The result of lactose deficiency. Lactose intolerance in infants: symptoms and diet of a nursing mother with lactase deficiency in a newborn

The most natural way to feed babies under one year of age is breast-feeding, however, in some cases, the baby’s body cannot absorb either mother’s milk or formula made from cow's milk. This phenomenon is often called lactose (sugar) deficiency, although we need to talk about the symptoms of lactase deficiency.

Statistics show that every 5th newborn suffers from this disease. Symptoms appear very quickly and are usually pronounced. When the first signals appear, measures must be taken to ensure adequate nutrition for the baby.

The body of some children cannot digest the protein contained in milk - this is lactase deficiency.

Terminology. Don't be confused!

Two similar terms: lactose and lactase mean completely different things. Lactose is milk sugar, of which breast milk contains up to 85%. It stimulates the absorption of microelements, promotes the formation of intestinal microflora, and is necessary for the construction and proper functioning of the immune system.

In the gastrointestinal tract, milk sugar decomposes, forming glucose and galactose. Glucose is the body’s main “fuel”; it covers 40% of the body’s energy needs. Galactose is necessary for the development of central nervous system, as well as for the formation of the retina.

Lactase is not a sugar, but an enzyme that breaks down milk sugar into glucose and galactose in the gastrointestinal tract. It is produced by the newborn's intestines. The reason for poor absorption of milk is precisely the lack of the lactase enzyme in the baby’s body, because he receives a lot of milk sugar from his mother’s milk. Insufficient lactase production leads to a phenomenon called lactase intolerance, which is the same thing as lactose intolerance, which is sometimes mistakenly called lactose intolerance.

Lactase is an enzyme in the human body. Its task is to break down lactose contained in milk

Causes and types of disease

Whether a child is breastfed or formula-fed, the same factors lead to lactose intolerance. Milk sugar may not be absorbed by the body for 3 main reasons:

First of all, you need to pay attention to heredity. Genetic characteristics can lead to the fact that the production of the lactase enzyme does not reach the required level. This type of disease is called primary lactase deficiency.
Diseases of the gastrointestinal tract can also lead to disruption of lactase production. Such consequences are possible with various infectious diseases, enterocolitis, as well as allergic reactions or the appearance of worms. Similar view lactase deficiency is called secondary.
A premature or weakened baby may suffer from transit lactase deficiency.

There are 2 types of lactase deficiency: alactasia and hypolactasia. Alactasia is characterized by a complete lack of lactase production, while hypolactasia is a lack of an enzyme produced by the body.

Dr. Komarovsky about lactase deficiency

The famous pediatrician Komarovsky believes that the disease does not occur as often as they say. In many cases, milk is not digested because children are overfed. There is enough lactase to digest the amount of milk a baby needs, but excessive feeding leads to extra stress on the body. A diet that involves some restriction of food intake can help in both diagnosis and treatment. To establish the exact cause of what is happening and determine the appropriate treatment measures, you need to visit a gastroenterologist and undergo a series of tests.

How to determine that a child is sick?

The disease can manifest itself already in the first days of life, so mothers need to closely monitor the baby’s health and pay attention to his behavior. By ignoring the characteristic manifestations of milk intolerance, you can start the disease and cause significant harm to the baby’s health. Characteristic features are:

A child’s quick refusal to suckle, if the baby willingly takes the breast, but after a few minutes stops sucking, shows anxiety, and cries, this should alert the mother.
Abdominal pain and colic that appear during feeding or immediately after it are easily recognized by crying, accompanied by twisting of the legs; they can also be signs of lactase deficiency.
, turning into vomiting.
Bloating, loud rumbling.
Disorder or, as well as changes in the consistency, color and smell of stool. When the stool has, it foams. There is heterogeneity in the stool, it contains lumps, and the smell is sour. Up to 12 bowel movements per day can occur - this phenomenon is called fermentative dyspepsia.
, signaling the occurrence of atopic dermatitis. Since this disease is hereditary, parents should be prepared for such a reaction of the baby’s body to milk.
The child is not gaining weight or is gaining weight more slowly than he should. It is also possible to develop malnutrition, when the baby loses weight instead of gaining weight.

