Signs of lactase deficiency in newborns. Lactase deficiency: treatment and signs of lactose intolerance in infants

Lactase deficiency is a deficiency of the enzyme lactase, which is necessary to break down lactose (milk sugar). The main symptoms of FN: bloating, colic, foamy, loose stool greenish color. Most often, FN manifests itself in newborns and infants in the first half of life.

Lactase deficiency in infants is dangerous due to diarrhea, weight loss and severe dehydration. This condition also leads to persistent malabsorption of microelements necessary for the growth and development of the child. The intestines suffer the most with LN. Undigested sugar negatively affects the formation of healthy intestinal microflora and leads to fermentation, the growth of pathogenic microorganisms, and impaired peristalsis. All these processes affect the work immune system baby.

How does the disease manifest itself?

What symptoms of lactase deficiency may be observed in an infant? Which of them are dangerous to the health and life of the baby? General signs LN:

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

Dangerous symptoms:

• vomiting after each feeding;
• diarrhea;
• weight loss or significant underweight according to age standards;
• refusal to eat;
• dehydration of the body;
• severe anxiety or, conversely, lethargy of the baby.

The more milk sugar enters the body, the stronger the symptoms of LD appear. The severity of lactase deficiency is determined by the infant's dehydration and low body weight, and stool analysis shows a high sugar content.

Types of lactase deficiency

All types of drugs can be divided into two large groups: primary and secondary. In babies infancy Both types of lactase deficiency can be diagnosed.

Primary LN

It is caused by a deficiency of the lactase enzyme, but the baby does not have pathology of intestinal epithelial cells (enterocytes). What are the possible forms of primary LN?

• Congenital. Very rare and explained gene mutation. Congenital LI is called hypolactasia or alactasia. The control of lactase production and synthesis in a newborn is genetically impaired. If the enzyme is not produced at all or there is very little of it, and the infant will not be provided with adequate health care, the disease may end fatal in the first months of life. The main sign of congenital LI is underweight, weight loss, and rapid dehydration. Children with congenital LI require a strict lactose-free diet for a long time. Even at the beginning of the twentieth century, such babies were doomed. In conditions modern medicine Alactasia is effectively treated with a lactose-free diet.
• Transitional. Diagnosed in low birth weight and premature babies. The enzyme system begins to form in the fetus already at 12 weeks, lactase is activated at 24 weeks intrauterine development. If the baby is born ahead of schedule, his enzyme system has not yet developed to the extent that it can effectively process the lactose contained in breast milk. Transient LN resolves quickly and usually does not require treatment.
• Functional. This is the most common type of primary LN. It is not associated with any pathologies or disorders of lactase production. The most common cause of functional LI is overfeeding of the baby. The enzyme does not have time to process large amounts of milk sugar supplied with food. Also, the cause of functional LI may be low fat content of breast milk. In this case, food quickly passes through the gastrointestinal tract, milk sugar (lactose) enters the large intestine undigested, which causes symptoms of LN.

Secondary LN

It is caused by a lack of lactase, but the production and function of enterocytes is impaired. Intestinal epithelial cells may be affected by diseases small intestine(enteritis), giardiasis, rotavirus intestinal infections, gluten allergies, food allergies, radiation exposure. Also, after removal of part of the intestine or with congenital short intestine, disturbances in the production of enterocytes may occur. At inflammatory process The mucous membrane of the small intestine primarily disrupts the production of lactase. This is explained by the fact that the enzyme is located on the very surface of the epithelial villi. And if there is a malfunction in the intestines, then lactase is the first to suffer.

Lactase activity changes with the age of the child. Its deficiency may also be associated with dysfunction of the pituitary gland, pancreas, thyroid gland. Biologically active substances(hormones, acids) are important for the formation of the child’s enzyme system. If a baby has signs of functional LI, but is gaining weight well and developing normally, then special treatment is usually not required.

Diagnostic methods

Diagnosis of FN often gives false positive results and is difficult due to the age of the young patient. What examinations can a doctor prescribe if LN is suspected?

