Breastfeeding is the most natural way of feeding babies up to one year old; however, in some cases, the baby’s body cannot absorb either mother's milk or infant formula made from cow's milk. This phenomenon is often called lactose (sugar) deficiency, although it is necessary to talk about the symptoms of lactase deficiency.
Statistics show that every 5th newborn suffers from this disease. Symptoms appear very quickly and, as a rule, are pronounced. When the first signals appear, it is necessary to take measures to ensure proper nutrition of the infant.
The body of some children can not digest the protein contained in milk - this is lactase deficiency
Symptoms of the disease
What are the symptoms of LN in a newborn baby under one year old? Which of them are dangerous for the life and health of the child? Are common the symptoms lactase deficiency:
- constant rumbling in the intestines, colic,
- increased flatulence, bloating,
- crying, worried baby during feeding, with colic,
- greenish and frothy stools with a sour smell.
- vomiting after any feeding,
- refusal to eat
- significant weight loss or weight loss based on age
- lethargy of the infant or, conversely, great anxiety,
The more intake of milk sugar, the stronger the symptoms of lactase deficiency. The severity of LN is determined by the underweight of the child and dehydration, and the analysis of feces determines an increased amount of sugar.
What is lactose and its role in the nutrition of the child
Lactose is a carbohydrate, sweet to the taste that is found in milk. Therefore, it is often called milk sugar. The main role of lactose in the nutrition of an infant, like that of any carbohydrate, is to provide the body with energy, but because of its structure, lactose does not only fulfill this role. Getting into the small intestine, part of the lactose molecules under the action of the enzyme lactase breaks down into its constituent parts: the glucose molecule and the galactose molecule. The main function of glucose is energy, and galactose serves as a building material for the child’s nervous system and the synthesis of mucopolysaccharides (hyaluronic acid). A small part of the lactose molecules does not undergo splitting in the small intestine, but reaches the fat one, where it serves as a nutrient medium for the development of bifidobacteria and lactobacilli, which form the beneficial intestinal microflora. After two years, lactase activity begins to naturally decrease, however, in countries where since ancient times milk remains in the diet of a person in adulthood, its complete extinction, as a rule, does not occur.
What is dangerous lactase deficiency?
- Dehydration due to diarrhea develops, this is especially dangerous in infants.
- Absorption of calcium and other minerals is impaired.
- Growth of beneficial microflora is impaired due to the lack of nutrients resulting from the breakdown of milk sugar
- Reputable rotten microflora
- Disrupted intestinal motility regulation
- Immunity suffers
- Natural involution (reverse development) of enzyme activity
- Intestinal diseases (inflammatory, infectious, dystrophic), which led to the destruction of enterocytes
- infections: rotavirus, giardiasis and others
- food allergies
- gluten intolerance (celiac disease)
- Crohn's disease
- radiation injury
- drug exposure
2. Reducing the area of the intestinal mucosa after the removal of part of the intestine or with short bowel syndrome
Lactase activity may vary. In addition to the main factors, numerous biologically active substances affect the enzyme: thyroid and pancreas hormones, pituitary hormones, nucleotides, fatty acids and amino acids in the intestinal lumen, glucocorticosteroid hormones.
Symptoms of lactase deficiency in both primary and secondary are usually similar. The only difference is that with primary LN, pathological manifestations are observed after a few minutes, their severity depends on the amount of lactose consumed. Secondary LN reveals itself by drinking even a small amount of milk sugar, since the absence of its cleavage is combined with any intestinal pathology.
Common signs of lactase deficiency are:
- diarrhea, characterized by a watery, frothy stool with greens and a sour smell, a lot of gases
- pain, rumbling in the stomach, vomiting
- abdominal distention, decreased appetite
- regurgitation in infants (causes), attacks of intestinal colic, anxiety, reduced weight gain, crying during feeding are characteristic of lactase deficiency in infants.
Terminology. Do not be confused!
Two similar terms: lactose and lactase mean completely different things. Lactose is milk sugar, which in breast milk contains up to 85%. It stimulates the assimilation of microelements, contributes to the formation of intestinal microflora, is necessary for the construction and proper functioning of the immune system.
Lactase is not sugar, but an enzyme that decomposes milk sugar into glucose and galactose in the digestive tract. It is produced by the intestines of the newborn. The reason for the poor absorption of milk is just the lack of the enzyme lactase in the body of the baby, because he gets a lot of milk sugar from his mother’s milk. Insufficient lactase production leads to a phenomenon called lactase deficiency, which is the same as lactose intolerance, which is sometimes mistakenly called lactose deficiency.
Lactase is an enzyme of the human body. Its task is to break down the lactose contained in milk.
Lactose and lactase: why they should not be confused
Often on the Internet you can find the radically incorrect term "lactic insufficiency". What is lactose and lactase?
Lactose, or milk sugar, is a carbohydrate from the group of disaccharides present in the milk of any animal.
Lactase is an enzyme produced by cells of the mucous membrane of the small intestine and involved in the breakdown of lactose.
Hypolactasia: its types and causes
A decrease in the activity of lactase (and sometimes the complete absence of this enzyme) is called hypolactasia or lactase deficiency (LN). This condition entails the impossibility of how to digest milk sugar, which serves as a breeding ground for the reproduction of various microorganisms. Bacteria cause severe gas, stool, cramps, and many other problems.
Lactase deficiency is divided into two types.
Primary lactase deficiency
Due to shortage an enzyme lactase, but moreover, in the newborn there are no violations of the enterocytes (intestinal epithelial cells). What are the forms of primary lactase deficiency?
