactase deficiency. This situation occurs in every tenth inhabitant of the Earth. It is difficult to completely cure a child; it is recommended to use lactose-containing medications throughout his life.
3. The effect of viral and intestinal infections. Lactase deficiency can develop after a child becomes ill. The described disease can lead to simple cold. In this case, lactase deficiency is considered acquired. After eliminating the cause, the child’s condition returns to normal.
4. Malfunctions gastrointestinal tract. Lactase deficiency occurs when the pancreas is not functioning properly or as a result of dysbacteriosis. This happens in the first year of life after the introduction of improper complementary feeding or when the mother of the child violates the diet.

A combination of several causes of lactase deficiency is possible.

Congenital lactase deficiency

Congenital lactase deficiency is rare and severe form enzyme deficiency. It is dangerous due to dehydration of the body and the development of severe toxicosis. The mother may not quickly recognize this condition, even if breastfeeding occurs against a background of vomiting and diarrhea, which is difficult to stop. Only by stopping breastfeeding and switching to lactose-free formulas can the situation be leveled out

Transient lactase deficiency

This form of lactase deficiency occurs in children who were born prematurely, as well as in infants who are underweight and significantly delayed in development. The digestive system of such children is not yet sufficiently developed and does not ensure the production of the required enzymes in sufficient quantities. The enzyme is produced in the child’s body around the twelfth week of the child’s development in the womb. The enzyme is activated from about the twenty-fourth week of pregnancy. The highest degree of its activity is observed when a child is born. If the baby is born prematurely, even with the production of lactase there will not be sufficient activity. This is the essence of the process of transient lactase deficiency. If lactase activity increases with age, the condition resolves on its own.

Secondary lactase deficiency in infants

Secondary lactase deficiency is caused by infectious and inflammatory diseases intestines. They interfere with the normal production of lactase in the child’s body.

In addition, the cause of secondary lactase deficiency may be damage to enterocytes, the cells that produce lactose. In such cases, the situation is associated with damage to the mucous membrane of the small intestine. This occurs with giardiasis, drug or radiation enteritis, and rotavirus infection.

Allergic reactions can also cause secondary lactase deficiency. We are talking about individual intolerance to casein protein. In such situations, a certain volume of milk sugars does not break down, in small intestine they are not absorbed and are sent to the large intestine.

There are some similarities between primary and secondary symptoms lactase deficiency. The only difference is that with primary failure pathological manifestations occur after a few minutes, their severity is determined total number consumed sugar. Secondary failure causes the consumption of even a small amount of sugar, since intestinal pathology is associated with deficiencies in its breakdown.

Symptoms of lactase deficiency are:

• The stool with diarrhea is watery, foamy, with green impurities, its smell is sour;
• gagging occurs;
• the stomach starts rumbling and becomes bloated, the child loses his appetite;
• the child often spits up and becomes restless;
• the child’s weight gain is either completely absent or becomes completely insignificant;
• When feeding, the child behaves restlessly and often cries.

Symptoms can occur individually or in combination of several. Lactase deficiency can appear both immediately after childbirth and some time after it. It is recommended to consult a doctor immediately after symptoms of lactase deficiency appear.

Baby stool with lactase deficiency

Lactase deficiency can often be indicated by changes in the child's stool. It becomes liquid and begins to foam. At the same time, its color is greenish and is accompanied by a sour smell. Stool with lactase deficiency in a child is characterized by the presence of lumps of mucus with foamy water. The child’s intestines in this state empty themselves quite often, up to a dozen times a day.

Nutrition for lactase deficiency in infants

The majority of pediatricians are of the opinion that if a child has lactase deficiency, the mother’s diet should not include a decrease in the amount of glucose in the diet. The arguments presented are convincing, but most mothers believe that, nevertheless, some kind of dietary prescription should be followed.

Prevention of the formation of lactase deficiency involves limiting the consumption of foods with a high protein content. Such restrictions form the basis of a mother’s nutrition in case of lactase deficiency in her child. When the mother consumes whole milk, it is absorbed from digestive system into the bloodstream, and from there into mother’s milk. Disturbances in the activity of the child’s intestines that have not yet matured are possible if he develops an allergic reaction to this protein. The result will be fermentation of lactose in insufficient quantities, and, consequently, the development of lactase deficiency.

