Lactase deficiency in infants: symptoms and treatment, diet. lactase deficiency

A couple of decades ago, young mothers enthusiastically ran to the dairy kitchen, and no one knew about terrible words like "", "lactose intolerance" and "lactase deficiency". Today they fly off the tongue of every second mother and rustle through the corridors of children's clinics, terrifying others. What is the meaning of the concept of "lactase deficiency in infants" and how terrible is this diagnosis? Let's figure it out together.

Recently, the question of lactase deficiency has been raised more and more often.

Where does it all start

Probably not everyone knows what lactose is. Lactose is the sugar found in breast milk in mammals. The more it is present in milk, the more intelligence (mind) this biological species has. The person has highest degree saturation of milk with lactose.

Mother's milk has a beneficial effect on the development of the baby.

Sugar has a great influence on the development of the brain and contributes to the production of energy (mainly motor). In the baby's intestines, large molecules of lactose are exposed to an enzyme with the similar name "lactase". Lactose is broken down by lactase into 2 smaller and more digestible molecules. The first - glucose - is just spent on energy production, the second - galactose - is involved in the development of the central nervous system.

The lack of lactase affects the quality of life of the baby.

If the activity of lactase (a splitting enzyme) is small or absent at all, then milk sugar is eaten by the bacteria of the small and large intestines, as a result of which the protozoa multiply rapidly. At the same time, the stool of the baby becomes liquid. The baby often and strongly swells the tummy. Gas formation is accompanied by pain in the stomach and intestines. The condition when the enzyme lactase refuses to work is called in science "lactase deficiency". Ordinary people sometimes say not "lactase", but "lactose deficiency". This is not entirely correct, since lactose in this case is just in abundance.

The question arises for some young parents: "" A well-designed schedule will allow mothers to find free time for household chores and recreation.

There is still debate on the topic of "whether to give a newborn to drink water." The most different opinions about this question.

Deficiency is dangerous

Lactase deficiency is a pretty serious thing, here's why:

• slows down the baby's weight gain;
• interferes with the full absorption of lactose (sugar);
• the ability to absorb and digest other useful and nutritious substances available in mother's milk is reduced.

Is it worth describing the consequences of such pathologies?

Why activity is declining

What are the causes of low lactase activity in the small intestine of a toddler?

Lactase deficiency can be:

1. congenital as a result genetic disease(extremely rare);
2. observed in premature babies due to the immaturity of the intestine itself;

Premature babies may be susceptible to this diagnosis.

1. progressive (adult type) - manifests itself somewhere by the 12th month of a baby's life and gains momentum throughout growing up and throughout subsequent life.

In this case, the cells of the small intestine remain intact, and the activity of the lactase enzyme is very low or zero. Such insufficiency is called primary.

Secondary lactase deficiency occurs due to damage to lactase-producing cells due to an intestinal infection suffered by the baby, an allergy to the protein contained in cow's milk, due to any chronic sore or inflammation of the intestine. Parents encounter secondary LN much more often than primary or imaginary ones.

Carefully monitor the condition of the baby after suffering from intestinal diseases.

Imaginary lactase deficiency can occur with improper breastfeeding. A baby with sufficient lactase production suffers from symptoms of lactase deficiency due to excessive production of mother's milk.

The baby sucks out only the foremilk, saturated with lactose, without getting to the rear, more fatty (fats play an important role in the digestion of crumbs). Foremilk is digested quickly and produces the same symptoms as true lactase deficiency.

Manifestations of the disease

What are the symptoms of lactase deficiency?

• Bloating and increased gas formation in the baby's tummy.
• The child behaves restlessly during and after feeding.

The whims of a child when feeding is an unkind sign.

• The baby is losing weight or gaining it disproportionately and poorly.
• Feces excreted by the baby have a sharp sour smell, liquid (or too thick) consistency and foamy structure. Defecation can be very frequent (more than 10-12 times a day) or absent for several days (typical for infants who eat mixtures).
• The baby is often and plentifully.

note

Signs of lactase deficiency are difficult to miss:

• The baby refuses the breast or throws it during feeding.
• When feeding, rumbling and gurgling in the stomach is heard.