Congenital lactose deficiency is a lack of the enzyme lactase, which is required for the breakdown of milk sugar (lactose). The main signs of LN: frothy, loose stools of green color, colic, bloating. As a rule, LN appears in newborns and infants in the first year of life.
In infants lactase deficiency is dangerous by drastic dehydration, weight loss and diarrhea. Also this condition can lead to sustainable violation of the absorption of trace elements that are required for the development and growth of the child. During lactase deficiency, the intestines suffer the most. Lactose adversely affects the formation of healthy intestinal microflora and leads to impaired peristalsis, the growth of pathogenic microorganisms, and fermentation. All these processes affect the work of the immunity of the newborn.
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 the complete absence of its activity. It should be noted that very often there is confusion in writing - instead of the correct “lactase” they write “lactose”, which does not reflect the meaning of this concept. After all, the lack is not in carbohydrate lactose, but in the enzyme that breaks it down. There are several types of lactase deficiency:
- primary or congenital - the lack of activity of the enzyme lactase (alactasia),
- secondary, develops as a result of diseases of the mucous membrane of the small intestine - a partial decrease in the enzyme lactase (hypolactasia),
- transient - occurs in premature babies and is associated with the immaturity of the digestive system.
Distinctive features of individual forms
Congenital LN is a rare but severe type of enzymatic deficiency, dangerous by dehydration and severe toxicosis. Mom can understand this from the first days of the baby’s life when breastfeeding leads to vomiting and unstoppable diarrhea. It only helps to cancel breastfeeding and use lactose-free mixtures.
Primary LN appears only after ingestion of a large amount of milk. At an early age, she may be disguised as normal intestinal colic, which most babies bother. With the growth of a child, the microflora can adapt to milk sugar by multiplying the relevant bacteria. Over time, symptoms manifest themselves only when excessive consumption of milk. While dairy products are well tolerated, as they support the growth of bacteria that break down milk sugar.
Secondary LN can occur at any age due to a disease. Specific symptoms of lactase deficiency are manifested poorly, since the main role is played by the main pathology of the intestine. However, a non-dairy diet helps to improve a little.
How to determine for yourself that this is exactly lactase deficiency? Symptoms are very persistent, there is no effect of treatment. Pathological manifestations disappear only if a diet with the exception of lactose is observed.
Causes and types of disease
Whether the baby is breastfed or gets artificial formula, the same factors lead to lactose intolerance. Milk sugar can not be absorbed by the body for 3 main reasons:
- First of all, it is necessary to pay attention to heredity. Genetic characteristics can lead to the fact that the production of the enzyme lactase does not reach the required level. This type of disease is called primary lactase deficiency.
- Diseases of the gastrointestinal tract can also lead to impaired lactase production. Such consequences are possible with various infectious diseases, enterocolitis, as well as with allergic reactions or the appearance of worms. This type of lactase deficiency is called secondary.
- A premature or weakened infant may suffer from transitory lactase deficiency.
There are 2 types of lactase deficiency: alactasia and hypolactasia. Alactasia is characterized by a complete lack of lactase production, hypolactasia is a lack of an enzyme produced by the body.
Lactase and lactose
Lactase deficiency is a type of disease that is manifested by a lack of the enzyme lactase, which performs the function of sugar breakdown. And lactose is a disease in which the intestine cannot cope with the digestion of carbohydrate lactose. Both diseases are characterized by the absence of the lactase enzyme in the infant’s intestine, which breaks down the carbohydrate lactose into two components - glucose and galactose.
Lactose is important for the development of the child, as it gives the baby 40% of the energy he needs, normalizes the work of the microorganisms needed by the intestines and helps the brain and eyes of the newborn to develop properly. Lactase deficiency does not allow lactose to be absorbed in the intestines of the baby. It leads to a shortage of essential substances and energy, with the result that the development of the child can slow down.
Secondary lactose deficiency
Due to the lack of lactose, but at the same time violated functions and enterocyte production. Intestinal epithelial cells are affected by enteritis (diseases of the small intestine), rotavirus intestinal infections, giardiasis, radiation exposure, food allergies, and gluten allergies. Also during the congenital short intestine or after removal of a 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 disturbed. 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 of the intestinal tract, the first lactase suffers.
With the age of the child activity lactase is changed. Its deficiency can also be associated with disruption of the thyroid and pancreas, pituitary. Active biological substances (acids, hormones) are important for the development of the enzyme system of the baby. When an infant has signs of a functional lactose system, but he develops normally and gains weight well, then special treatment is not required.
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 absorbed because children are overfeeding. To digest the amount of lactase milk needed by the infant is enough, but over-feeding leads to an extra burden on the body. Diet, which consists in a certain restriction of food intake, can help in 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 pass a series of tests.
The absence or insufficient activity of lactase leads to the fact that lactose, having a high osmotic activity, contributes to the release of water into the intestinal lumen, stimulating its motility, 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, colic, diarrhea. The active formation of organic acids reduces the pH of the intestinal contents. All these violations of chemical composition ultimately contribute to the development of dysbiosis. Thus, lactase deficiency has the following symptoms:
- frequent (8-10 times a day) liquid, frothy stools that form a large water stain with a sour odor on a gauze diaper. It should be borne in mind that on a disposable diaper water stain can not be noticed because of its high absorbency,
- bloating and rumbling (flatulence), colic,
- detection of carbohydrates in feces (over 0.25g%),
- acidic feces (pH less than 5.5),
- against the background of frequent stools, symptoms of dehydration may develop (dry mucous membranes, skin, decreased urination, lethargy),
- in exceptional cases, the development of hypotrophy (protein-energy deficiency) is possible, which is expressed in a poor weight gain.
