The baby hardly eats and is lactose intolerant. The use of lactase preparations and specialized mixtures. What is lactose and its role in child nutrition?

Mother's milk is a unique substance: it contains easily digestible proteins and fats, essential acids, minerals, vitamins, enzymes, immunoglobulins and many other components necessary for the development of the baby. This ideal baby food cannot be completely reproduced by any manufacturer of adapted formulas. But there are situations when healthy milk causes health problems in children. It's about about lactose intolerance. Let's look at the causes and symptoms of this condition, and also find out how you can help the baby.

The essence of the problem

One of basic components Human milk contains sugar - lactose. It consists of two substances: glucose, the main source of energy for infants, and galactose, a compound that takes part in the formation of the nervous system.

Most of the milk sugar that enters the gastrointestinal tract is broken down and absorbed with the help of lactase, an enzyme produced by enterocytes, special cells of the intestinal mucosa. When too little lactase is produced, undigested lactose remains in the intestine, becoming a breeding ground for the development of various microorganisms that provoke increased gas formation, abdominal pain, change in stool consistency and other unpleasant symptoms.

This condition is called lactose intolerance or lactase deficiency. In addition, the term lactose allergy is used, although it is not entirely correct: an allergy is a specific immune reaction, and lactose intolerance is associated with a malfunction in the digestive system.

For newborns and infants, lactase deficiency is a huge problem, because breast milk or formula is their main diet. If a baby’s body produces an insufficient amount of lactase, then it not only has intestinal problems and pain, but also systemic disruptions in the functioning of the body. Excess lactose leads to excessive acidic environment in the intestines and damage to its walls. As a result, the absorption of nutrients from food is disrupted and physical development delays occur.

Causes and types

Depending on the causes and mechanism of development of lactose intolerance, there are two types:

1. Primary. It is diagnosed when the enterocytes are normal but produce too little or no lactase. Reasons for this deficiency:
2. immaturity of the gastrointestinal tract - characteristic of premature newborns; over time (by about 3-4 months) lactase synthesis becomes sufficient
3. -genetic disorders (very rare)
4. “adult” type of functioning of the digestive system - normally, by the end of the first year, the activity of lactase production decreases and continues to decrease throughout life, but in some children this process starts earlier
5. Secondary. Caused by damage to enterocytes. Her reasons:
6. intestinal infections
7. inflammatory diseases of the mucous membranes of the gastrointestinal tract
8. allergies to cow's milk, gluten or other foods

Another type of lactose intolerance can be distinguished, or rather, a condition similar to it, which is excess milk sugar. The baby's enzyme system is working normally, but he is getting too much lactose, causing problems. typical symptoms insufficiency. This happens if the baby’s diet consists mainly of foremilk- the fluid that is released from the breast first and contains a lot of sugar.

Signs of lactose deficiency

Symptoms of lactose intolerance increase as the baby gets older. In the first weeks of life, there are no signs of trouble at all. Then observed:

1. gases in the intestines that are produced in increased quantity and cause pain to the baby
2. rumbling in the tummy, tension in the anterior abdominal wall
3. loose stool with a sour odor and foam, with primary failure it is yellow, and with secondary failure it is green with mucus and food particles
4. increased frequency of bowel movements or, conversely, constipation (characteristic of “artificial” patients)
5. excessive regurgitation after eating
6. weight loss or poor weight gain (in advanced cases)

Children with lactose intolerance, as a rule, have a good appetite, they eat willingly, but a few minutes after the start of the meal they turn away from the breast (bottle) and begin to cry, “wiggle” their legs, and arch.

If there is a diet with an excess content of milk sugar, then the baby experiences similar symptoms, but he gains weight well.

Diagnostics

An allergy to milk sugar, or rather its intolerance, is diagnosed using:

1. Intestinal biopsy - taking samples of the lining of the small intestine. This method is considered the most informative, but due to the traumatic nature and the need for anesthesia, it is rarely used in children.
2. Preparation of lactose curve and hydrogen test. Both methods involve oral administration of a dose of lactose to the infant. Then blood is taken several times to create a lactose graph or exhaled air is analyzed. These methods are used infrequently due to the fact that lactose can cause discomfort The child has. In addition, there are no clear indicators of hydrogen levels in newborns.
3. Analysis of feces for carbohydrates. It is used most often, but has the least veracity, since uniform standards for the content of carbohydrates in the feces of infants have not been developed. It also does not show exactly what carbohydrates are present.
4. Coprograms - studies of stool for the level of acidity and fatty acids. If these indicators exceed the norm, they suggest lactose intolerance.

In domestic practice, the diagnosis is made on the basis of an analysis of carbohydrates, coprograms and clinical signs. If there are deviations in the test results, but there are no symptoms of deficiency, treatment is not carried out.

Treatment

To treat lactose intolerance you must:

• Set up breast-feeding so that the child has the opportunity to get to fat milk:

– express a little milk before feeding

– practice applying to one breast at one meal

– teach your baby to grasp the nipple correctly so that he gets milk more actively

– do not take the breast until the baby lets go

• Review maternal nutrition:

– remove whole milk from the menu, an allergy to which very often provokes secondary lactase deficiency; in severe cases, abstinence from all dairy products is required

- exclude all treats that may cause allergies - chocolate, red fish, caviar, sweets, etc.

Often these two steps are enough to alleviate the baby’s condition, but if they do not help, then it is worth moving on to drug therapy.

• Taking the enzyme lactase. It is added to a large number of breast milk and is given to children before each feeding. The dosage is determined only by the doctor.
• Partial or complete transition to nutrition with low level lactose. This measure is considered a last resort.

In addition, when secondary failure Lactase treatment treats the underlying disease that provoked it: allergies, dysbacteriosis, gastroenteritis.

Treatment of lactose intolerance takes several months, then the baby’s body begins to produce the necessary enzymes in normal quantities. If a genetic defect of enterocytes is established, then the person must adhere to a lactose-free menu throughout his life.

Lactose intolerance is a diagnosis that last years is given to many babies. But primary lactase deficiency is very rare. Usually, intestinal problems in a baby arise due to improper organization of breastfeeding. Therefore, giving your baby lactase or switching him to a low-lactose diet is only worth it if no other measures can eliminate health problems.