Problems with a chair in a child should alert mom.

• He cries and presses his legs to his tummy, randomly jerking them.
• In the feces, there are lumps or lumps of undigested milk. The chair is usually with a clear. This is typical for secondary LN.

LN differences

It is rather difficult to suspect primary LN in the first weeks of life because the baby eats his mother's breast or bottle in small portions. It all starts with bloating in the abdomen, later pains appear, and behind them - problems with defecation.

It is difficult to detect lactase deficiency in the first weeks of life.

With imaginary LN, the baby eats well and gains weight, but suffers from pain in the tummy. Stool greenish and sour smelling. At the same time, the mother’s milk leaks between feedings.

Dear mothers, it is impossible to say that your child has lactase deficiency, based on the signs and symptoms listed above, since many of them fit perfectly into the clinical picture of many other sores. Only a special analysis can show the presence of LN.

Diagnostic methods

Today, there are several ways to determine the presence or absence of LN:

1. The hydrogen test is carried out as follows: the baby is given lactose and they look at the numbers of hydrogen released after taking milk sugar on the exhale. Based on the readings, the LN is determined. The procedure gives the baby a mass discomfort from ingested lactose. It is useless for children under 3 months to do this procedure, since the hydrogen content standards for them have not been established.
2. Biopsy (extraction of a small piece of tissue) of the small intestine. The analysis is painful. Must be done under anesthesia. It is very rarely given.
3. The most common, but not too effective method- taking a fecal analysis for carbohydrates. The limits for the content of carbohydrates in the faeces of carbohydrates are not clearly defined, and many experts now advocate delimiting the standards by months for children in the first year of life. Another minus this method: it does not show the presence of a certain type of carbohydrate, which is important in diagnosing LN.

Fecal analysis is the most painless method, but a 100% result is not guaranteed.

1. Within an hour after taking (on an empty stomach) lactose, the baby takes blood several times. Based on the indicators of blood components, a curved line is constructed depicting sugar fluctuations. This method is called the lactose curve.

The lactose curve will clearly show the presence of sugar in the baby's body.

1. An analysis based on the determination of the acidity of the child's stool. It's called a coprogram. This diagnosis is carried out at the choice and recommendation of a doctor in combination with other described research methods. The acidity rate is 5.5 pH. If the stool shows that the acid content in it is more than normal (the lower the pH numbers, the greater the acidity), then this clear sign LN.

- this is a real event for mom. However, there is no specific time when the baby should smile. It all depends on the individual characteristics of the crumbs.

We fight for peace

There is a disease, there are ways to detect it - so there is a treatment. What is it, what are the features?

Nuances 2:

• LN type.
• The type of baby's nutrition (GV or IV).

Depending on the severity of these factors, based on the tests and the clinical picture, the doctor prescribes treatment. In acute primary LN, the baby is prescribed nutrition with lactose-free mixtures: Nutrilak, Nutrilon, Nan, Enfamil Laktofri, Humana. But blends are a last resort.

In general, experts recommend keeping breastfeeding through proper organization the process of breastfeeding. In addition, a nursing mother must follow a certain diet. The diet is based on the exclusion of whole cow's milk from the diet. You can replace it with goat's milk.

Mom will have to endure a strict diet.

In rare cases, you have to give up beef, butter and all kinds of pastries. If the situation is very acute, then you will have to give up all dairy products. best way out will follow the usual diet of a breastfeeding mother, unless otherwise recommended by the doctor.

Add an enzyme to milk, and the child's condition will improve.

With secondary LN, getting rid of dysbacteriosis can be added to the methods of treatment described above. “Dysbacteriosis is treated with drugs such as and / or. They contain lactose in their composition, so they cannot be treated, ”warns E. Komarovsky.

Early feeding

Complementary foods with LN should be introduced, but a little earlier than six months. From 4 months we begin to give and, later - juices, followed by cereals on a dairy-free basis.

Babies with LN need complementary foods earlier.