• Biopsy of the small intestine. It is done in extreme cases when congenital LN is suspected. It's expensive operative method research, but only he can confirm congenital hypolactasia.
• Dietary diagnostic method. Its essence is to temporarily exclude breast milk and infant formula from the baby’s diet and replace them with low-lactose or lactose-free formulas. If the symptoms of LI decrease or disappear altogether, the diagnosis is confirmed. Diet diagnostics is the most reliable and accessible examination method. But difficulties often arise with its implementation: children refuse the new formula, are capricious, and the transition to an experimental formula itself can have negative consequences for the immature intestinal microflora.
• Analysis for acidity and sugar content in stool. If the pH shifts toward acidity (below 5.5), this may indicate lactase deficiency. If carbohydrates are found in the baby’s stool (above 0.25%), this can also confirm FN. However, these tests often give false positive results and may indicate other intestinal disorders and immature microflora.
• Hydrogen breath test. In the large intestine, during the fermentation of lactulose, hydrogen is produced, which is absorbed into the blood and removed from the body with exhaled air. With excess lactulose, the hydrogen concentration is higher, which indicates lactase deficiency.
• Lactose load test. This analysis is usually performed for lactase deficiency in older children, since certain conditions are required for its implementation. Blood glucose is examined first on an empty stomach (you cannot eat 10 hours before the test), then you are given a lactose solution to drink and the blood is examined again after 2 hours, with an interval of 30 minutes to look at changes in sugar. Normally, lactose in the intestines is broken down into glucose, which is absorbed into the blood and should double (compared to fasting sugar levels). But if there is a lactase deficiency, lactose is not broken down, and blood glucose levels do not increase or increase slightly.

In the first months of life, infants experience incomplete digestion of lactose, which is why lactose load tests and hydrogen tests often give positive results. In most cases, they only talk about functional LI.

Principles of treatment

Treatment of lactase deficiency becomes difficult if a diagnosis of congenital hylactasia is established. With transient and functional LN, the picture is not so critical. What are the ways to eliminate the symptoms of LI?

• Nutrition correction. It would seem that completely eliminating milk sugar from a baby’s diet solves all problems with lactose intolerance. But this substance is a natural probiotic and is useful for the formation of intestinal microflora; it cannot be completely abandoned. IN acute periods and at severe forms LN milk sugar is completely excluded. But with functional LI, its quantity is limited. The amount of lactose allowed in the diet is regulated by sugar levels in feces.
• Natural and artificial feeding. What to feed the baby? Is it really necessary to give up breastfeeding(HW) and switch to artificial? There is no need to give up breastfeeding. For breastfed babies, enzyme supplements are recommended: “Lactase Baby”, “Lactazar” and others. The enzyme is diluted in expressed breast milk and given to the baby before feeding. If the child is on artificial feeding, low-lactose or lactose-free mixtures are recommended. Also, during an exacerbation, a combined type of feeding can be introduced.
• Features of complementary feeding. In children with signs of LI, complementary foods should be introduced with great caution and the reaction to a particular product should be recorded. Complementary feeding should start with vegetables. Porridge should be cooked only in water (preferably rice, corn, buckwheat). Low-fat fermented milk products can be introduced little by little only after 8 months and monitor the reaction. The baby should not have bloating, rumbling, abdominal pain, or diarrhea after eating fermented milk products. Whole milk is prohibited; cottage cheese can be given after a year.
• Volume of food. If you have symptoms of FN, it is important not to overfeed your baby. It is better to feed more often, but in smaller portions. The baby produces as much lactase as is necessary for the normal volume of milk and the lactose contained in it. The enzyme system cannot cope with large amounts of lactose. Therefore, it often happens that reducing the volume (while the baby gains weight normally) solves the problem of LI.
• Enzymes to improve the pancreas. The doctor may prescribe a course of Mezim, Creon, Pancreatin and other enzymes that will ease the functioning of the gastrointestinal tract.
• Probiotics. With the help of probiotics, the intestinal microflora is corrected and its peristalsis is normalized. These preparations should not contain lactose, and they should also break down carbohydrates well.
• Symptomatic treatment. For severe flatulence, colic, persistent diarrhea and abdominal pain, the doctor may prescribe medications for diarrhea, bloating, and antispasmodics.

Functional LI is well eliminated with the help of a specially selected diet, when you can combine lactose formulas or breast milk with lactose-free artificial nutrition.