Watch this video about lactose intolerance

Lactose intolerance cannot be called an independent disease: in almost all cases, the pathology develops against the background of other diseases. This is a condition of the body that causes a lot of discomfort for both the baby and his mother. Clinical manifestations of lactose intolerance include:

• abnormal stool pattern in the newborn. After birth, the baby's stool can have any consistency. But if it happens more than 10 times a day, has a sour smell, white lumps, which are, in fact, undigested milk, then this may be a symptom of lactase deficiency;
• stomach problems. Another sign indicating lactose intolerance is colic and bloating. This symptom should be correlated with all others, since colic often occurs in infants during the formation of intestinal microflora;
• frequent regurgitation. If spitting up occurs rarely, there is no need to worry. But if milk comes out constantly and in large quantities during regurgitation, you should see a pediatrician;
• poor appetite, moodiness. If a baby throws the bottle or breast during feeding, is capricious and cries, if after feeding he actively passes gas, this may also be a sign of lactase deficiency.

Diagnosis of lactose intolerance in a newborn

Lactose intolerance in a newborn is diagnosed based on symptoms of the condition as well as laboratory tests. The baby may be prescribed:

• stool analysis to determine carbohydrate content and acidity;
• urine analysis to determine the level of lactose in it;
• intestinal biopsy to determine the level of enzyme activity;
• analysis of intestinal microflora;
• genetic examination.

If the disease is secondary, additional examinations in order to establish the main reason that caused it. For example, enteritis or allergies.

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Causes of pathology and its types

Lactase deficiency (LD) can be primary or secondary. Doctors also identify a special condition similar to it - “lactose overload.” Primary LN is a congenital pathology of the gastrointestinal tract structure, in which the infant does not produce enough enzyme, or its intestinal cells are not able to produce lactase:

• due to genetic disorders;
• due to immaturity of the gastrointestinal tract in premature babies(transient, or transient LN).

The cause of secondary lactase deficiency is damage to lactase-producing cells. They partially or completely atrophy after acute or against the background of chronic intestinal infection, inflammatory bowel diseases, food allergies(for example, cow's milk).

Lactic sugar overload occurs when a baby produces normal amount enzyme, but due to the structural features mother's breast or feeding regimen, milk digestion is disrupted. There is no need to treat this condition, but the mother will be advised to establish proper nutrition for the baby.

Symptoms

Symptoms of lactase deficiency in children increase with age. In the first weeks of life, infants do not have any digestive problems, but over time they begin to be bothered by abundant gases, and later by painful colic during feeding and diarrhea.

1. The stool of an infant with primary FN is frequent and watery, yellow with a sour odor and foamy, like yeast dough; The child’s stomach often rumbles, the baby burps frequently and profusely. In severe cases, he loses weight or stops gaining weight.
2. With secondary LN, the same symptoms are observed as in the first case, but mucus, “greens” and lumps are added to them undigested food in feces.
3. The doctor will suspect lactose overload if the baby is gaining weight well, but he is often bothered by colic and diarrhea, and the mother has much more milk than he needs (breast fullness, milk leakage).

It is not difficult to distinguish intestinal disorders in FN. Such a baby has a normal appetite; at the beginning of feeding, he begins to suck greedily, but after a few minutes he drops the breast, cries, and curls up his legs due to pain in the tummy. The rumbling in your baby's stomach can be so loud that it becomes the first noticeable symptom of lactose intolerance in a newborn.

How to avoid making a mistake with a diagnosis?

There are several ways to check whether a child really has an intolerance. mother's milk. But some of them are traumatic or unpleasant for the baby, others cannot accurately indicate lactase deficiency.

1. Most reliable method to confirm the diagnosis of LN - a biopsy (taking a tissue sample with a needle) of the mucous membrane of the small intestine, which is done under anesthesia.
2. Lactase curve and breath test. For the first study, the child is given a portion of lactose on an empty stomach and blood is taken several times for glucose within an hour. For the second, after feeding the baby lactose, a “hydrogen test” is performed.
3. Stool carbohydrate testing is the best known but imprecise test for lactose intolerance in a newborn. The levels of carbohydrates in baby stool are vague, and the test does not determine which of them is detected in the analysis: lactose, glucose or galactose.
4. The coprogram shows the acidity of stool (in case of FN it is increased) and the amount of fatty acids in it - the more there are, the greater the likelihood of pathology.

The diagnosis is made by combining the clinical picture, symptoms of the disease and examination results ( bad analysis stool and coprogram, positive hydrogen test, high blood glucose). If after the start of treatment the baby’s well-being improves, then the diagnosis was carried out correctly.

Non-drug treatments

Most breastfeeding women secrete at the beginning and end of breastfeeding. different milk: first of all, the watery “front”, and as the baby sucks at the breast, the more fatty “back”. Due to the fat content, the second portion of milk enters the intestines slowly, and if the baby produces enough enzyme, lactose has time to be processed.

Light, watery milk moves through the gastrointestinal tract much faster, and some of it may end up in the large intestine without having time to be digested. In order for the baby to receive more “hind” milk and less “front” milk, the mother needs to adhere to several rules:

• Express not after feeding, but before it. Then the baby will immediately receive fatty milk;
• do not change breasts between feedings;
• do not take the nipple away from the baby until he releases it himself;
• apply the baby to the breast correctly. A baby who has difficulty sucking may not be able to suck out enough watery milk to begin receiving fatty milk;
• If possible, feed at night: more fatty milk is produced at night.

Sometimes, in addition to this, the mother has to follow a diet. Most often, it is enough to exclude only milk or dairy products from the diet. However, any other protein, such as that found in eggs or meat, can also be an allergen.

Drug treatment

If the baby’s digestion cannot be established, the doctor will prescribe lactase. The enzyme is given before feedings or between them, dissolving in small quantity breast milk. The course of treatment is preliminarily prescribed for the first 3–4 months of the baby’s life: in many children, by this time the production of their own lactase is normalized.

In difficult cases, infants are transferred to dairy-free options artificial mixtures Nutrilon and Nan (Holland), Nutrilak (Russia), Mamex (Denmark). For some children, it is enough to replace it with fermented milk or dairy-free formula only part of the feedings. If the treatment regimen is chosen correctly, the baby begins to eat normally within 2–4 days, and after a few days, stool and well-being return to normal.