The intensity of the symptoms will depend on the degree of reduction of the enzyme activity, the amount of lactose from food, the characteristics of the intestinal microflora and its pain sensitivity to stretching under the action of gases. The most common secondary lactase deficiency occurs, the symptoms of which begin to appear especially strongly at 3-6 weeks of a child’s life as a result of an increase in the amount of milk or mixture that a child eats. As a rule, lactase deficiency is more common in children suffering from hypoxia in the intrauterine state, or if the immediate family has its symptoms in an adult state. Sometimes there is a so-called "locking" form of lactase deficiency, when in the presence of liquid stool there is no independent stool. Most often, at the time of introduction of complementary foods (5-6 months), all the symptoms of secondary lactase deficiency disappear.
Sometimes the symptoms of lactase deficiency can be found in children "dairy" mothers. A large volume of milk leads to a rarer attachment to the breast and obtaining mainly “front” milk, especially rich in lactose, which leads to an overload of the body and the appearance of characteristic symptoms without reducing weight gain.
Many of the symptoms of lactase deficiency (colic, flatulence, frequent stools) are very similar to the symptoms of other diseases of the newborn (intolerance to cow's milk protein, celiac disease, etc.), and in certain cases are a variant of the norm. Therefore, special attention should be paid to the presence of other less common symptoms (not just frequent stools, but its fluid, frothy 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. О неперносимости других углеводов читайте ниже.
Important! The symptoms of lactase deficiency are the same as the symptoms of any other disease characterized by intolerance to one or more carbohydrates.
Doctor Komarovsky about lactase deficiency video
Ways to diagnose
Often diagnosing LN shows false positive results and is complicated due to the age of the child. What kind analyzes may recommend a doctor during suspected LN?
- The way dietary diagnosis. Its meaning is to temporarily exclude breast milk from the baby’s food and replace them with lactose-free or low-lactose mixtures. When the symptoms disappear or disappear altogether, the diagnosis is confirmed. Dietary diagnostics is the most accessible and reliable method of examination. However, there are often difficulties with its implementation: the kids are capricious, refuse to mix, and even the transition to the experimental mixture can have negative consequences for the immature intestinal flora.
- Small intestine biopsy. It is performed in extreme situations during suspected congenital lactose deficiency. This is a fairly expensive operational method of research, but only he will be able to confirm congenital hypolactasia.
- Trywith lactose load. This survey is usually performed during lactase deficiency in adolescents, since certain conditions for its implementation are necessary. Glucose is inspected in the blood first on an empty stomach (food cannot be consumed 10 hours before the analysis), a lactose solution is given after drinking, and the blood is examined again two hours later, the change in sugar is determined with an interval of 25 minutes. Lactose is normally broken down in the intestine into glucose, which in turn is absorbed into the blood, and is bound to double. However, when there is a shortage of lactase, the lactose does not break down, the blood glucose does not increase or increases slightly.
- Exhaled Hydrogen Analysis. During the fermentation of lactulose in the intestine, hydrogen is formed, it is absorbed into the blood and exits with exhaled air from the body. During excess lactulose, the amount of hydrogen is greater, indicating a lack of lactase.
- Sugar Content and Acidity Test. When the pH is shifted towards acidity (less than 5.4), this may indicate lactase deficiency. When carbohydrates are detected in the feces of a newborn baby (more than 0.30%), LN can also confirm this. But these studies often show false positive results and can speak of unformed microflora and other disorders of the bowel.
In the first days of life in newborns, incomplete digestion of lactose is observed; therefore, the hydrogen test and samples with a load of lactose often show positive results. Most often they only talk about normal LN.
How to determine that a child is sick?
The disease can manifest itself in the first days of life, so mothers need to carefully monitor the health of the baby, pay attention to his behavior. Ignoring the characteristic manifestations of intolerance to milk, you can start the disease and cause significant harm to the health of the crumbs. Characteristic features are:
- The quick refusal of the child to suck, if the baby readily takes the breast, but after a few minutes it stops to suck, shows anxiety, cries - this should alert the mother.
- The pains in the tummy and colic that appear during feeding or immediately after it can be easily recognized by crying, accompanied by a knuckle of the legs, they can also be signs of lactase deficiency.
- Regurgitation, vomiting.
- Abdominal distention, loud rumbling.
- Disorder or constipation, as well as a change in the consistency, color and smell of feces. With diarrhea, the stool has a greenish color and foams. There is a heterogeneity of the chair, it contains lumps, the smell is sour. Up to 12 bowel movements a day can occur - this phenomenon is called fermenting dyspepsia.
- Skin rashes that indicate the occurrence of atopic dermatitis. Since this is a hereditary disease, parents should be prepared for such a reaction of the baby’s body to milk.
- The child does not gain weight or adds more slowly than it should. It is also possible the development of malnutrition, when the baby loses weight instead of recovering.
Whatever the manifestations of the disease, to make the diagnosis yourself should not be. Signs of lactose intolerance are easily confused with symptoms of other diseases of the gastrointestinal tract. Similar manifestations can give dysbacteriosis, rotavirus and intestinal infections. An accurate diagnosis is made only by a doctor based on the results of the necessary tests.