Nutrition of a nursing mother and features of breastfeeding

Nursing mothers are not recommended to consume whole milk, but fermented milk products are not prohibited. Breastfeeding specialists do not give any special instructions on a mother’s diet if her baby has LI. But they pay attention to the application of the baby to the breast and feeding features. Foremilk contains the largest proportion of lactose. If there is a lot of milk, the baby quickly becomes saturated with lactose-rich milk and does not reach the “back”, the fattest one. In case of FN, it is recommended not to change breasts during one feeding, and to express a little bit of lactose-filled foremilk so that the baby sucks out nutritious hindmilk. In this case, food lingers in the gastrointestinal tract much longer, and lactose will have time to break down in the intestines. Signs of LI will gradually go away.

Nursing mothers today may also hear this recommendation from doctors: stop breastfeeding and completely switch to a low-lactose or lactose-free formula. This is a last resort measure for severe, severe forms of LI. In most cases breastfeeding saving is not only possible, but also necessary. The diagnosis of “lactase deficiency” in modern pediatrics is so popular and “hyped” that it arouses suspicion and mistrust among many sensible mothers.

Treatment of lactase deficiency in infants is carried out comprehensively: a low-lactose diet, enzyme therapy, a course of probiotics to normalize the intestinal microflora. If a child with functional LI has normal weight and development, there is no need to look for a disease in the baby. However, with congenital, severe forms of lactase deficiency, there may be a threat not only to the health, but also to the life of the child. With persistent LI, the nervous system suffers and there may be developmental delays.

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Today every fifth child in Russia is treated for lactase deficiency. This diagnosis, which a decade and a half ago was considered only a scientific term that had little to do with practice, has now become more than popular. However, pediatricians have not come to a consensus, and therefore it is difficult to find a more controversial and incomprehensible issue regarding the health of infants. The well-known pediatrician and the author of books and articles, Evgeny Olegovich Komarovsky.

About the problem

Lactase deficiency is the absence or temporary decrease in the body of a special enzyme called lactase. It can break down milk sugar called lactose. When there is little enzyme, milk sugar remains undigested and fermentation begins in the intestines.

Most often, this diagnosis is given to children under one year of age. Quite rarely, lactase deficiency affects children under 6-7 years of age. After this age, a physiological decline in enzyme production occurs, since nature does not provide for the consumption of milk by adults. It is extremely rare that the pathology persists in adults, but this is considered to be a variant of the norm, since milk is not an important product for their body.

Lactase deficiency can be congenital or primary. It can also be secondary, acquired. This deficiency occurs when the walls of the small intestine are damaged. This may be a consequence of previous infection (rotavirus, enterovirus), toxic poisoning, severe damage helminthic infestations, allergic reaction for cow protein.

More often than others, lactase deficiency affects premature babies and toddlers who are overfed and receive more milk than they can digest.

Regarding this diagnosis, modern medicine has quite rosy forecasts: in 99.9% of cases, enzyme deficiency goes away on its own, once the causes that caused it are eliminated.

Doctor Komarovsky about the problem

For adults, lactase deficiency is not a problem, says Evgeny Komarovsky. Nothing bad will happen if a person simply does not eat dairy products. However, for infants, for whom milk is the mainstay of nutrition, things are somewhat more complicated.

A decrease in lactase levels may be genetically determined, says Evgeny Komarovsky. If mom or dad cannot tolerate milk or did not like milk in childhood, then the likelihood of having a baby with lactase deficiency is quite high.

However, Evgeniy Olegovich emphasizes that medicine knows very little about real cases of congenital primary lactase deficiency (30-40). These are really very sick children who do not gain weight, constantly spit up profusely, and suffer from tummy troubles. The share of such cases is about 0.1%.

In all other cases, it was not without the influence of pharmaceutical magnates, who really need to sell large volumes of lactose-free milk formulas for artificial feeding. They cost much more than other food, but parents, who are put in a hopeless situation, are ready to pay whatever they want so that the baby lives and develops normally.

In premature babies, a lack of lactase can be explained by the immaturity of the body; they often experience transient deficiency. It goes away on its own - as organs and systems mature. Depending on the severity, the disease can be complete or partial.

Evgeniy Komarovsky emphasizes that true lactase deficiency is a rather rare case. For this reason, it is not worth giving up breastfeeding and switching your child to lactose-free formula due to suspected deficiency of the lactase enzyme.

To dispel doubts or confirm a diagnosis that has become so popular in Lately, Various additional diagnostic methods are used:

• determination of stool acidity level;
• analysis for carbohydrate content;
• dietary tests.