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General information

Lactose is a disaccharide carbohydrate found in mammalian milk, a product of the breakdown of glucose and galactose. Another name for lactose is milk sugar. This is a powerful source of energy necessary for the natural development and growth of the child's body.

TO beneficial properties lactuloses include:

• strengthening the walls of blood vessels, resulting in a reduced risk of heart and vascular diseases;
• maintaining a healthy balance of intestinal microflora, since lactase is the environment that is necessary for the functioning of lactobacilli;
• participation in calcium absorption;
• maintaining a healthy nervous system;
• promoting the growth of muscle tissue.

For reference. The highest percentage of lactulose is found in human breast milk: about 6-6.5%, slightly less in cow's milk (4-4.5%). In fermented milk products, the disaccharide is present in very small quantities, and sometimes completely absent.

The human gastrointestinal tract is designed in such a way that lactase is most actively produced in it during infancy, when the body needs to digest and absorb the highest daily concentration of milk sugar throughout life.

After three years, the production of the enzyme begins to decline, since during this period of time the baby’s need for breast milk or formula practically disappears. This is precisely what is associated with the aversion to milk that can be observed in most grown-up children and adults. And although a dislike for milk does not at all mean lactase deficiency, this fact still signals that the content of this enzyme in the body is low.

Causes

There are congenital and acquired hypolactasia. In the first case, manifestations of the pathology can be observed soon after the child starts feeding breast milk or an adapted formula; in the second, symptoms can develop at any age due to the influence of various factors.

Genetic lactose intolerance is a disease whose causes are not fully understood. Race plays a big role - a high percentage of lactose intolerance occurs among residents of Africa and Asia, southern peoples, and Jews. Rare case– A 100% lack of the enzyme necessary to digest milk sugar is noted among the indigenous people of North America.

In addition to the genetic factor, heredity plays a role in the development of congenital hypolactasia. The likelihood of having a child with this condition is much higher if one or both parents also have a milk allergy. Babies born prematurely are also at risk.

Acquired lactose intolerance appears as a result negative factors or a combination of them:

• intestinal infections;
• abuse of milk for a long time, especially in adulthood;
• intestinal dysbiosis;
• unhealthy diet;
• worms;
• stress.

Risk of acquired hypolactasia naturally increases with age. Sometimes in children school age milk allergy appears without intervention additional factors, if the lactase level falls below the maximum permissible norm.

Exists mixed form diseases - congenital lactase deficiency with late symptomatic manifestation. It is diagnosed on average at 20-40 years of age.

Symptoms

Lactose intolerance is expressed in different ways: depending on the amount of enzyme produced and the body’s reaction to it, patients are divided into several groups:

1. Children who can consume about a glass of milk per day without consequences for digestion and respond well to fermented milk products.
2. Children who cannot tolerate milk and are able to consume fermented milk products in limited quantities.
3. Children whose gastrointestinal tract reacts equally poorly to milk and fermented milk products.
4. Children who show symptoms of lactase deficiency even when consuming products containing milk components in very small quantities.

Signs of lactose intolerance in children boil down to indigestion: bloating appears, excessive gases form in the intestines, and the child suffers from constipation and belching. Parents note that the child’s stomach is rumbling, there is frequent flatulence (gas passing), in his stool contains fragments of undigested food, he may complain of pain in the intestinal area.

Lactose intolerance in infants can be determined if their stool appearance resembles curdled milk: it is not homogeneous, the liquid component and undigested milk are visually separated in it. Sometimes mucus and bile may be present in the stool - in this case, the stool takes on an unhealthy green tint.

Also, babies with hypolactasia are more likely than other children to suffer from colic and excessive regurgitation. You can tell that a child is lactose intolerant by symptoms of poor digestion such as nausea and vomiting.

Regardless of age and severity, all symptoms after consuming milk/fermented milk products become brighter and more pronounced. The disease may also be accompanied by manifestations of allergies: skin rashes, itching, swelling of the mucous membranes.

Congenital lactase deficiency is the most severe - in this case, all the symptoms are pronounced, the child’s well-being leaves much to be desired due to constant pain and digestive discomfort. As a result constant shortage nutrients and vitamins, such children have a deficiency of body weight and a lag in physical development: They later begin to hold their heads, sit, crawl. Mental development also suffers.

Diagnostics

To identify lactose intolerance in a child, to an experienced pediatrician sometimes the clinical picture is enough, which consists in the presence of the above symptoms in the patient. However, to exclude the possibility of diseases of the digestive system with similar symptoms, it is necessary to check the stool for worm eggs, the presence of pathogenic bacteria, and impurities of blood and bile.

You can find out if older children are lactose intolerant using a special elimination diet. To do this, products containing milk sugar are almost completely excluded for two weeks (depending on the clinical picture, the patient’s age and other indicators, 1-8 g of disaccharide per day is allowed during an elimination diet).

If after the trial period the patient’s condition improves significantly, the symptoms disappear or appear less pronounced, this indirectly confirms the preliminary diagnosis.

Laboratory confirmation of the disease can be done using a number of other methods:

1. Test for the body's tolerance to milk: depending on the age, the child is given 200-500 ml of milk to drink, after half an hour it is carried out laboratory analysis blood for glucose. If its content in the blood exceeds 9 mg/dl, the patient is diagnosed with lactase deficiency.
2. Determining the amount of carbohydrates in feces (Benedict test) helps to identify hypolactasia in infants.
3. A breath test for lactose intolerance involves measuring the level of hydrogen in the patient's exhaled breath. The amount of this gas directly depends on the activity of the microflora of the large intestine. If anaerobic bacteria are forced to process undigested lactose, they release large quantity hydrogen than normal operation Gastrointestinal tract (≥20 ppm).
4. Test for lactose intolerance using an indicator strip. The patient is given a solution of milk sugar (50 g/100 ml of water) to drink, after which the level of galactose in the urine is measured several times over a period of half an hour with a test strip.

In addition to testing, identification of disaccharide intolerance, as well as determination of the type of disease (congenital or acquired) is carried out using instrumental gastroenterological examination: x-ray of organs abdominal cavity, irrigoscopy, colonoscopy, endoscopy.