Regulation of lactose intake by natural methods
Symptoms of lactase deficiency are quite common in healthy children and not at all associated with insufficient activity of the enzyme lactase, but due to improperly organized breastfeeding, when the child sucks the "front" milk rich in lactose, and the "back" rich in fat remains in the breast.
Proper organization of breastfeeding in children under one year implies in this case:
- no pumping after feeding, especially with an excess of breast milk,
- breastfeeding until it is completely emptied, possibly using the breast compression method,
- frequent feeding of the same breast,
- correct capture of the breast by a child
- nightly breastfeeding for greater milk production,
- in the first 3-4 months it is undesirable to tear the baby from the breast until the end of her sucking.
Sometimes to eliminate lactase deficiency helps to exclude for some time from the diet of the mother dairy products containing cow's milk protein. This protein is a strong allergen and, in case of significant consumption, can penetrate into breast milk, causing allergies, often accompanied by symptoms similar to lactase deficiency or provoking it.
It is also useful to try to decant before feeding, to prevent the ingress of excess milk rich in lactose into the body of a child. However, we must remember that such actions are fraught with the occurrence of hyperlactation. Read how to express breast milk in this article.
If the symptoms of lactase deficiency persist, you should seek the help of a doctor.
Types of lactose intolerance
There is a congenital and acquired intolerance to this enzyme.
- Congenital is the absence or reduction of lactase, so it can often be determined during the first 30 days of a newborn's life.
- Acquired intolerance is caused by diseases of the digestive system, which reduces the level of lactase. With proper treatment, it passes within 60 days.
Secondary lactase deficiency
In this case, lactase deficiency is caused by damage to the enterocytes. It occurs much more often than primary hypolactasia and is provoked by such diseases as:
- cow's milk protein allergy
- intestinal infection,
- intestinal inflammation
- atrophic changes after prolonged probe feeding or in celiac disease (intolerance to the gluten cereal protein).
Tests for lactase deficiency
- Lactose stress test: determine the increase in blood sugar by constructing a curve. With an enzyme deficiency, a flattened curve is visible on the graph, that is, there is no normal increase due to the lack of sugar absorption.
- Analysis of feces: feces for lactase deficiency pass for the determination of carbohydrates. In normal carbohydrates should not be allowed to 0.25% in infants, also assessed its pH - when the LN level drops below 5.5.
- Hydrogen breath test. Along with the load test, you need to pass an analysis to determine the concentration of hydrogen in the exhaled air: a sample is taken every 30 minutes for three hours after being loaded with lactose.
- Determination of enzyme activity from a biopsy or washout from the intestinal mucosa. This is the most informative method for determining LN, but its use is not always justified due to the complexity of the analysis.
- Genetic research to identify mutations of certain genes responsible for lactase activity.
- Diagnostic (elimination) diet with the exception of milk sugar in the presence of lactase deficiency improves the condition of the intestine, the symptoms of the disease disappear.
If lactase deficiency is suspected, other possible causes of diarrhea should be excluded, which can be quite serious (see diarrhea and vomiting in a child without fever).
Treatment of LN is complicated when a congenital gilactasia is diagnosed. During functional and transient LN, the picture is not so serious. What methods are treated for LN symptoms?
- Artificial and natural feeding. How to feed a newborn? Is it really necessary to switch to artificial feeding and refuse breastfeeding (HB)? From GW do not need to give up. For children who are on natural feeding, the following enzyme supplements are recommended: "Lactazar", "Lactase Baby", etc. The enzyme must be diluted in the expressed breast milk and given to the baby before feeding. When the baby is on artificial feeding, non-toxic or low-lactose mixtures are recommended. Also during the exacerbation, you can enter the combined method of feeding.
- Adjustment power supply. It would seem that the absolute exclusion of milk sugar from the baby’s nutrition can solve all the problems with lactose intolerance. However, this substance is a natural probiotic and is necessary for the formation of intestinal microflora, you can not completely abandon it. In severe forms and in acute periods of LN, milk sugar is completely excluded. However, during functional impairment, its use is only limited. The amount of permissible lactose in the daily menu is regulated by the content in the feces of sugar.
- Volume food consumed. During the symptoms of LN, it is very important not to overfeed the child. It is necessary to feed often, but in small portions. A child produces as much lactase as needed. An enzyme system with an increased amount of lactose cannot cope. Therefore, it often happens that a decrease in volume (with the child gaining normal weight) can solve the problem of LN.
- Special features complementary foods. For babies with symptoms of LN, it is necessary to very carefully introduce complementary foods and note the reaction to a particular product. Lure you need to start with the addition of vegetables. Porridge must be cooked exclusively on water (best of all - buckwheat, corn, rice). Fermented milk non-fatty products can be slightly introduced only after eight months and watch the reaction. A child after taking fermented milk products should not have diarrhea, rumbling, swelling, pain in the stomach. Cottage cheese can be added after a year, whole milk is prohibited.
- Probiotics. With the help of probiotics, it is possible to correct the intestinal microflora, to restore its motility. In these tools should not be lactose, while they are required to well break down carbohydrates.
- Enzymes for better pancreas performance. The pediatrician can prescribe the course “Pancreatin”, “Creon”, “Mezim” and other enzymes that facilitate the work of the gastrointestinal tract.
- Functional LN is perfectly eliminated with the help of a specially developed diet, in this case, you can combine breast milk with lactose-free artificial feeding and lactose mixtures.
- Symptomatic treatment. With colic, severe flatulence, abdominal pain and persistent diarrhea, the doctor may prescribe antispasmodics, anti-bloating agents, diarrhea.