During the tests, under the supervision of a doctor, breastfeeding and adapted formulas are temporarily discontinued.

The child is given only lactose-free or soy formula for 2-3 days. When decreasing clinical manifestations A diagnosis of lactase deficiency is made.

In all cases (except for severe congenital ones, which, as already mentioned, occur only in 0.1% of cases), lactase deficiency is purely temporary.

The most common cause of milk sugar intolerance in children is banal overfeeding. Parents try so hard to feed their child that they give him an amount of formula or milk that exceeds all imaginable norms. As a result, a child whose enzymes are normal is diagnosed with lactase deficiency only because his little body cannot break down such a large amount of milk sugar.

Bottle-fed babies are the most likely to suffer from overfeeding because they make little or no effort to get bottle-fed food.

For babies who suckle at the breast, it is much more difficult to give milk. Sometimes mothers and fathers do not understand what exactly the child wants. The child is thirsty and screams, but they give him food, believing that the baby is hungry. This can also lead to transient lactase deficiency.

Treatment according to Komarovsky

Temporary (transient) deficiency of the lactase enzyme does not require treatment, says Komarovsky. The production of the enzyme in the required quantity will be restored immediately after the cause of the disorder is eliminated (the baby will no longer be overfed and will begin to follow a drinking regime).

In case of secondary lactase deficiency caused by intestinal viral infections, the child is prescribed special medications. It is advisable to limit food intake and reduce its volume. Sometimes it is appropriate to start giving your baby probiotics.

A child with a genetically determined lactase deficiency is given lactose-free formula for up to six months, and then carefully, gradually begin to introduce dairy products into the diet.

A nursing mother should not sound the alarm when she sees greenish liquid stool with a sour odor. This is a reason to contact a pediatrician, but not a reason to wean the baby from the breast. Moms shouldn't start making fun of themselves. The opinion that the mother's diet affects the lactose content in milk is nothing more than a myth. Breast milk always contains the same amount of lactose, which does not depend on a woman’s gastronomic preferences, time of day or frequency of feedings.

• To prevent the artificial baby from overeating, you need to give him the mixture from a bottle with a nipple with a small hole. The harder it is for him to suck, the faster he will feel full. The less likely he is to eat too much.
• When planning to reduce the amount of lactose in food, you need to find out which foods contain the most lactose. The undisputed leader in the percentage of lactose is human breast milk (7%), while cow and goat milk sugar contains approximately equal amounts (4.6% and 4.5%, respectively). The lactose content in mare and donkey milk is almost the same as in women's milk - 6.4%.
• If you are thinking about purchasing a lactose-free formula, you should first try giving your child low-lactose “Nutrilon” and the same “Nutrilak”.

Dr. Komarovsky will tell you more about lactase deficiency in the video below.

Quite often today you can hear the diagnosis “lactase deficiency”.

This is a pathology that is expressed either in a lack of, or even in lack of lactase enzyme, which digests lactose.

This violation leaves its mark on eating behavior baby. We will talk about the symptoms of lactase deficiency in infants in this article.

How does a child have a gluten allergy? Find out about this from ours.

General concept

Lactase deficiency is a syndrome that occurs as a result of lactose digestion disorders, and it appears watery.

The problem is discovered when there is no enzyme in the baby’s intestines such as lactase, which naturally digests lactose, i.e. milk sugar. If this enzyme is absent or low, a diagnosis of lactase deficiency is made.

Every patient has a pathology individual severity. For example, someone’s body cannot digest whole milk, but with fermented milk products no problems arise.

And this is easy to explain: in fermented milk foods, some lactose is processed. There is simply less of it there, and there are enough enzymes in the intestines for such processing.

Causes

There are a few possible reasons, capable of triggering the mechanism of this pathology. For certain determine what caused the disease, can only be done by a doctor by conducting special studies.

Pathology occurs due to:

• genetic conditioning - the disease can be inherited;
• complications after intestinal diseases;
• taking some;
• to cow protein;
• intestinal immaturity.

In the latter case, the disease eventually it will go away on its own.

We are talking about transient insufficiency, which is explained by intestinal immaturity.

More often this happens with premature babies who are weakened.