The identified pathological changes mucous membranes also make it possible to differentiate hypolactasia from irritable bowel syndrome, diabetic diarrhea, and other inflammatory and infectious diseases of the rectum and colon.

Treatment

To cure lactose intolerance, a combination of properly selected diet therapy, enzyme therapy and symptomatic drug treatment is necessary.

Diet therapy

The basis of treatment for hypolactasia is the complete or partial exclusion of lactulose-containing products from the child’s diet. Depending on the severity of the symptoms, this may be the exclusion of only milk or all milk-containing products, including fermented milk: kefir, simbivita, sourdough, fermented baked milk, yogurt, ice cream, soft and hard cheeses, cottage cheese, milk chocolate.

In addition, some products are also included in the list of prohibited products. meat products(sausages, sausages, boiled sausage, ham), baked goods (cakes, pies, buns, pastries, muffins), confectionery, covered with glaze, sauces (mayonnaise, mustard, ketchup), fast food dishes, dishes instant cooking(soups, purees, jelly, pasta in bags), cocoa powder, meat by-products (liver, kidneys, brains), sweeteners.

What you can eat if you are lactose intolerant:

• boiled and baked meat (beef, rabbit, turkey, chicken);
• vegetable oils (olive, sunflower, flaxseed, corn, etc.);
• fish;
• vegetables and fruits, herbs;
• natural vegetable and fruit juices;
• bread made from white and rye flour, whole grain bread, bran;
• honey, sugar, jam, marmalade, jams;
• extra dark chocolate;
• rice, pasta, buckwheat;
• chicken eggs;
• nuts;
• tea, coffee, compotes, jelly.

How to replace milk if you are lactose intolerant? They will come to the rescue soy milk and tofu cheese, bean curd, as well as products made from them. Soy dairy products are hypoallergenic, palatable, and contain large amounts of vegetable protein. Animal protein in high concentration found in meat, vegetable - in legumes, so excluding milk and dairy products from the diet with a varied menu will not negatively affect health.

The diet must be competent - it is necessary to monitor the body’s reaction so as not to exclude from the diet what is well tolerated by the patient. Very often, a complete exclusion of fermented milk products from the menu is not required - if a child tolerates consuming even 100-150 grams of kefir per week without consequences, it must be introduced into the diet in exactly that quantity.

Not only the volume of dairy food, but also the intervals between its consumption can be important. To make it easier for yourself to create a low-lactose menu, you can keep a food diary.

Nutrition for lactose intolerance in infants

The issue of feeding infants in the event of symptoms of hypolactasia must be especially carefully weighed and depends on the severity of the symptoms. If the child’s condition is severe enough, then the issue of abandoning breastfeeding and switching to a special lactose-free milk formula is considered.

If the signs of lactase deficiency are not pronounced, the baby’s condition does not cause concern, development occurs in accordance with age standards, strict adherence to the diet by a nursing mother may be sufficient. If a woman excludes foods with high content milk sugar, the lactose content in her milk will decrease and the load on the baby’s digestive system will become less.

If pathology is detected in children who are bottle-fed, they are transferred to lactose-free formulas or mixtures with a low lactose content. They are enriched with essential components for growth and development. useful substances, so the transition should not cause concern for parents. In the future, after consulting with your pediatrician, you can try to very gradually introduce regular formula and milk-containing products into the diet.

Drug therapy

Drug treatment of hypolactasia is prescribed if diet therapy has not brought satisfactory results and the patient’s condition cannot be normalized. The patient is prescribed medications containing enzymes that help digestive system digest foods that are difficult for her.

The second point is seeding the intestines with beneficial microflora. For this purpose, probiotics that contain lactobacilli are prescribed. They help suppress pathogenic microflora, help digest food and absorb lactose, and also normalize the production of gases in the intestines.

For relief of severe symptoms little patient Prescribe tablets for constipation or diarrhea, drugs that improve intestinal motility. To reduce Negative consequences diseases and get rid of vitamin deficiency, vitamin-mineral complexes are introduced into the course of treatment.

Prevention of lactose intolerance involves careful attention to the symptoms of indigestion, especially in infants, as well as a rational and varied diet without overloading the menu with dairy products. It is impossible to leave the disease unattended - this can lead to serious allergic reactions, weight loss, and the occurrence of intestinal diseases.

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Symptom complex of pathology

For allergic condition caused by breast milk, the symptoms are the same as for any type of allergy:

• rash;
• skin itching;
• sometimes dyspeptic disorders.

The following symptoms are typical for lactose intolerance:

• the child is not gaining weight well;
• within 15-30 minutes the baby burps;
• laboratory testing reveals an increase in lactose in the baby’s stool;
• within 15-30 minutes after drinking milk, the child develops pain in abdominal area (intestinal colic) and diarrhea opens (profuse, foamy with a sour odor), accompanied by flatulence; in some cases, loose stools may be replaced by constipation;
• the child's anxiety when breastfeeding, the baby throws the breast, cries and bends over.

With primary lactase deficiency, symptoms appear from the first days of the baby’s life.

If your baby has symptoms allergic reaction or lactase deficiency or you think you have such symptoms, consult a specialist (pediatrician and allergist).

You should not self-medicate. Since regurgitation or loose stools and flatulence can be both normal variants and signs of an incipient serious disorder or infectious process.

Types of lactase deficiency

• primary;
• secondary;
• transient.

Primary lactase deficiency is caused by the inability of the newborn to produce lactase. Typically due to gene mutation. This is a rare pathology.

Secondary - occurs frequently, fortunately it is temporary and rarely an independent pathology. Caused by past gastrointestinal diseases. It develops more often in children with allergies, in children who have had intestinal infections and in those suffering from celiac disease.

Transient – ​​typical for premature or weakened children and is associated with the immaturity of the child’s intestines. Within a few months after birth, the newborn's intestines become capable of producing lactase. Mother's milk begins to be absorbed and symptoms disappear.

Causes of allergic reaction and lactase deficiency

An allergic reaction to breast milk is considered impossible, since its composition is the most balanced for absorption by the child’s body. And yet, an allergy is possible, if not to the milk itself, then to some of the chemicals contained in it and passing from the mother’s food into breast milk and then into digestive tract crumbs. In case of errors in the mother’s diet, for example, consumption of alcohol and sweets. The baby develops a so-called milk rash, small itchy blistering rashes on the skin.