Regurgitation and vomiting after drinking milk may be a symptom of lactase deficiency

Whatever the manifestations of the disease, you should not make a diagnosis yourself. Signs of lactose intolerance are easily confused with symptoms of other gastrointestinal diseases. Dysbacteriosis and intestinal infections can give similar manifestations. An accurate diagnosis can only be made by a doctor based on the results of the necessary tests.

How is the disease diagnosed?

To determine whether the above symptoms are a consequence of lactose intolerance, proceed as follows:

The doctor examines the baby, gets acquainted with the peculiarities of his behavior, and studies the feeding procedure.
The next stage is dietary diagnostics. Products containing milk are excluded from the baby’s diet, or their quantity is sharply reduced.
A laboratory analysis of stool is performed to determine its carbohydrate content. In a healthy baby, the carbohydrate content in stool is 0.25%. With the disease, the stool becomes acidic, the pH value is less than 5.5.
It is also possible to conduct research small intestine for lactase activity, but this is a very complex analysis, so it will not be carried out without sufficient evidence.
A genetic test should be done if similar cases have previously been observed in the family and there is a suspicion that the disease is hereditary.

For diagnostic purposes, the baby can be temporarily transferred to a formula that does not contain milk.

Help for a child suffering from lactase deficiency

After establishing an accurate diagnosis and finding out the causes of the disease, the doctor prescribes appropriate treatment, and the treatment is not lactose deficiency, but lactase deficiency. When secondary lactase deficiency is detected, it is aimed at eliminating the cause of the disease. With primary, hereditary, therapeutic effects will be required throughout life. The treatment plan must be developed by a specialist.

The baby cannot tolerate milk. What to do in this case:

give lactase during breastfeeding;
a lactose-free diet is established: depending on the form and severity of the disease, lactose consumption should be reduced or stopped altogether;
combination feeding replaces breastfeeding; up to 6 months, milk should be alternated with that recommended by a doctor;
when breastfeeding, the first portion of milk, since it contains the highest percentage of lactose;
the choice of mixture is agreed with the doctor; he may recommend a special diet: soy-based, with the addition of lactase.

Preventive measures

The hereditary form cannot be eliminated by any means preventive measures, lactase deficiency cannot be treated, but parents in this case know about the danger in advance and must be prepared. In other cases, prevention can prevent the occurrence of the disease.

Moms need to pay attention infectious diseases gastrointestinal tract. Their prevention consists of observing hygiene requirements, monitoring the quality of products and avoiding contact with sick people.

Forecast

The prognosis for the disease is as follows:

hereditary primary form of lactase deficiency cannot be cured;
in case of secondary, resulting from a previous disease, it is possible to restore lactase production partially or completely, the result depends on the severity of the disease and the correctness of the chosen treatment regimen;
the transient form is cured completely, it goes away as the gastrointestinal tract develops, and can disappear by 6 months.

If a child's lactose intolerance is hereditary, he will have to put up with it for the rest of his life.

Attentive attention to the health of the baby is the key to a successful fight against the disease. The presence of even a mild form, accompanied by insufficient weight gain, can further lead to rickets, dysbacteriosis, developmental delays, muscle weakness and even convulsions. Ignoring the symptoms of lactase deficiency can lead to dehydration, sudden weight loss, and mental retardation, one should not ignore the baby’s increased excitability, sleep disturbances, and frequent crying, especially if they are combined with defecation disorders and changes in stool.

The disease cannot be eliminated by a special diet, a lactose-free diet for a nursing mother. Her nutrition should be complete and sufficient. A nursing mother should only give up regular milk in favor of fermented milk products.

It is better to express the first portion of milk to reduce the amount of sugar supplied to the baby through breast milk. In addition, if there is a lot of milk, the baby will be full before he gets to the “hind” milk, which is richest in fats. You should also not change breasts during feeding for the same reasons. Fattier hindmilk takes longer to digest, which helps your baby produce more lactase. Symptoms indicating lactase deficiency require immediate consultation with a doctor.