How is a disease diagnosed?
To determine whether the above symptoms are due to lactose deficiency, proceed as follows:
- The doctor examines the baby, gets acquainted with the peculiarities of its behavior, examines the procedure for feeding.
- The next stage is diet diagnostics. Products containing milk are excluded from the baby’s diet, or their amount is sharply reduced.
- Laboratory analysis of feces for the content of carbohydrates in it. In a healthy baby, the carbohydrate content in the stool is 0.25%. When a disease of feces becomes acidic, the pH is less than 5.5.
- It is also possible to conduct a study of the small intestine regarding the activity of lactase, but this is a very complex analysis, therefore it will not be carried out without sufficient grounds.
- A genetic test must be done if the family has previously experienced similar cases and there is a suspicion that the disease is hereditary.
In addition to these two types, there is a state similar to signs of hypolactasia - lactose overload. At the same time, the necessary enzyme is produced in the intestines of infants in sufficient quantities, but due to the large volume of the “front tank” in the breast between feedings, too much “front” milk with a high content of lactose and other carbohydrates (more than 130) accumulates.
Also, as noted famous pediatrician E.O. Komarovsky, lactose overload may occur due to the banal overfeeding of the child (details in the video below): this condition does not require treatment, but proper organization of HBs.
- The most severe form of the disease develops due to genetic predisposition, when the body of the infant suffers from lactase deficiency and cannot provide enough enzyme due to genetic disorders. This disease is diagnosed by increasing the amount of breast milk consumed by the baby, which usually occurs in 3-4 weeks of life. In this form of the disease, there is no treatment, and the baby is given a special diet and medications containing lactase.
- If a baby is born prematurely, then its body lacks lactase, as this enzyme begins to be produced by the baby still inside the mother’s womb from 6 to 9 months of pregnancy.
- With the defeat of enterocytes that produce lactase, acquired lactase deficiency develops in the intestines of a newborn. This disease can occur due to rotavirus infection, giardiasis, viral or drug enteritis.
Treatment of lactase deficiency
It includes several stages:
- Medical nutrition, reception of food supplement Lactase Baby (370-400 rubles), Lactase Enzyme (560-600 rubles), Lactazar for children (380 rubles), Lactazar for adults (550 rubles).
- Pancreas help (enzymes: pancreatin, mezim forte, festal, creon and others)
- Correction of intestinal dysbiosis (prebiotics and probiotics: bifidumbacterin, Linex, hilak forte, etc., see the full list of probiotics)
- Symptomatic treatment:
- Medications for bloating - Espumizan, Subsimplex, Bobotic
- Diarrhea - see all medications for diarrhea
- From pain - antispasmodics No-shpa, drotaverina hydrochloride.
The use of lactase preparations and specialized mixtures.
Reducing the amount of milk is extremely undesirable for the child, so the first step, which the doctor will most likely advise, will be the use of the enzyme lactase, for example "Lactase Baby" (USA) - 700 units in a capsule that is used one capsule per feeding. To do this, it is necessary to decant 15-20 ml of breast milk, inject the preparation into it and leave for 5-10 minutes for fermentation. Before feeding, first give the baby milk with an enzyme, and then breastfeed. The effectiveness of the enzyme increases when it processes the entire volume of milk. In the future, with the ineffectiveness of such treatment, the dosage of the enzyme is increased to 2-5 capsules per feeding. The analogue of "Lactase Baby" is a drug "Laktazar". Another lactase drug is "Lactase Enzyme" (USA) - 3450 units in the capsule. Begin with 1/4 capsules for feeding with a possible increase in the dosage of the drug up to 5 capsules per day. Treatment with enzymes is carried out by courses and most often they try to cancel when the child reaches 3-4 months of age, when their own lactase begins to be produced in sufficient quantity. It is important to choose the correct dosage of the enzyme, as too low will be ineffective, and too high will contribute to the formation of a plasticine stool with the likelihood of constipation.
In case of ineffective use of enzyme preparations (preservation of pronounced symptoms of lactase deficiency), they begin to use lactose-free milk formulas before breastfeeding in an amount of from 1/3 to 2/3 of the volume of milk that a child eats at one time. Maintenance of a lactose free mixture begins gradually, at each feeding, adjusting its consumption volume depending on the degree of symptoms of lactase deficiency. The average volume lactose-free mixture is 30-60 ml per feeding.
Help for a child with lactase deficiency
After establishing an accurate diagnosis and ascertaining the causes of the disease, the doctor prescribes an appropriate treatment, and the treatment is not lactose deficiency, namely, lactase. When detecting secondary lactase deficiency, it is aimed at eliminating the cause of the disease. With primary, hereditary, therapeutic effects will be required throughout life. Схема лечебных мероприятий должна быть разработана специалистом.
Малыш не переносит молоко. Что делают в таком случае:
- дают лактазу при грудном вскармливании,
- a lactose free diet is established: depending on the form and severity of the disease, lactose intake should be reduced or stopped altogether,
- combined feeding replaces breast feeding; up to 6 months, milk should be alternated with a lactose-free formula recommended by a doctor,
- when breastfeeding, the first portion of milk is decanted, as it contains the largest percentage of lactose,
- the choice of the mixture is agreed with the doctor, he may recommend a special diet: soy-based, with the addition of lactase.
The hereditary form cannot be eliminated by any preventive measures, lactase deficiency cannot be treated, but parents in this case are aware of the danger in advance and must be prepared. In other cases, prevention can eliminate the occurrence of the disease.