Sometimes they talk about an allergy to milk sugar. This is possible in the case of a mother’s malicious abuse of foods with a high content of it; in this case, the enzyme produced by the baby’s body is simply not enough to break it down, and satiety and hyperreaction sets in.

In other cases, an allergy occurs not to lactose, but to cow's milk protein in cases where the mother abuses dairy products, especially whole cow's milk and condensed milk to increase lactation. Milk protein is perceived as a foreign aggressive agent, and the immune system begins to vigorously fight him.

The second allergenic component is gluten (also a protein, although plant origin). If the baby does not have a sufficient amount of the enzyme that breaks down gluten, an allergic reaction develops. Therefore, in the first months, mothers are advised to eat gluten-free cereals, buckwheat, rice and corn.

Lactose allergy, which is actually hypolactasia, occurs due to:

• genetic defect;
• immaturity of the child's intestines;
• previous infectious intestinal diseases;
• helminthic infestations;
• constant stress.

Treatment of problems associated with milk consumption

Treatment measures depend on the cause of the body’s inadequate response. children on mother's milk.

If the reaction is allergic, then the mother will need to adjust her diet. Depending on the allergen, eliminate it or at least reduce your intake. Reduce the amount of cow's milk or products containing gluten (semolina, millet, wheat) she consumes.

Perhaps this will be enough. If not, you will have to prescribe the appropriate medications: antihistamines, enterosorbents, and in severe cases, corticosteroids.

If the reaction is caused by lactose intolerance, which appeared from the first days of the baby’s life and is caused by a genetic defect, the baby will have to be switched to lactose-free formulas. If intolerance is temporary, treatment of the underlying disease is required. Once your health is restored, you can return to breastfeeding.

Basic principles of treating lactose intolerance

The solution is to eat a lactose-free diet. If the child is bottle-fed and there are no problems, it is enough to switch him to one of the lactose-free formulas or formulas containing a small amount of lactose. Depending on the presence of a small amount or complete absence of the lactose enzyme in the baby’s body.

If the mother has a sufficient amount of milk, then it is worth trying to maintain breastfeeding. If the baby still produces the lactase enzyme, albeit in small quantities, the mother needs to reduce the consumption of foods containing lactose, both explicitly (milk, fermented milk products, nougat, yoghurts, etc.) and hidden (for example, baked goods, seasonings, meat dishes, candies and a number of others). In this case, symptoms may disappear, allowing you to continue feeding.

If this is not enough, a special enzyme can be prescribed, which is given to the baby during each feeding. The drug allows you to break down lactose and obtain all the beneficial components of breast milk. However, not all children can be prescribed this drug; for example, an allergy to the enzyme is a strict contraindication to its use. In this case, the baby is removed from breastfeeding and transferred to lactose-free formulas.

Children should be transferred gradually over a couple of days. In some cases, it is enough to replace several feedings with the mixture. And keep at least a mixed feeding option.

Typically, symptoms of lactose intolerance go away within 2-4 days after eliminating lactose from food. Allergy symptoms also begin to subside by this time.

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1 What is lactose?

Lactose is a natural sugar found only in dairy products. Breast milk is a unique substance that contains easily digestible proteins, fats, vitamins, essential acids, immunoglobulins and many other components, necessary for infants for proper development and good health. Mother's milk is indispensable in terms of naturalness. It's ideal for baby food, which is why mothers are advised to breastfeed for as long as possible, because not a single manufacturer of baby powder formula can produce a complete analogue of mother’s milk. However, sometimes it happens that milk causes problems in children.

Lactose, which is one of the components of breast milk, consists of:

• glucose (a colorless crystalline substance that has a sweet taste and is a source of energy for infants);
• galactose (a substance that forms the nervous system).

Lactose entering the gastrointestinal tract is absorbed with the help of lactase, an enzyme produced by enterocytes. When this enzyme is produced in small quantities, undigested lactose remains in the intestines, thereby becoming food for microorganisms that can cause the formation of gas, abdominal cramps, changes in stool, rash, etc. This is lactose intolerance, or, as it is also called, lactase deficiency.

Lactic sugar intolerance is quite common and cannot always be considered a disease. Most people do not experience discomfort due to this phenomenon. However, for newborn children such deficiency is big problem, because Mother's milk is the main food for children under 1 year of age. This anomaly poses a threat to the baby, because Excess lactose, causing malfunctions in the body, can lead to delayed physical development. In addition, research shows that drinking breast milk and digesting it normally increases the level of absorption of vital important minerals(calcium, magnesium, zinc, iron), which the child needs for proper mental development. In adults, such intolerance does not cause any particular problems, because they can simply stop drinking milk and get their vitamins and minerals from other types of food.

Which mixture is better for allergies Diathesis symptoms

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 helminthic infestation, or an allergic reaction to 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 quite rosy forecasts: in 99.9% of cases, enzyme deficiency goes away on its own, when 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 mixtures. 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 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 percentage lactose - human breast milk (7%), cow's and goat's milk sugar contains approximately equal amount(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.

Lactose is the main carbohydrate found in dairy products. It consists of glucose as well as galactose. When lactose is broken down, an enzyme, lactase, is released. Lactase deficiency in the body is the root cause of lactose intolerance.

This condition in a child can be determined genetically, that is, transmitted by inheritance. It is usually observed in children born prematurely and in infants who are underweight.

Older children usually exhibit secondary lactose intolerance, which occurs as a result of a chronic or acute illness. The causes of intolerance may be:

• intestinal infections;
• allergy to cow's milk protein;
• inflammation in the intestines;
• celiac.

Thus, among the factors provoking the development this state, relate:

• ethnicity;
• heredity;
• premature birth;
• pathologies affecting the small intestine, in which the process of lactose breakdown and synthesis occurs.

Symptoms

Signs of lactose intolerance in children younger age usually manifested in the character of the stool. It has a distinct sour odor and watery consistency. In infants, pathology also manifests itself in the form of frequent and severe regurgitation, flatulence, whims during feeding, refusal of the breast or bottle.

Often, older children lag behind their peers in physical development: they grow poorly and gain little weight. Moreover, they may experience decreased muscle tone and seizures.

Also, clinical manifestations of lactose intolerance in older children include stomach rumbling and flatulence. In some cases, pain appears in the umbilical region: it is spasmodic in nature.