We will not let LN develop

Prevention of LN in infants is the periodic delivery of a fecal analysis for carbohydrates. Also, refusal to take drugs and products containing lactose (an exception may be dairy products).

Pay close attention to the composition of the sweets that your child consumes.

Lactose.

Lactose is the main carbohydrate in human milk, although it also contains small amounts of galactose, fructose and other oligosaccharides. This sugar is found only in milk, and human milk contains the highest concentrations of it (on average 4% in colostrum, rising to 7% in mature milk). Lactose is a specific food in infancy because the lactose enzyme is found only in young mammals. Lactose is inherent in Europeans and some other peoples, but most people do not digest lactose, starting from the middle childhood; therefore, food containing lactose can cause digestive disorders.

Primary lactose intolerance is a rare congenital anomaly (see below). Different degrees of temporary lactose intolerance can occur, leading to various damage to the intestinal bristles and loss of lactose (for example, putrefaction virus, Gardia lamblia, or cow's milk protein intolerance). In the absence of a digesting enzyme, lactose is fermented by intestinal bacteria, resulting in extremely acidic stools, which can itself cause further damage to the intestinal bristles. The child has pain in the abdomen; followed by frequent, frothy, loose stools; and in extreme cases, the child may stop developing or become dehydrated. Only in rare cases is it necessary to temporarily stop breastfeeding; in fact, breast-feeding one must almost always continue, and even intensify during diarrhea. Recently, another type of relative lactose intolerance has been identified that can be cured by a simple change in the usual way of breastfeeding. The mother may find that she has an irritable, unbalanced, "colic" child with loose and frequent stools, frequent urination and spitting up, but otherwise develops; he can gain mass well or badly. It is hypothesized that when a mother, who usually has more than enough milk, does not give her baby enough time to suckle the first breast, but instead switches to another breast some time later, the baby may be fed a diet that is too high in lactose and low in fat.

Lactose intolerance sometimes disappears after 24 hours if a mother lets her baby "finish" the first breast before offering the second, in case the baby is not full. After a day or two, single-breastfeeding choices will be deficient, and the baby will need to be fed with both breasts every feed, showing no signs of lactose intolerance. This theory is supported by the observation that many of these unsatisfied children have above average levels of hydrogen respiration.

Despite the obvious importance of lactose for normal children, not all substitutes breast milk contain this carbohydrate. This is understandable in the case of mixtures intended for use in the short-term treatment of children with lactose intolerance. The immediate and long-term effects of using lactose-free substitutes to feed healthy babies from birth are not known. The role of other human milk oligosaccharides has also not been fully elucidated, although they make up 25% of colostrum, and at least one of them, a carbohydrate known as the bifidus factor, prevents colonization by pathogenic microbes.

Galactosemia.

There are two main forms of this disease; one is characterized by a deficiency of galactokinase, which is an enzyme needed to break down galactose, a component of lactose. If children suffering from this disease are fed milk or any lactose-containing drug, the level of galactose in their blood increases, sugar appears in the urine, and clinically they lead to cataracts.

Another form of this disease is even more serious. It is caused by a deficiency of another enzyme, galactose-1-phosphate-uridyltransferase, which is needed later in the metabolism of galactose. As a result, the metabolite accumulating in the blood leads to even greater disorders than in the first form of this disease. Symptoms in a child include diarrhea, vomiting, an enlarged liver, jaundice, and an enlarged spleen. If lactose is not eliminated from the diet, it will lead to cataracts, cirrhosis of the liver and mental retardation.

If there are reasons to suspect the presence of galactosemia, it is necessary to clarify the diagnosis by taking laboratory tests, either in utero or immediately after birth. Since lactose must be eliminated from the diet of children with both forms of the disease, they should not be fed either human or other milk, including conventional breast milk substitutes. Specially formulated formulas based on milk, but without lactose, or mixtures based on soy are required. Some babies have thrived on lactose-hydrolysed human milk. Fortunately, this disease is rare; data are available only for industrial developed countries, where its frequency varies from 1 in 20,000 to 1 in 200,000 children (0.5-5 per 100,000 people).

lactase deficiency(lactose intolerance) is a condition that is characterized by the inability of the body of a child or adult to digest milk sugar (lactose) due to insufficient production of the enzyme lactase in the intestine.