By the way, if you believe the statistics, up to 70% of the planet's inhabitants To one degree or another, they cannot tolerate milk. But they know about this peculiarity of theirs, and simply cross out the product from their diet.

The same cannot be said about children, especially infants - milk is their main food, which is why the problem is so acute.

Far Not everyone considers lactase deficiency a disease, preferring to call it just the characteristics of the body. This makes common sense, but when a baby’s body reacts to lactose with unhealthy symptoms, we can call it a disease or pathology.

Types and forms

It is customary to designate primary lactase deficiency and secondary. Primary called this type of pathology in which enzyme deficiency is observed with intact enterocyte cells.

This is a congenital form that occurs rarely; it is associated with a genetic mutation.

Transitional observed in premature babies. Well, such a form of pathology as deficiency in adults may not even be considered a disorder. This is a natural process of age-related decrease in lactase activity.

Secondary Lactase deficiency is found when there is a deficiency of the enzyme, which occurs due to damaged intestinal cells.

This can happen after intestinal diseases, taking antibacterial drugs, the influence of worms on the tissues of the digestive tract.

Symptoms and signs

How does lactase deficiency manifest in a newborn? Symptoms may appear from the first days of a child’s life, but it's too early to make a diagnosis. In infants, it is difficult not to notice the body’s negative reaction to milk.

Signs lactase deficiency:

1. In babies older than 3-4 months, half an hour after eating food (namely milk), liquid, foamy stools with a characteristic sour odor were detected.
2. The baby's tummy is rumbling, and...
3. The child spits up frequently.
4. The baby is vomiting.

If the child undergoes a stool test, an increase in the amount of lactose will be detected.

But it is very difficult for parents to say whether these symptoms indicate lactase deficiency or indicate other intestinal diseases. Therefore, any such symptoms - a reason to see a pediatrician.

In older children the symptoms will be similar, but they will appear later than half an hour after drinking milk.

The child will complain of abdominal pain, diarrhea will begin, and may even lead to vomiting.

Complications and consequences

It is very important here that parents notice alarming symptoms and reacted on time. If no measures are taken, the consequences will not be the best. Yes, baby will stop gaining weight, which in infancy is a risk threatening the health and life of the child.

Also consequence undetected pathology may be:

• defective synthesis of lactose;
• inability to assimilate and digest those useful material that are included in breast milk.

If the child is not prescribed therapy, if he does not adhere to a certain diet, his condition will definitely only worsen.

'Cause baby need to see a doctor, and he, with the help of accurate diagnostic methods, will find out what’s going on and whether we are talking about lactase deficiency.

Diagnostic methods

The most precise method counts biopsy of the intestinal mucosa, and they do it under anesthesia.

This method demonstrates lactase activity.

Pathology can be determined breath test, and the so-called curve construction. To do this, the baby is given a certain amount of lactose on an empty stomach, and then blood is taken for study.

A stool test for carbohydrates is also done. If you see them, you have to clarify what type they are - glucose, lactose or galactose.

The definition is also used stool acidity, a method to determine how much fatty acids in biomaterial. Such detailed diagnosis is important to accurately determine the type of disease.

Treatment

The doctor prescribes therapy depending on the manifestation of the pathology and the baby’s condition. It will either complete avoidance of products containing lactose, or restrictions on their use.

Usually complex therapy is as follows:

1. Medical nutrition (this includes taking a special nutritional supplement).
2. Taking enzymes for the pancreas.
3. Correction.
4. Symptomatic therapy (for diarrhea, bloating, pain).

Treatment, of course, depends on the age of the child.

Treatment of pathology in different categories small patients:

1. In infants- A nursing mother should limit her intake of foods high in protein. Also, sweets and foods that cause gas formation are often prohibited for mothers.
2. Among artificial people- switching to a low lactose content or even its complete absence; the mixtures contain special prebiotics that are beneficial for the intestines.
3. In older children the diet is selected individually, first strictly lactose-free products are selected, then products with lactose are gradually added, and the body’s reaction to its introduction is monitored.

It turns out that the older children, who are already moving to the common table, first eat lactose-free foods- these are fruits and vegetables, meat and fish, rice and durum pasta, legumes, buckwheat porridge, nuts.

After this, cheese, yogurt, sour cream, butter are gradually added to the diet, ice cream, and milk are allowed.