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

General information

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

Causes of lactase deficiency

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

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

Classification

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

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

Symptoms of lactase deficiency

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

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

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

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

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

Diagnostics

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

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

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

Treatment of lactase deficiency

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

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

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

Forecast

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

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

From the first weeks of life, children are often bothered by abdominal pain, accompanied by green stools and increased gas production. Most often, these symptoms are caused by the body's inability to digest the lactose contained in breast milk, or lactase deficiency.

Lactose is a carbohydrate that is found only in the milk of mammals, the so-called “milk sugar”. First of all lactose is a source of energy for the baby. Lactose helps digestion useful microelements: calcium, magnesium, iron, which promotes the growth and strengthening of the baby’s bones and prevents the development of rickets. In addition, it is an important component for the formation of healthy intestinal microflora. And most importantly, lactose is involved in the development of the child’s central nervous system and brain.

Lactase is an enzyme that is present in the small intestine. It is necessary for the breakdown of loctase into components: glucose and galactose, which, in turn, are absorbed by the intestinal walls. Glucose gives the baby energy, and galactose is building material for the formation of cells of the central nervous system.

Lactose, which lacks the enzyme, enters the intestines and promotes the growth of intestinal bacteria Lactobacillus bifidus. These bacteria maintain an acidic environment in the intestines and inhibit the growth of pathogenic bacteria. Side effects such bacteria is the formation of gases. Thus, the formation of gases in healthy infants is not a pathology.

What is lactase deficiency?

Lactase deficiency is a condition of the body in which the intestines do not produce enough lactase enzyme, or it is not produced at all.

What is lactose intolerance?
In this case, lactose is not absorbed by the body, and the child stops gaining weight. Undigested lactose enters the rectum and becomes a source of formation. pathogenic microorganisms, causing stool liquefaction, increased gas formation, and damage to the intestinal walls.

Causes of lactase deficiency

Depending on the reasons for the decrease in lactase production, primary and secondary lactase deficiency are distinguished.

If the lactase enzyme is not produced by the body, or very little of it is produced, this is primary lactase deficiency.

Occurs in three cases:

Congenital genetically determined disease. This condition is very rare. Only a few dozen such cases have been described in medicine. A distinction is made between alactasia, when lactose is not produced by the body, and hypolactasia, when lactase is produced in insufficient quantities.
Lactase deficiency in premature infants. The fact is that lactase in babies begins to be produced only at the time of birth - at 39-40 weeks. Accordingly, in children born significantly ahead of schedule, lactase production will be reduced.
Lactase deficiency in adults. This occurs due to the fact that lactase production decreases with age. Occurs in 18% of the adult population.

Secondary lactase deficiency occurs after suffering any intestinal infection, allergies, inflammation in the intestines or atrophic changes in the intestines.

Symptoms of lactase deficiency

The following symptoms may indicate lactase deficiency in a child:

The baby will have a loud rumbling in the stomach.
Severe pain in the intestines that occurs during or immediately after feeding.
Liquid, foamy stool, possible lumps of mucus in the stool, sour, unpleasant odor.
The child eats well, but does not gain weight.

In primary lactase deficiency, these symptoms appear several weeks after birth, as the baby's milk intake increases.

Analysis for lactase deficiency

To begin treatment, it is first necessary to correctly diagnose the disease. There are several tests that can indicate whether a child has lactase deficiency.

The most reliable analysis is rectal biopsy. The analysis is complex and expensive, so it is most often not performed on infants.
Lactose curve analysis. The child is given a portion of lactose, after which a blood test is taken. If the curve showing the amount of lactose is less than the average glucose value, lactase deficiency can be suspected.
Hydrogen test. The patient is given lactose and the amount of hydrogen in the exhaled air is measured. The fact is that lactose, entering the rectum unchanged, promotes the formation of lactic acid, which decomposes into carbon dioxide and hydrogen. Some of the hydrogen is released through the lungs. Thus, during illness, the number of hydrogen molecules will be increased.
Stool analysis for carbohydrates. Lactase deficiency may be indicated by a carbohydrate content greater than 0.25%. This test is considered the most unreliable and is used in conjunction with other tests and clinical symptoms.
Coprogram. With lactase deficiency, the stool will be more acidic. The presence of a large amount of fatty acids will also indicate the presence of the disease.
Diagnostic diet. Products containing lactose are excluded from the diet. In case of lactose deficiency, all symptoms stop and intestinal condition improves.