Causes of lactase deficiency in children

Physiological (normal) lactase deficiency

In most children over 6-7 years old, adolescents and adults, lactase deficiency is a consequence of the body growing up and is considered a completely normal, physiological phenomenon.

A natural and gradual decrease in the production of lactase in the intestines of a child begins by the end of the first year of life. By the age of 6, lactase levels may drop so much that the child can no longer digest large amounts of milk normally.

This is a genetically programmed process.

However, in some cases it is sufficient high level lactase production in the intestine persists even in adults. Scientists explain this fact by the fact that in ancient times, due to the development of animal husbandry, people gained access to animal milk, which became part of the diet of adults. This fact influenced the evolution of human ability to digest milk and made some people able to produce lactase even as adults.

Congenital and acquired lactase deficiency

A much greater problem than the physiological decrease in lactase activity in adults is early lactase deficiency in newborns and children in the first months of life, for whom milk is the main food.

Lactose intolerance in children early age may be due to the following reasons.

Congenital (primary) lactase deficiency- characterized by a complete inability of the intestines of a newborn child to produce lactase. According to special literature, carbohydrate metabolism diseases associated with changes in the activity of enzymes that break down sugars, including lactose, are extremely rare in the population. The frequency of such diseases varies from 1 in 20,000 to 1 in 200,000 children. As a rule, congenital lactase deficiency develops due to a mutation in the genes responsible for the production of lactase. In this regard, in children under 2 - 3 years of age, any symptoms that are usually "attributed" to lactase deficiency, with a high degree of probability, may be symptoms of some other disease.

transient lactase deficiency- this is a temporary inability to produce lactase in sufficient quantity / with a sufficient degree of activity, characteristic of preterm or immature newborns and associated with the unpreparedness of their intestines for the process of digesting food. Typically, within a few months after birth, the intestines premature baby develops the ability to produce lactase in sufficient quantities, and the child begins to absorb breast milk or milk formulas well.

Acquired (secondary, temporary) lactase deficiency- occurs quite often and, as a rule, is a consequence various diseases intestines (intestinal infection, allergic processes in the intestines, celiac disease, etc.), which disrupt the ability of the small intestine to produce lactase and digest food efficiently.

Acquired lactase deficiency is a temporary phenomenon. After eliminating the diseases that caused lactase deficiency, the ability of the intestine to produce lactase is restored and lactase deficiency completely disappears.

"Overload" with lactose. This is a condition similar to transient lactase deficiency, which can be corrected by changing the organization of breastfeeding. The amount of lactose in breast milk is about the same throughout the feeding, but the amount of fat that the baby receives at the beginning and at the end of feeding is different. The fat content gradually increases from the beginning to the end of each feeding, the greater the difference, the more time has passed since the previous feeding, the greater the mother’s breast capacity, the less baby sucked in the previous feeding. Thus, in the beginning, the child sucks out a more watery white or slightly yellowish color. The lighter foremilk moves rapidly through the gastrointestinal tract, and most of the lactose can enter the large intestine before it can be broken down by the lactase enzyme. There, lactose causes fermentation, gas formation, and frequent sour stools. In small quantities, unsplit lactose in any case enters the large intestine and this is the norm for a child on breastfeeding, but when the child systematically receives only forward milk that passes quickly through the gastrointestinal tract (for example, due to limited feeding time, too frequent breast changes, too long breaks in feeding) and does not get back, there are signs of lactase deficiency.

Thus, in the vast majority of cases, lactase deficiency in children of the first years of life is not an independent disease, but only a consequence of other diseases or errors in the organization of nutrition. In this regard, the diagnosis of lactase deficiency established in a child under 2-3 years of age can almost never be considered a complete explanation of his condition. In all cases when a child is diagnosed with lactase deficiency, it is necessary to establish the cause that has disrupted the ability of the intestine to digest milk sugar, since only the elimination of this cause will help to effectively solve the problem.