Possible allergic reaction to a different type of protein. Therefore, sometimes a mother should stop eating sweets. In addition, dietary prescriptions for lactase deficiency involve the exclusion from the diet of everything spicy and salty, foods with a lot of seasonings, alcoholic beverages and caffeine, preservatives, various allergens, red foods and exotic fruits. It is also recommended to reduce the consumption of foods that cause increased gas formation, such as sweet pastries, brown bread, grapes and sugar.

Mixtures for lactase deficiency

If a child has lactase deficiency, it is necessary to switch to formulas with a low lactose content or with its complete absence. They can be very different. Some people like domestically produced mixtures, others prefer imported ones. Modern mixtures containing lactose can not only guarantee good nutrition child, but also provide high-quality prevention of future problems with his health. Such mixtures contain prebiotics that correct changes in the intestinal microflora, specifically changes in its motor activity. In addition, such mixtures can resist infections that affect the intestines, as well as eliminate food intolerances.

Lactose-free formulas should be used in two cases. Either with an allergy to breast milk, or, in fact, with lactase deficiency. Their preparation is based on soy protein, which is similar in composition to milk, but does not contain cholesterol. There is no lactase in such mixtures, therefore, they are recommended for a similar problem.

Complementary feeding for lactase deficiency

In case of lactase deficiency, the timing of introducing complementary foods in infants is the same as in children who do not suffer from a similar problem. The principles of complementary feeding remain the same, but the technology changes somewhat.

Complementary feeding of a child with lactase deficiency should begin with vegetable puree. It contains many useful substances, in particular pectin, minerals and vitamins. This is required to maintain the child’s body and give it strength. It is recommended to feed your child zucchini, cauliflower, carrots and potatoes. In this case, you should focus on the child’s condition, since carrots cause an allergic reaction in some children. You should not mix several types of products at once; it is recommended to give them to the child one by one, checking how his body will react. Puree from one type of product should be given to the child for three days, after which he moves on to the next type. At the same time, you need to monitor the baby’s well-being and how his body digests food. Over time, it will be possible to give your child purees from several types of products, preferably two or three.

Treatment of lactase deficiency in infants

The choice of treatment for lactase deficiency is determined by the age of the child, the cause of his condition and the degree. The treatment itself may involve either choosing a different type of diet or avoiding foods containing lactose. The best option in such cases is to use a soy-based mixture.

If a child has a lack of digestibility of lactose at birth, it should be used special means for its splitting. These include Lactase Enzyme, Lactazar for Children and Lactase Baby. Only a doctor can prescribe them. The products are dissolved in expressed breast milk and given to the baby.

Lactase deficiency in infants: how to treat it?

Treatment of lactase deficiency is carried out by prescribing lactase to the child. This is possible if it is not possible to establish normal digestion for the baby. Lactase should be given to the baby between feedings, dissolving it in a certain amount of mother's breast milk. This treatment is most often prescribed in the first few months of a child’s life. This is carried out until children's body will not begin to produce the enzyme on its own.

If the cases are complex, the child is prescribed formulas of artificial origin without milk. With the right treatment regimen, the child begins to gain weight within three days.

How to replenish calcium for lactase deficiency in infants

It is not recommended to compensate for the lack of calcium in a child’s body by introducing dairy products into his complementary foods. Complementary foods containing other foods rich in calcium are best suited for this. These can be grated green vegetables, in particular white cabbage and broccoli, as well as soy cottage cheese and flour with a high calcium content. Gradually adding grated nuts and legumes to your diet is also good.

When does lactase deficiency go away?

Complete relief from lactase deficiency is possible only if it is not congenital. Provided the mother follows the diet prescribed by the doctor, this condition will begin to gradually disappear within a few days. The first improvements will be noticeable after just three days of the diet.

It is difficult to say how long it will take full recovery child, since the child’s body is individual. With proper treatment, lactase deficiency is completely eliminated within a week.

Almost every second baby is now diagnosed with lactase deficiency, but this is very reckless and unjustified. True lactase deficiency in infants is a rare event. The main symptoms indicating lactase deficiency are the banal immaturity of the baby’s enzyme system or improper organization of breastfeeding, during which the child eats little, eats only foremilk, rich in lactose, and does not get to the fatty and nutritious milk. Due to poor digestibility and absorption of such milk, a gastrointestinal disorder appears, which in its symptoms is very similar to lactase deficiency, for example, dysbiosis.

Causes of lactase deficiency

1. Insufficient amounts of lactase are produced (or not produced at all).
2. Hyperlactation in the mother; during feeding, the baby becomes full before reaching the hindmilk (fatty, nutritious milk).
3. Diseases that affect the intestinal cells responsible for the production of lactase.