Lactose intolerance can, among other things, cause irritability, frequent shifts moods and increased fatigue The child has.

Diagnosis of lactose intolerance in a child

Lactose intolerance in children is diagnosed based on clinical manifestations. If necessary, the child is prescribed additional examination methods, for example, in order to identify the pathology that provoked this condition.

As a rule, dietary diagnostics are used, during which products containing lactose are excluded from the child’s diet. After this, they look at the clinical picture and conduct a stool analysis. If the symptoms decrease and the stool pH level is normal or higher, then the child truly has lactase deficiency.

Children may also be prescribed a chromotagrophic study, which will allow them to select an adequate diet.

Complications

Secondary lactase deficiency has virtually no consequences. Over time, the child’s body will begin to absorb any dairy products normally. After 6-7 months, lactose intolerance will completely disappear.

With primary pathology, lactose intolerance will persist for life. But absolute lactase intolerance is rare, so children with this condition can still drink some milk. Signs of pathology will begin to appear only if the norm is increased. It is determined individually in each case.

Sometimes primary lactose intolerance is combined with secondary lactose intolerance. IN in this case the state of the intestinal microflora should be constantly monitored.

Treatment

What can you do

Parents of children with lactose intolerance should take care special nutrition for a child. It should include low-lactose products, in quantities that are suitable for the child according to his age. Lactic acid products can also be included in the diet: usually children with lactase deficiency tolerate them quite well.

You should not consume condensed or concentrated milk, or medications that contain lactose. If signs of the condition appear, the child should be shown to a doctor who will diagnose and prescribe adequate treatment.

What does a doctor do

In cases where lactose intolerance develops as secondary pathology, the doctor treats the underlying disease. In this case, the child is assigned special diet. If it is possible to achieve remission or recovery, they usually begin to gradually expand the list of foods included in the diet. At the same time, the clinical picture of the disease is constantly monitored and the necessary tests are carried out.

With primary lactose intolerance, children are prescribed a diet that they must adhere to throughout their lives. Such a diet has particular inconveniences, according to medical practice, does not deliver.

Children over one year old are advised to replace milk with products low in lactose and fermented milk. Confectionery products with dairy fillings are also excluded from the diet. In some cases, children are prescribed drugs with the lactose enzyme, which are taken in combination with dairy products.

Prevention

There are a number of preventive measures that can prevent the development of lactose intolerance in children. Among them:

• timely treatment of any intestinal infections and pathologies of the gastrointestinal tract;
• compliance with hygiene rules;
• proper feeding of newborns.

To secondary preventive measures This includes following a diet based on the consumption of foods low in lactose or without it at all. This will avoid the occurrence of symptoms of lactase deficiency.

In general, it is impossible to exclude foods with lactose from the diet, as this will reduce the amount of calcium entering the child’s body.

Articles on the topic

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Arm yourself with knowledge and read a useful informative article about lactose intolerance in children. After all, being parents means studying everything that will help maintain the degree of health in the family at around “36.6”.

Find out what can cause the disease and how to recognize it in a timely manner. Find information about the signs that can help you identify illness. And what tests will help identify the disease and make a correct diagnosis.

In the article you will read everything about methods of treating a disease such as lactose intolerance in children. Find out what effective first aid should be. How to treat: choose medications or traditional methods?

You will also learn what can be dangerous untimely treatment the disease lactose intolerance in children, and why it is so important to avoid the consequences. All about how to prevent lactose intolerance in children and prevent complications.

And caring parents will find on the service pages complete information about the symptoms of lactose intolerance in children. How do the signs of the disease in children aged 1, 2 and 3 differ from the manifestations of the disease in children aged 4, 5, 6 and 7? What is the best way to treat lactose intolerance in children?

Take care of the health of your loved ones and stay in good shape!

Congenital or acquired decrease in the activity of lactase, a parietal digestive enzyme that breaks down milk sugar - lactose, can be either manifest or hidden. Lactose intolerance usually refers to the clinically manifested inability of the intestinal enzymatic systems to break down lactose. Essentially, lactose intolerance is a clinical manifestation of lactase deficiency (LD), i.e., a decrease in lactase activity in the intestines.

Lactose intolerance is extremely common and should not always be considered a disease that can be treated. Many people are lactose intolerant, but do not experience any inconvenience due to this, since they do not eat it and most often are not aware of their enzymatic characteristics. The problem of lactose intolerance is of greatest importance for young children, since for them milk is the main food product.

Lactose is the main carbohydrate in milk, a disaccharide consisting of glucose and galactose. The breakdown of lactose into monosaccharides occurs in the parietal layer of the small intestine under the action of the enzyme lactase-phlorizin hydrolase into glucose and galactose.

A decrease in lactase activity can be genetically determined and inherited in congenital or familial LI. Normally, lactase activity is first detected in the intestines at 10–12 weeks intrauterine development, and from the 24th week it increases significantly, reaching a maximum at the time of birth. From the 28th to the 34th week of intrauterine development, lactase activity is no more than 30% of its level at the 39th–40th week. This circumstance determines the possibility of developing LI in premature and immature children at the time of birth.

For all mammals, including humans, a decrease in lactase activity during the transition to an adult type of diet is typical, with a simultaneous increase in the activity of sucrase and maltase. In humans, lactase activity begins to decrease at the end of the first year of life (up to 24 months it is inversely proportional to age), and this process reaches its greatest intensity during the first 3–5 years of life. The decrease in lactase activity may continue in the future, although, as a rule, it passes more slowly. The presented patterns underlie adult-type LI (constitutional LI), and the rate of decline in enzyme activity is genetically predetermined and is largely determined by the ethnicity of the individual. Thus, in Sweden and Denmark, lactose intolerance occurs in approximately 3% of adults, in Finland and Switzerland - in 16%, in England - in 20–30%, in France - in 42%, and in the countries of Southeast Asia and in African-Americans in the USA - almost 100%. High frequency constitutional disability among the indigenous population of Africa, America and a number of Asian countries is to a certain extent associated with the lack of traditional dairy farming in these regions. Thus, only the Maasai, Fulani and Tassie tribes in Africa have been raising dairy cattle since ancient times, and FN is relatively rare in adult representatives of these tribes. The frequency of constitutional LI in Russia is 16–18%.