If the stool is normal, gas formation is not increased, there is no discomfort in the tummy, the child gradually switches to a normal, nutritious and varied diet.

The famous pediatrician Komarovsky believes that this diagnosis diagnosed more often than objectively, what needs to be done. Dr. Komarovsky also assures that in the first months of a baby’s life it is simply dangerous to completely remove products containing lactose.

Moreover: the tele-doctor says that the symptoms of LI sometimes indicate that the child is simply fed incorrectly.

Here it is worth remembering the so-called foremilk and hindmilk. The front has a lot of carbohydrates and lactose, but it is less nutritious.

The back contains all the important components that nourish the baby. Therefore, Evgeny Komarovsky emphasizes, you need to focus on studying the diagram and feeding rules, and not looking for pathologies in the baby.

And one more point: if a newborn is diagnosed with lactase deficiency, this at least indicates the incompetence of the doctor, at most it can simply be called a crime.

The lactose enzyme does not mature in the baby’s body immediately; this happens in three to four months. Therefore, it is simply impossible to consider this diagnosis until this time.

Forecast

In general, we can say that the prognosis for this pathology is favorable. But it can only be achieved by strictly following the doctor’s recommendations, in particular, a special diet. For infants, it is important how the mother eats and whether she violates the diet.

Important for older children gradual introduction of lactose-containing products, clear tracking of the body’s response to such an administration. Plus, all this needs to be monitored by constantly visiting a doctor.

Lactase deficiency - common but controllable pathology. It needs to be identified, not just assumed.

Digestive problems in a baby that arise due to lactase deficiency are often mistaken for lactase deficiency. wrong scheme nutrition. Therefore, you need to figure everything out without the help of a specialist.

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How to recognize and how to treat lactase deficiency? Find out about it in the video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

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

What is lactose and its role in child nutrition?

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

Lactase deficiency in infants and its types

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

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

Clinical symptoms

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

• frequent (8-10 times a day) liquid, foamy stools, forming a large water spot with a sour odor on the gauze diaper. Please note that a water stain on a disposable diaper may not be noticeable due to its high absorbency;
• bloating and rumbling (flatulence), colic;
• detection of carbohydrates in feces (over 0.25g%);
• acidic stool reaction (pH less than 5.5);
• against the background of frequent bowel movements, symptoms of dehydration may develop (dry mucous membranes, skin, decreased number of urinations, lethargy);
• in exceptional cases, malnutrition (protein-energy deficiency) may develop, which is expressed in poor weight gain.

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

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

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

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

Doctor Komarovsky about lactase deficiency video

Tests for lactase deficiency

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

None of the diagnostic methods existing today allows us to give an accurate diagnosis when used only. Only comprehensive diagnostics in combination with the presence of a complete picture of the symptoms of lactase deficiency will give the correct diagnosis. Also, an indicator of the correctness of the diagnosis is the rapid improvement in the child’s condition during the first days of treatment.

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

Treatment with breastfeeding

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

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

Regulating lactose intake using natural methods

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

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

• lack of pumping after feeding, especially if there is an excess of breast milk;
• feeding with one breast until it is completely empty, possibly using the breast compression method;
• frequent feeding from the same breast;
• correct latching on the breast by the baby;
• night breastfeeding for greater milk production;
• In the first 3-4 months, it is undesirable to tear the baby off the breast until the end of sucking.

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

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

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

The use of lactase preparations and specialized mixtures.

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

Lactase Baby Lactase Enzyme
Lactazar

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

Treatment with artificial feeding

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

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

Important! Pay attention to the presence of lactose in medicines, since manifestations of lactase deficiency may worsen.

Treatment during the introduction of complementary foods

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

Intolerance to other carbohydrates

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

1. Congenital deficiency of sucrase-isomaltase (practically not found in Europeans). Manifests itself in the first days of introducing complementary foods in the form of severe diarrhea with possible dehydration. Such a reaction can be observed after the appearance of sucrose in the child’s diet (fruit juices, purees, sweetened tea), less often starch and dextrins (porridge, mashed potatoes). As the child gets older, symptoms decrease, which is associated with an increase in the absorption surface area in the intestine. A decrease in the activity of sucrase-isomaltase can occur with any damage to the intestinal mucosa (giardiasis, celiac disease, infectious enteritis) and cause secondary failure enzyme, which is not as dangerous as the primary (congenital) one.

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