Today in Russia, the diagnosis of "lactase deficiency" is made to a lot of babies. Naturally, if all these children really suffered from such a serious disease, accompanied by weight loss, the person would simply die out as a species. Very often, lactase deficiency is confused with an allergy to cow's milk protein (CMP). The symptoms are similar, and CMP is a very strong and common allergen.

Symptoms and signs of lactase deficiency in newborns and children of the first years of life

The problem of correctly assessing the symptoms and signs of lactase deficiency in young children is of great importance, since in most cases the diagnosis and initiation of treatment are entirely based on determining the likely signs of impaired milk absorption in the intestine.

The main signs of lactase deficiency include:

Developmental delay of the child (slow and insufficient increase in weight and height).

Very frequent watery stools in a child, possibly with greenery, frothy, combined with a developmental delay.

False constipation: prolonged absence of stools, frequent ineffectual urge to defecate - and loose stools, or alternating constipation and diarrhea.

Severe persistent gas formation, bloating a few minutes after the start of feeding or later.

IMPORTANT! Not episodic moments of anxiety (“I feed calmly in the morning and at night, and in the evening it starts to cry, tighten my legs, writhe”), but a reaction to every full meal (milk or mixture) containing lactose.

In children with lactase deficiency, other pathological processes may occur. Often lactase deficiency is accompanied by anemia or allergic skin rashes. This is due to the fact that lactase deficiency can provoke a deterioration in food absorption, an increase in the permeability of the intestinal wall, etc.

Symptoms that are NOT in themselves signs of lactase deficiency

Colic and bloating - can occur in many healthy children and are considered completely normal up to 6 months of age. Therefore, only because of the presence of colic in a child during the first months of life, it cannot be said that he suffers from lactase deficiency.

Regurgitation (rare and not very abundant) - like colic, is considered a completely normal phenomenon (up to the age of 8-10 months) that does not require any treatment. Only very frequent and profuse regurgitation should cause concern, especially if they lead to malnutrition and development of the child.

Regurgitation cannot be considered a direct symptom of lactase deficiency, since the main cause of their occurrence is a malfunction of the valve that blocks the transition from the esophagus to the stomach, and with lactase deficiency, as mentioned above, there is a violation of the digestion of milk sugar in the small intestine.

Frequent loose stools in children of the first months of life, provided that the child looks happy and healthy, in no case can be considered a sign of lactase deficiency.

During the first year of life, stools MUST BE:

frequent (in the first month up to 10 times a day or more),
liquid,
With a small amount slime,
with white lumps of undigested milk,
greenish stool color should also be considered perfectly normal.

Such a chair baby is not diarrhea!

The infrequent appearance of a stool (once every few days) is considered by many parents as a clear sign of constipation and leads them to take measures to "stimulate the appearance of a stool." These actions are in most cases unreasonable and can even harm the child.

Even if a baby older than 6 weeks on exclusive breastfeeding has only one stool per week, this should not be considered constipation, as long as the stool remains soft and the baby feels good and develops normally. Such a delay in stool cannot be considered a sign of lactase deficiency.

Anxiety of the child from the first minutes of feeding - in no case can be a sign of lactase deficiency. With lactase deficiency, the digestion of milk in the intestines is impaired. Milk enters the intestines at least 15-30 minutes after the start of feeding, and the stomach and esophagus of the child (which may be associated with crying and anxiety during feeding) with lactase deficiency work completely normally.

Methods for addressing the causes of temporary lactase deficiency or lactose overload

1) You can not express after feeding (especially if this is combined with limiting the time the baby stays at the breast), because. in this case, the mother pours out or freezes the hind milk, and the child, breast sucker, milk with a low fat content is obtained, which can provoke the development of signs of LN.

2) (usually it takes at least 15-20 minutes for a child of the first months of life), otherwise the child will receive a lot of foremilk and, not having time to suck out the hindmilk, will again switch to foremilk from the second breast.