Thus, by origin, primary LN is distinguished, a congenital decrease in lactase activity with intact enterocytes, the variants of which are:

• congenital (genetically determined, familial) LI;
• transient LI of premature and immature children at the time of birth;
• Adult type LI (constitutional LI).

Secondary LN is a decrease in lactase activity associated with damage to the enterocyte due to any acute or chronic disease. Such damage to the enterocyte is possible with infectious (intestinal infection), immune (cow's milk protein intolerance), inflammatory processes in the intestines, atrophic changes(for celiac disease, after a long period of complete parenteral nutrition etc.), lack of trophic factors.

According to the severity, lactose intolerance is divided into partial (hypolactasia) or complete (alactasia).

In cases where lactase activity is insufficient to digest all the lactose that enters the small intestine, the undigested disaccharide enters the large intestine in greater or lesser quantities, where it becomes a nutrient substrate for various microorganisms that ferment it to short-chain fatty acids, lactic acid, carbon dioxide, methane, hydrogen and water, which leads to the development of osmotic diarrhea. It should be noted that the intake of lactose into undigested form into the large intestine minimum quantities in full-term newborns with sufficiently high lactase activity is important for the formation of normal intestinal microflora, however, excess lactose leads to serious negative consequences.

Lactase activity is influenced by glucocorticoid hormones (shorten the cycle of enterocyte division, increase lactase activity during gestation, accelerate the decrease in activity in animals during the transition to an adult type of feeding), thyroid hormones (glucocorticoid synergists when the spectrum of disaccharidase activities changes in the postnatal period), somatotropic hormone (renders trophic effect per enterocyte), insulin (increases enzyme activity during gestation), peptide growth factors (accelerate the division and maturation of enterocytes), transforming growth factors and epidermal growth factor (affects the reproduction of intestinal epithelial cells, primarily crypts, the shape of the brush membrane border and the expression of disaccharidases on it), insulin-like growth factors 1 and 2 (stimulate). Also, lactase activity is increased by biogenic amines, short-chain fatty acids, nucleotides, and amino acids (glutamine, arginine, ornithine) located in the intestinal lumen.

Expressiveness clinical symptoms with lactose intolerance, it varies widely, since it is caused by different levels of enzyme reduction, differences in the intestinal biocenosis, individual characteristics sensitivity of the intestines and the body as a whole and, of course, the amount of lactose entering the body with food.

Main clinical manifestations FN is osmotic (“fermentation”) diarrhea after taking milk or lactose-containing dairy products (frequent, liquid, foamy stools with a sour odor, abdominal pain, child restlessness after taking milk), increased gas formation in the intestines (flatulence, bloating, pain in a stomach). In young children, against the background of diarrhea syndrome, symptoms of dehydration and/or insufficient weight gain may develop.

The severity of the disease is determined by the severity of nutritional status disorders (hypotrophy), dehydration, dyspeptic symptoms(diarrhea, abdominal pain) and duration of the disease.

It is important to note that neither in adults nor in children is there a correlation between the level of lactase activity and the severity of clinical symptoms. With the same degree of enzyme deficiency, there is great variability in symptoms (including diarrhea, flatulence and abdominal pain). However, in each individual patient there is a dose-dependent effect on the amount of lactose in the diet: an increase in lactose load leads to more pronounced clinical manifestations.

The diagnosis of lactose intolerance is usually made on the basis of a characteristic clinical picture and, if necessary, confirmed by additional examination methods. Unfortunately, many of existing methods diagnostics of FN are provocative in nature, which limits the possibilities of their use against the backdrop of a clear clinical picture. However, in most cases, the picture of the disease itself is sufficiently indicative for making a diagnosis.

As an auxiliary measure, the so-called dietary diagnosis is usually used, the essence of which is to reduce dyspeptic symptoms when switching to a lactose-free diet, as well as determining stool pH (normally 5.5 and above), which decreases with LN.

The determination of total carbohydrate content in feces reflects the body's ability to metabolize carbohydrates. Without additional chromatographic research, the method does not allow differentiation different kinds disaccharidase deficiency, however, together with clinical data, it can be considered quite adequate for screening and monitoring the correctness of diet selection. The advantage of the method is its low cost and availability. A limitation of the method is the fact that during the study, the patient must receive an adequate amount of lactose with food, otherwise the test result may be false negative.

In infancy, the carbohydrate content in feces should not exceed 0.25 g%, and in children over a year old they are normally absent. The normal lactose content in feces is 0.07 g% in children under 1 year of age, and in children over 1 year of age and adults it is absent.

Determining the content of hydrogen, methane or 14C-labeled CO2 in exhaled air makes it possible to identify the activity of microflora in lactose fermentation. It is advisable to determine the concentration of gases after a dosed load of regular or labeled lactose.

The diagnostic criterion is an increase in hydrogen in the exhaled air after a load of lactose (1 g/kg body weight, but not more than 50 g) by 20 ppm (parts per million). The method is widely used to diagnose LI in adults and older children. In children under 3 months without clinical signs of lactase deficiency, the hydrogen content in exhaled air corresponds to that in adults with lactose deficiency. Therefore, at this age, the diagnostic criteria should be different, and at present they have not yet been developed. The method has its limitations: the high cost of equipment, the need to administer lactose.

Glycemic load test with lactose has been widely used for many years. The level of glycemia recorded before and after lactose loading reflects the overall result of the breakdown and absorption of lactose in the small intestine. The nature of the glycemic curve is influenced by the level of insulin and the degree of its increase when the concentration of glucose in the blood rises. This circumstance should be taken into account in children with impaired glucose tolerance. In addition, lactose loading can trigger the development or intensify existing clinical symptoms of lactose intolerance.

Normally, within 60 minutes after taking lactose (1 g/kg body weight, but not more than 50 g), the blood glucose level should increase by at least 20% of the original (approximately 1 mmol/l). Typically, blood glucose levels are determined on an empty stomach and 15, 30 and 60 minutes after exercise. This test It is recommended to precede the test with a standard glucose tolerance test. It is rational to combine a lactose load with determination of carbohydrate content in feces.