The prognosis for the disease is as follows:
- hereditary primary form of lactase deficiency is not cured,
- in case of a secondary disease caused by the transferred disease, it is possible to restore the lactase production partially or fully, the result depends on the severity of the disease and the correctness of the chosen treatment regimen,
- transient form is cured completely, it goes away with the development of the gastrointestinal tract, may disappear by 6 months.
Careful attitude to the health of infants - the key to successful struggle with the disease. The presence of even a mild form, accompanied by insufficient weight gain, may further lead to rickets, dysbacteriosis, developmental delays, muscular weakness, and even seizures. Ignoring the symptoms of lactase deficiency is fraught with dehydration, severe weight loss and mental retardation, should not be overlooked by the increased excitability of the infant, sleep disturbances, frequent crying, especially if they are combined with impaired defecation and changes in stool.
The disease cannot be eliminated with a special diet, a lactose-free diet of a nursing mother. Her food should be complete and sufficient. A nursing mother should only abandon the usual milk in favor of fermented milk products.
It is better to decant the first portion of milk to reduce the amount of sugar supplied to the baby with mother's milk. In addition, if there is a lot of milk, the baby will eat before it gets to the “back”, which is the most fat-rich milk. It is also not necessary to change a breast in the course of feeding from the same reasons. Fatter "back" milk is digested longer, which helps the baby to develop a greater amount of lactase. Symptoms that speak of lactase deficiency require immediate medical attention.
Artificial feeding therapy
In this case, a low-lactose mixture is used, with the lactose content that is most easily tolerated by the child. Low lactose mixture is introduced gradually into each feeding, gradually replacing the previous mixture with it in full or in part. It is not recommended to completely transfer an artificial-fed baby to a lactose-free mixture.
In the case of remission after 1-3 months, you can begin to enter the usual mixtures containing lactose, controlling the symptoms of lactase deficiency and excretion of lactose with feces. It is also recommended in parallel with the treatment of lactase deficiency conduct a course of treatment of dysbiosis. Caution should be taken when treating medications containing lactose as an excipient (Plantex, Bifidumbacterin), since manifestations of lactase deficiency can be exacerbated.
Important! Attention should be paid to the presence of lactose in drugs, since the manifestations of lactase deficiency may be exacerbated.
Treatment with the introduction of complementary foods
Meals of prikorma with lactase deficiency prepared in the same mixtures (lactose-free or low-lactose), which the child received before. Lure start with fruit puree industrial production in 4-4.5 months or baked apple. Starting from 4.5-5 months, you can begin to enter the rice, corn, buckwheat porridge or vegetable puree with a weak fiber (zucchini, cauliflower, carrots, pumpkin) with the addition of vegetable oil. With good tolerance of complementary foods, meat puree is introduced in two weeks. Fruit juices in the diet of children suffering from lactase deficiency are administered in the second half of their life, diluting with water in a 1: 1 ratio. Dairy products also begin to enter in the second half of the year, initially using those where the lactose content is low (cottage cheese, butter, hard cheese).
Intolerance to other carbohydrates
As noted above, the symptoms of lactase deficiency are characteristic of other types of carbohydrate intolerance.
- Congenital insufficiency of sucrase-isomaltase (almost never occurs in Europeans). Manifested in the first days of the introduction of complementary foods in the form of severe diarrhea with possible dehydration. Such a reaction can be observed after the appearance of sucrose (fruit juices, mashed potatoes, sweetened tea) in the child's diet, less often starch and dextrins (cereals, mashed potatoes). As the child grows up, the symptoms decrease, which is associated with an increase in the surface area of absorption in the intestine. Reduced activity of sucrase-isomaltase can occur with any damage to the intestinal mucosa (giardiasis, cliacia, infectious enteritis) and cause secondary enzyme deficiency, which is not as dangerous as the primary (congenital).
- Starch intolerance. It can be observed in premature babies and children of the first half of the year. Therefore, in the composition of mixtures for such children should avoid starch.
- Congenital glucose-galactose malbabsorption. There is severe diarrhea and dehydration when you first feed a newborn.
- Acquired intolerance to monosaccharides. It is manifested by chronic diarrhea with delayed physical development. May accompany severe intestinal infections, celiac disease, cow's milk protein intolerance, hypotrophy. Characterized by a low pH in the feces and a high concentration of glucose and galactose. Acquired intolerance to monosaccharides is temporary.
Symptoms of the disease
The following symptoms of lactase deficiency may indicate the disease in question:
- Liquid feces (may be frothy and with a sour odor).
- Restless behavior of the baby when feeding or after it.
- Poor weight gain or even its loss (in severe cases of LN).
Sometimes abundant regurgitation is added to the symptoms.
During primary hypolactasia, the first few weeks of life of an infant LN do not manifest at all, then there is flatulence, followed by abdominal pain and liquid stool.
A distinctive feature of secondary hypolactasia is the appearance in the stool of a large amount of mucus, greenery and undigested food pieces.
In the case of lactose overload, the child gains weight well, but at the same time he is disturbed by pain, and his feces may be green and sour.
Hypolactasia or common allergies?
There are frequent cases when an allergy to breast milk or complementary foods is taken by an inexperienced pediatrician for lactase deficiency, which leads to the appointment of the wrong treatment. Food allergies to breast milk are provoked by the diet of a nursing mother, and its specific pathogens are:
- Gluten. Even in the absence of celiac disease (gluten protein intolerance) in a child, a nursing mother should limit the intake of gluten-containing foods in the first months of lactation.