Types of lactase deficiency

1. primary. The surface cells of the small intestine are intact, but lactase activity is reduced or absent altogether.

Subtypes of primary lactase deficiency:

• innate or true. This type of lactase deficiency, fortunately, is very rare and genetics is to blame. At the beginning of the twentieth century, children with congenital lactase deficiency were doomed, and often the consequences of this disease were death baby. Now this disease is successfully treated with a lactose-free diet;
• transient (temporary, passing) is not as dangerous as congenital. It is detected in premature babies with an immature enzyme system. As the baby grows, everything returns to normal and, as a rule, transient lactase deficiency does not require treatment;
• functional. The most common lactase deficiency in infants. The reason for its occurrence is overfeeding of the child. The lactase enzyme does not have time to break down all the lactose and undigested milk sugar begins to ferment in the intestines and cause symptoms of lactase deficiency. Another reason for the occurrence of this type of ln is the low fat content of the milk of a nursing mother and a large amount of low-fat but sweet milk. The child becomes full without ever reaching the rich, nutritious milk.

1. secondary. Lactase production is reduced due to damage to the cells that produce it (it is provoked by intestinal infection, allergic reaction to cow's milk protein, inflammation in the intestines, and so on). If signs of secondary LI are present, but the child eats well and gains weight, then there is no cause for concern and treatment is not required.

How to determine lactase deficiency? What symptoms occur with lactose intolerance?

• flatulence and rumbling in the stomach;
• colic;
• anxiety during feeding: the child abandons the breast, bends his legs, twists them and cries;
• nausea;
• frequent regurgitation;
• Thin, foamy, watery stools that are yellowish or greenish in color with a sour odor, mucus, and you may see blood in the stool. The frequency of bowel movements reaches 8-10 times a day, and constipation may even occur;
• the child is rapidly losing weight or gains are scanty;
• low hemoglobin;
• symptoms of dehydration;
• skin allergies (spots, rashes, pimples, cracks);
• problems with stool.

Diagnosis of lactase deficiency

• biopsy of the small intestine. Lactase deficiency in infants is not diagnosed in this way, except in particularly suspicious cases and dangerous condition child's health. During this procedure, anesthesia is administered, and its use in such early age is fraught with developmental disorders. Therefore, it is necessary to evaluate all the pros and cons of this procedure;
• stool analysis for carbohydrates. If, according to the results of the analysis, a high content of carbohydrates is detected in the stool, its acidity is increased at a pH of 5.5, then this may be a sign of lactase deficiency. However, such analysis often gives false positive result due to still unformed intestinal microflora or other gastrointestinal diseases;
• coprogram. The baby's stool is taken for analysis. If it contains fatty acid and soap, this may indicate FN;
• rapid test analysis of exhaled air for children over 3 months (test for high hydrogen content). During the fermentation of lactulose, hydrogen is released, which leaves the body with exhaled air. If there is an excess of lactulose in the body, the concentration of exhaled hydrogen is higher, which indicates a lack of lactase;
• lactose curve. A portion of lactose is given on an empty stomach, and a blood test for sugar is done several times within an hour. With a sufficient amount of lactase in the body, lactose is broken down into glucose and the sugar level becomes 2 times higher than before taking lactose. If this does not happen and glucose remains at the same level or increases slightly, it means that the child’s body does not have enough lactase enzyme to break down lactose;
• dietary diagnostics. Breast milk is temporarily excluded from the infant’s diet and the baby is fed a lactose-free formula. A decrease or complete disappearance of symptoms of FN indicates that the diagnosis is correct. However, the very transfer of a child from one diet to another can negatively affect the condition of the newborn (he may simply not like the formula, or it may not suit him for some reason and there will be a need to select a lactose-free formula from another manufacturer).

Treatment of lactase deficiency

If a doctor has diagnosed “lactase deficiency,” then you should not panic and torment yourself with questions “What should I do?”, “When will this go away?” What is, is, you cannot escape from it. Now your task is to follow all the doctor’s recommendations and wait for improvement, but it will definitely come.

In case of true lactase deficiency, prohibited foods are: whole milk, condensed milk with or without sugar!

Clinical guidelines

• diet by a nursing mother, keeping a food diary;
• introduce complementary foods carefully, carefully monitor the child’s reaction to the product and make entries in the complementary feeding diary (““);
• introduce low-fat fermented milk products no earlier than 8 months (““);
• It is allowed to introduce a baby to cottage cheese only after a year, and feeding it with whole milk is prohibited.