To make an accurate diagnosis, the child must have all the signs of the disease. If a child’s test results indicate the presence of a disease, it is imperative to look general condition child: he should have increased gas formation, frequent foamy stools, and severe abdominal pain. The main symptom indicating the presence of the disease will be underweight or weight loss.

How to treat lactase deficiency

If, in the presence of green stool and increased gas formation, the child is gaining weight well, in this case no special treatment is required. Lactase production is formed in a child up to 3-4 months. Therefore the body healthy child may not cope with a large number lactose supplied to him along with breast milk. Sometimes it is enough to establish breastfeeding.

You need to make sure that the baby is latching onto the breast correctly. The baby must suck the milk from the breast completely, because... The first portion of milk contains more lactose, and subsequent milk contains more fat, it is more nutritious for the baby.
A lactose-free diet is prescribed. All foods containing lactose are excluded from the mother's diet. The most common cause of allergies is cow's milk protein. If such an allergy is detected, the mother is prescribed a diet that excludes all dairy products, including butter, it is also forbidden to eat beef. When intestinal activity is restored, foods are gradually returned to the diet.
Sometimes it is recommended to express the first portion of milk, which contains more lactose.

Typically, these measures help to regulate the child’s stool and reduce excessive gas formation.

Lactase deficiency in infants - treatment will be prescribed by Dr. Komarovsky (video):

If these measures do not help, the child will be prescribed the following treatment:

Before feeding, the baby is given the enzyme lactase - it is diluted in a small portion of breast milk. Treatment must be carried out in courses; after 3-4 months, they try to cancel the therapy; if the production of lactose in the intestines has not resumed, a new course is prescribed.
Breastfeeding is combined with a lactose-free formula. This treatment is temporary, because... Lactose-free formulas made from soy can cause allergies in children.
Restoration of intestinal microflora. Typically, treatment of dysbacteriosis leads to the cure of lactase deficiency.

The genetic form of the disease cannot be cured; in this case, lifelong treatment and diet will be required.

The transient form (underdevelopment of intestinal functions in premature infants) goes away on its own by 6 months. But until the child has developed lactase production, it will be necessary to follow all of the above treatment methods.

The secondary form of lactase deficiency, which appears after an intestinal infection or disruption of breastfeeding, is completely cured.

Lactose production is formed in newborns only by 3-4 months. Therefore, at this age it would be premature to diagnose a child with lactase deficiency. Under no circumstances should you give up breastfeeding, because... the absence of mother's milk in a child's diet will cause more harm than its consumption.

The well-known pediatrician Komarovsky believes that the too frequent detection of lactase deficiency is a consequence of the policy of manufacturers of lactose-free formulas. Therefore, there is no need to rush to stop breastfeeding if a secondary form of the disease is detected.

Treatment of lactose intolerance in infants (video):

You should start with vegetable purees, monitoring the child’s reaction to each new product. Fermented milk products can be given from 8-9 months (kefir, yogurt); cottage cheese is recommended to be introduced into the child’s diet only after one year.

Other diseases can cause similar symptoms in the form of green stools and increased gas production:

Underdevelopment of the small intestinal mucosa in premature infants.
Allergy to cow's milk protein, soy or other products.
Celiac disease is an intolerance to gluten found in some grains.

In this case, switching from breastfeeding to artificial formula can only worsen the situation. In this case, it will be necessary to follow the treatment for children with allergies.

Lactase deficiency in most cases is a physiological condition of newborns and is completely restored with age. Genetic disease must be confirmed by a number of tests, and have all the symptoms of the disease. Other diseases such as allergies, celiac disease, gastroenteritis, etc. have similar symptoms. Therefore, it is important to correctly diagnose the disease.