- Synthetic additives. The diet of the nursing mother should exclude any canned food. Sweets are better to eat white - without dyes.
- Spices and herbs.
- Milk products. Cow or goat milk is markedly different in chemical composition from human. Proteins of cow and goat milk often act as a strong allergen for the newborn.
Instead of treating LN and switching to artificial formulas for a nursing mother, for a start, it is better to correct your diet by excluding milk protein and other food allergens from it.
The first food should be vegetable puree (zucchini, potatoes, cauliflower). This is the only way to determine for sure the presence or absence of hypolactasia.
Against ordinary infantile colic, dill water will suffice.
Diagnosis of lactase deficiency
You can confirm the LN using several different analyzes:
- Biopsy of the small intestine. The most reliable, but also the least used method. The reasons are obvious: anesthesia and penetration of biopsy forceps into the intestines of a newborn.
- Hydrogen test. Measurement of the amount of hydrogen in the air exhaled by the patient.
- Lactose curve (blood test).
- Analysis of feces for carbohydrates. The most popular, but the least reliable method, since there are still no precise instructions with the norms of carbohydrates in feces.
- Coprogram analysis.
It must be remembered that the presence of one or two signs of hypolactasia does not mean that the child is sick. Only a combination of all the above symptoms with a bad analysis can indicate a real LN. Lactase deficiency in children is treated by the following methods.
Proper organization of GW
The instruction includes the following items:
- do not express milk after feeding,
- it is possible to change the breast only after the baby has emptied it completely,
- try to breastfeed but more often
- it is advisable not to skip night feeds,
- it is not recommended to take the baby away from the breast, if he is not yet full,
- proper attachment to the chest.
Prescribed lactase enzyme
A typical example is the “Lactase Baby” and “Lactazar” preparations in capsules or “Baby Dock” in the form of drops. Usually, the course of using the enzyme is canceled at 3-4 months of infancy when the production of its own lactase begins in its intestine. Enzymes from drugs are very effective and relatively safe, which is confirmed by many reviews. Care must be taken when purchasing such enzyme supplements, since there have been instances of counterfeiting Lactase Baby.
Treatment of "dysbiosis"
It implies the restoration of both microflora and the state of the intestinal walls (i.e. the treatment of the underlying disease in secondary hypolactasia - for example, gastroenteritis). Often accompanied by the use of "Lactase Baby", "Baby Dock" or other drugs with lactase.
Attention moms! In the treatment of dysbacteriosis, such drugs as bifidumbacterin, plantex or analogs may be prescribed to the baby. It is important to know that they contain lactose and with LN they absolutely can not be taken.
Feeding with fermented lactase breast milk, low-lactose or lactose-free mixture
It is practiced only in the most extreme and rare cases, when milk intolerance has a congenital character, and the enzyme deficiency is extremely pronounced (this is observed in one child out of 20 thousand). Such supplementation is usually a temporary measure. Prolonged use of lactose-free formulas can cause a complete failure of the baby from breast milk. In addition, the long-term effects of artificial feeding in infancy have not yet been studied. Of the immediate side effects, the child is allergic to soy protein, and soy includes most of these mixtures. Allergy to cow or goat milk protein is even more common - the second major component of lactose free blends.
As the same E.O. Komarovsky, there is a clear commercial link between the appearance of low and lactose-free mixtures in the country and the widespread appeals of doctors to treat “lactase deficiency”. So, Komarovsky has already collected more than 50 reviews from nursing mothers, whose doctors strongly (and without grounds) recommend them to refuse HB in favor of artificial nutrition.
Lactase deficiency is a fairly common phenomenon among children, characterized by the fact that milk is not absorbed by the body of the newborn. At the same time, the prescription of lactose-free or low-lactose mixtures is justified only in case of congenital pronounced LN, which should be confirmed by the clinical picture and “bad” analyzes. In other cases, it is enough to wait until the baby’s own lactase “matures” in the intestines of the baby, helping it by fermenting milk with the help of dietary supplements (“Lactase Baby”, “Baby Dock”, “Lactazar”, “Tilactase”, “Lactrasa”, etc.), a change in the diet of the nursing mother (in the period of GW, there are no products containing milk protein and other allergens), intake of dill water against colic, proper organization of GW, and the right supplements.
Diet for lactose deficiency involves the complete elimination of lactose or limiting it in the diet in accordance with the level of carbohydrates in the feces. Complete elimination of lactose is a temporary and necessary measure in case of a serious condition of the child (dehydration, persistent diarrhea, severe abdominal pain).
It is not necessary to refuse the use of lactose at all, as it is a natural prebiotic. Therefore, the main task at this stage is to individually select a diet with such a quantity of lactose that does not cause disturbance of digestion and does not provoke the excretion of carbohydrates with feces.
How to treat lactase deficiency if the baby is breastfed? Modern standards do not imply a complete abandonment of breastfeeding. Replacement enzyme therapy is used for these children: the drug is added to the expressed milk, and after fifteen minutes of aging the child is fed with mother's milk. To do this, use the food additive Lactase Baby (price 370 rubles): one capsule is enough for one hundred milliliters of milk. After feeding with expressed milk, the baby is given a breast.
Babies on artificial or mixed feeding are selected the optimal combination of lactose free mixture and the usual mixture. The ratio of mixtures with lactase deficiency may be different: 2 to 1, 1 to 1 and so on (depending on the reaction of the child). If lactase deficiency is severe, use only low- or lactose-free mixtures.