Determination of lactase activity in biopsies of the small intestinal mucosa is the “gold standard” for diagnosing LN, but the invasiveness, complexity and high cost of the method limit its use in everyday practice. The results obtained are also influenced by the location of the biopsy sample (from the duodenum or jejunum). In secondary lactase deficiency, a decrease in enzyme activity has varying degrees expression on the surface of the mucous membrane, as a result of which it is necessary to take several samples.

Finally, expensive genetic testing is possible. Primary lactase deficiency of the adult type is characterized by the presence of the C/T-13910 and C/T-22018 genes located on chromosome 2q21.

It is important that endoscopic and morphological examination of the mucous membrane of the small intestine does not provide information regarding LN, since it does not have specific endoscopic and morphological markers.

The basis of the treatment of LN is to reduce the amount of lactose in food, up to its complete elimination or the use of lactase preparations.

With primary LN, the amount of lactose in the diet is reduced, up to its complete elimination. In parallel with this, therapy is carried out aimed at correcting intestinal dysbiosis and other symptomatic treatment.

In secondary LN, the focus should be on treating the underlying disease, and reducing the amount of lactose in the diet should be considered a temporary measure until the small intestinal mucosa is restored.

You can reduce the amount of lactose in your diet by reducing or completely eliminating the consumption of lactose-containing products, primarily whole milk (Table 1). This method is quite acceptable for adults and older children with adult-type LI. It can also be used for secondary lactase deficiency. The use of fermented milk products, butter, and hard cheeses is allowed. In this case, one should take into account the possible decrease in calcium intake with a dairy-free diet.

In infancy, the problem of correcting the diet for LI becomes more complex. If the child is breastfed, then reducing the amount of breast milk in the diet is undesirable. In this case the best option is the use of lactase preparations (Natures Way, Schwarz Pharma Kremers Urban, Ecomarket), which are mixed with expressed breast milk and break down lactose without affecting the other properties of breast milk. If it is impossible to use lactase preparations, the issue of using low-lactose mixtures is resolved ( table 2).

Formula-fed babies should choose a formula with the maximum amount of lactose, not causing the appearance clinical symptoms and increased carbohydrates in feces. If the child’s condition is not disturbed, there is no toxicosis with exicosis and the increase in carbohydrates in feces is 0.3–0.6%, then you can start with a diet containing up to 2/3 of carbohydrates in the form of lactose. This ratio can be achieved by combining the usual adapted mixture with a low-lactose or lactose-free one (Mamex lactose-free, Nan lactose-free, Frisosa, Soya Samp) or by prescribing a fermented milk mixture. If two mixtures are used, they must be distributed evenly throughout the day (for example, at each feeding 40 ml of a low-lactose mixture and 80 ml of a standard one). After changing the diet, you should check the carbohydrate content in the stool after 1 week and decide whether it is necessary to further reduce the amount of lactose.

In case of severe lactase deficiency, no effect in case of reducing the amount of lactose by half, in case of primary LN, it is recommended to use low-lactose mixtures (Nutrilon low-lactose, Nutrilak low-lactose, Humana-LP) as the main food product.

Chemical composition And energy value low-lactose and lactose-free milk formulas (per 100 ml of mixture). Table 2.

In advanced cases, as well as in secondary LI on the background of polyvalent food allergies, in premature infants with an unclear cause of lactase deficiency and impaired food tolerance, in children with severe malabsorption syndrome, diet correction should begin with mixtures based on partial or complete protein hydrolyzate (Nutrilon Pepti TSC, Alfare, Nutramigen, Alimentum, etc.) until the main cause of the disease is eliminated. The diet can then be expanded, gradually increasing the lactose load to 1/3, then to half, and so on, monitoring the level of carbohydrate excretion weekly.

In any case, a child with lactase deficiency should monitor the carbohydrate content in the stool and, if symptoms return, reduce the amount of lactose, and if a tendency to constipation appears (which happens quite often, because with proper therapeutic tactics lactose tolerance increases over time) the amount of lactose should be increased. Thus, for the majority of premature infants with transient lactase deficiency, a return to a milk diet is possible by 3–4 months.

In breastfed children, in the absence of lactase preparations, similar tactics are used. In this case, part of the breast milk can be replaced with a low-lactose formula. The maximum amount of breast milk is preserved, not causing symptoms intolerance.

Complementary feeding dishes (porridge, vegetable purees) children of the first year of life with lactase deficiency are prepared not with milk, but with a low- or lactose-free product that the child receives. Fruit juices are introduced into the diet of such children later, as a rule, in the second half of life. Fruit purees, industrially produced cereals and juices (“Nutritsia”, Holland; “Samper”, Sweden; “Gerber”, USA; “Humana”, Germany) are prescribed from 3-4 months of age.

In children over 1 year of age and adults with lactase deficiency, it is advisable to replace milk and dairy products with specialized low-lactose dairy products: low-lactose milk, cream, sour cream, etc. in quantities determined by age-related needs. These patients usually tolerate fermented milk products (kefir, yogurt) well. Condensed and concentrated milk, confectionery products with milk fillings (buttercream, caramel, milk candies), as well as dosage forms(including biological products) that contain lactose. In the absence of low-lactose milk, it is recommended for children over one year of age and adults to use lactase preparations when consuming milk and dairy products.

With secondary hypolactasia, symptoms of FN are transient. Patients, along with treatment of the underlying disease, are prescribed a low-lactose diet in accordance with the principles outlined above. When the normal structure and function of the small intestinal mucosa are restored, lactase activity is restored. Therefore, when the underlying disease resolves (reaches remission) after 1–3 months, the diet should be gradually expanded by introducing lactose-containing dairy products, under the control of clinical symptoms (diarrhea, flatulence) and excretion of carbohydrates in feces. If the symptoms of lactose intolerance persist, one should think about the presence of primary (constitutional) LI in the patient.

In case of primary (constitutional) LI, a low-lactose diet is prescribed for life. However, as mentioned above, most people with this type of lactose intolerance do not consult a doctor because they do not consume dairy products (they say that they “don’t like them”).

Various types of lactose intolerance are widespread among the world's population, but only a relatively small proportion of people with lactose intolerance require serious intervention from a doctor. The clinical picture of LN is quite characteristic and makes it easy to make a diagnosis, and a wide selection of low-lactose products makes it possible to effectively correct the condition, primarily in children in the first year of life.