Lactose intolerance is associated with a genetically determined decrease in the activity of lactase (an enzyme necessary for the digestion of lactose) and is manifested by nonspecific symptoms that develop after consuming products containing milk sugar. Occurs after a period of breastfeeding. The study of the c.-13910 °C>T polymorphism of the LCT lactase gene has diagnostic and prognostic significance, allowing to identify lactose intolerance and predict the development of lactose intolerance in children over 1.5 years of age.

The LCT gene encodes the amino acid sequence of the lactase enzyme. This enzyme is produced in the small intestine and is involved in the breakdown of milk sugar - lactose. Lactase is usually present in children and the enzyme is no longer produced as they age (usually between 3 and 10 years of age). The consumption of dairy products in this case leads to intestinal disorders due to the inability to digest lactose. As a rule, after eliminating milk and other products containing lactose from the diet, most people with lactase deficiency return to normal health within 2–3 weeks. Conscious or unconscious avoidance by adults of milk and dairy products that are important source calcium, can lead to the development of calcium deficiency. For postmenopausal women, calcium deficiency is extremely unfavorable, as it leads to the development of osteoporosis. The c.-13910 °C>T polymorphism of the lactase gene affects lactase production in adults. This region of the genome is an element of internal regulation of the transcriptional activity of the lactase gene promoter. In this case, the normal variant of polymorphism C is associated with a decrease in lactase synthesis in adults, and the mutant variant T is associated with the preservation of high lactase activity in adults. Thus, homozygous carriers of variant C are not capable of digesting lactose (the level of mRNA synthesis of the lactase gene in such patients is reduced to 2–22%), while homozygous carriers of variant T easily digest lactose and tolerate dairy products well. Postmenopausal women with option C have a greater risk of developing osteoporosis and require calcium supplementation.
Lactose intolerance is more common in adults than in children. In most cases of lactose intolerance, hereditary mechanisms of transmission can be traced, and symptoms develop in adolescence or later. mature age. Most people with this type of lactose intolerance can consume milk and dairy products within small quantities without unpleasant consequences. In rare cases, lactose intolerance occurs from birth. Such people are completely unable to digest milk and dairy products. Sometimes premature newborns experience lactose intolerance, which is temporary. However, after the functions of the small intestine are normalized, this goes away. Symptoms of lactose intolerance can range from moderate to severe, depending on how much lactase the glands in the small intestine produce. They are usually felt within 30 minutes to two hours after eating.

Indications for the purpose of analysis:

Determination of lactose intolerance.
Determining the risk of osteoporosis.
Assessment of the likelihood of lactose intolerance in children over 1.5 years of age.

No special preparation is required for the study. Must be followed general rules preparation for research.

GENERAL RULES FOR PREPARATION FOR RESEARCH:

It is recommended to donate blood in the morning, between 8 and 11 o’clock, on an empty stomach (at least 8 hours must pass between the last meal and blood collection, you can drink water as usual), on the eve of the test light dinner with limiting intake of fatty foods.
On the eve of the study (within 24 hours), exclude alcohol, intense physical activity, reception medicines(in consultation with the doctor).
1-2 hours before donating blood, refrain from smoking, do not drink juice, tea, coffee, you can drink still water. Exclude physical stress(running, quickly climbing stairs), emotional excitement. It is recommended to rest and calm down 15 minutes before donating blood.
You should not donate blood for laboratory testing immediately after physiotherapeutic procedures, instrumental examination, X-ray and ultrasound examinations, massage and other medical procedures.

Today every fifth child in Russia is treated for lactase deficiency. This diagnosis, which a decade and a half ago was considered only scientific term, which has 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 famous children's doctor and author of books and articles, Evgeniy Olegovich Komarovsky, shares his opinion about lactase deficiency.

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 its 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 by 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 tycoons, who really need to sell large volumes of lactose-free milk formulas for artificial feeding. They cost much more than other foods, 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 clinical manifestations decrease, 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 this large number 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 lactose percentage - female breast milk(7%), cow and goat milk sugar contain 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”.