- Low lactose mixtures: Nutrilon low lactose, Nutrilak low lactose, Humana LP + CST.
- Lactose-free mixtures: Nan-lactose-free, Mamex lactose-free, Nutrilak lactose-free.
Introduction of complementary foods
When lactase deficiency should be especially careful to keep a diary introduction of complementary foods, as some products can cause the same pathological reaction: bloating, diarrhea.
Begin priming with vegetables, using one vegetable for several days. Their amount is adjusted to 150 grams within 14 days. Then add to the ration porridge on the water with low gluten content (rice, buckwheat, corn), also increasing the weight of the consumed complementary foods. The next step is to give the baby meat.
After 8-9 months you can give a little dairy products (kefir, yogurt), carefully tracking the reaction. But the cottage cheese is not recommended for sick children up to one year (see details on the introduction of complementary foods to healthy babies).
Further diet of the child, as well as an adult with an enzyme deficiency is selected individually, based on the reaction of the body. What signs indicate that the product can be consumed, even if it contains milk sugar:
- normal stool - decorated, without pathological impurities and sour smell
- no increased gas formation
- lack of rumbling and other discomfort in the abdomen
Initially, the diet should contain a lot of products that do not contain lactose: fruits, vegetables, rice, pasta, meat and fish, eggs, legumes, nuts, tea, coffee, buckwheat, corn.
Then in the diet you need to add products with lactose, but to monitor the reaction to the product and its quantity:
- dairy products - milk, cheese, yogurt, cottage cheese, sour cream, butter, ice cream (see if you can give whole milk to a child).
- other products in which lactose is added as an additional component - bread, sausages, biscuits, cocoa, ketchup, mayonnaise, chocolate and many others
Sour cream, cream, low-lactose milk, three-day kefir, hard cheese are considered low-lactose.
It must be remembered that the diet facilitates the condition of patients with LN, but also deprives them of the main source of calcium, so the question of the completion of this trace element must be solved with your doctor.
How to treat
Treatment of lactase deficiency is prescribed only by a doctor and after the diagnosis. With this disease when feeding a baby dairy products are excluded, constant monitoring of changes in its condition is carried out.
- If the analysis showed a severe course of the disease, instead of breast milk, mothers can offer the child medicinal lactose-free or soybean mixtures, which normalize the condition of the baby.
- If the amount of lactase is reduced in the body of the infant, the treatment is carried out with special preparations containing this enzyme. For mom developed a diet. Also, a woman should express the front portion of milk, because the back part contains more lactase.
- If the child is diagnosed with acquired lactase deficiency, the treatment of the underlying disease that affects the intestinal mucosa is carried out. Болезнь постепенно проходит, когда заболевание подвергается правильному лечению, и в конечном итоге все симптомы исчезают.
После того, как родители сдали нужный анализ, который подтвердил лактозную непереносимость, назначается диета и конкретные способы питания как для мамы, так и для грудничка. Diet is to exclude this carbohydrate from the diet. First you need to stabilize breastfeeding, for which the baby needs to be fed with more fat milk. There are several ways:
- decanting front milk,
- give the child only one breast,
- try to attach the newborn to the chest in the correct position,
- try to feed more often at night, when milk has a high fat content,
- finish feeding the baby when he comes off his chest.
Moms need to remove cow's milk from the diet, the protein of which can disrupt the functioning of the intestinal cells of the infant and reduce the formation of lactase. Also, the doctor may exclude other products that during the study will determine the analysis for the identification of allergens.
When the disease recedes
If a baby has hereditary lactose intolerance, the child will be assigned a lactose-free diet, adhering to which, he will ease the symptoms of the disease.
Acquired intolerance due to special treatment retreats to a year of life, but in rare cases, the symptoms disappear only by 3 years. For the diagnosis of recovery at the end of treatment, re-analysis is carried out.
To prevent lactase deficiency from developing in severe form, leading to a lag in the growth and development of the child, it is necessary to notice the signs of the disease in the child in time, to diagnose it and, when the doctor prescribes treatment, strictly adhere to it.
Features of breastfeeding and nutrition of a nursing mother
Do not recommend nursing mothers to drink whole milk, but fermented milk products are not prohibited. Breastfeeding specialists do not give any specific instructions regarding the nutrition of the mother in case of LN in a child. However, attention is paid to the features of feeding and attachment of the baby to the breast. Front milk has the main part of lactose. When there is a very large amount of milk, the child is quickly saturated with milk that is enriched with lactose and cannot reach the “back”, the most fat.
During LN, it is advised not to replace the breast with one feeding, to express lactose front milk a little, so that the baby consumes back nutritious milk. In this case, the food is delayed in the gastrointestinal tract much longer, and lactose in the intestine has time to break down. The symptoms of LN will eventually disappear.
Today, nursing moms can hear such advice from doctors: complete breastfeeding and go completely to lactose-free or low-lactose mixture. This measure is used in severe and severe form of LN. Most often, breastfeeding can not only be saved, but just needed. In modern pediatrics, the diagnosis of “lactase deficiency” is so “promoted” and popular that in most sensible mothers it causes mistrust and suspicion.
In infants the treatment of lactase deficiency is comprehensively: for the normalization of intestinal microflora, a course of probiotics, enzyme therapy, low-lactose diet. When, during functional LN, a baby has normal development and sufficient weight, then it is not necessary to look for a disease in the child. But with severe and innate types of LN, a threat may appear to both the health and the life of the baby. During persistent lactase deficiency, the nervous system begins to suffer, and developmental delays can occur.