3) If there is a lot of milk, the baby sucked the breast for a very short time and the mother feels that it is still quite full, and the baby no longer wants to eat, then in next feeding it is better to offer the same breast. General rule in case of excess milk: change the breast no more than once every 2-3 hours. Most likely, after a few days of such a regimen, the amount of milk will decrease, while the child will no longer show any signs of LN.

If the baby has symptoms similar to LN, it is possible that reducing the breast rotation (every 3 hours or even less often) in order to reduce the total volume of milk will lead to a decrease in the manifestation of symptoms.

4) Do not try to maintain certain intervals between feedings. It is better to feed more often, since the longer the break, the stronger the stratification of milk.

5) It is also necessary to monitor (best of all, a consultant on breastfeeding will tell you about this at an in-person consultation), and also make sure that the child does not just suck, but also swallows. In which case is it possible to suspect improper application? In case you have nipple abrasions and/or breastfeeding is painful, or you hear smacking, clicking and similar extraneous sounds while suckling. Also, feeding through pads often leads to improper grip and inefficient sucking.

6) Night feedings are very desirable: in a sleepy state, the child is relaxed, not distracted, sucks the breast longer and more “qualityally”, therefore, it empties it better.

7) It is undesirable to take the baby from the breast before he is full, let him suckle for as long as he wants (especially in the first 3-4 months).

If all this does not help, it may really be lactose intolerance, and not a similar condition that can be corrected with proper feeding, or other problems with similar symptoms.

What else can be done?

II. . Most often we are talking about cow's milk protein. If CMP is an allergen for a child (and this happens quite often), allergic inflammation can occur in the intestines, which, in turn, can lead to insufficient breakdown of lactose and lactase deficiency. Exit - exclude from the mother's diet whole milk. You may also need to eliminate all dairy products, including butter, cottage cheese, cheese, sour-milk products, as well as beef and anything cooked with butter (including pastries). Another protein (not necessarily cow's milk) may also be an allergen.

The most common food allergies include: cow's milk, chicken eggs and meat, soy, wheat, seafood, nuts. When it is possible to identify and eliminate allergens, the activity of the child's intestines improves and the symptoms of LN stop. The effect of a restrictive diet should be expected no earlier than in 2-3 weeks. With an allergy to cow's milk protein, the effect of eliminating the product may occur only after 3 weeks.

III. Pumping before feeding. If changing breasts less frequently and eliminating allergens is not enough, you can try some foremilk BEFORE feeding. This milk is not given to the child, and the child is applied to the breast when more fatty milk comes. However, this method must be used with caution so as not to start hyperlactation. The best way to use this method is to enlist the support of a breastfeeding consultant.

If all this does not help, and signs of lactase deficiency persist, you should consult a doctor!

Melnikova R., consultant on GW

Edited by Wolfson S., pediatrician

Sources

1. M., W. Sears. "Breast-feeding"

2. Website about lactase deficiency http://lactase.ru/

3. Scientifically based explanation of medical problems and questions http://www.sitemedical.ru/content/%D0%9F%D0%BE%D0%B4%D1%80%D0%BE%D0%B1%D0%BD% D0%BE%D0%B5-%D0%BE%D0%B1%D1%8A%D1%8F%D1%81%D0%BD%D0%B5%D0%BD%D0%B8%D0%B5-% D0%BB%D0%B0%D0%BA%D1%82%D0%B0%D0%B7%D0%BD%D0%BE%D0%B9-%D0%BD%D0%B5%D0%B4%D0 %BE%D1%81%D1%82%D0%B0%D1%82%D0%BE%D1%87%D0%BD%D0%BE%D1%81%D1%82%D0%B8-%D1% 83-%D0%B4%D0%B5%D1%82%D0%B5%D0%B9-%D0%B8-%D0%B2%D0%B7%D1%80%D0%BE%D1%81%D0 %BB%D1%8B%D1%85-%D0%BF%D1%80%D0%B8%D1%87%D0%B8%D0%BD%D1%8B-%D0%B2%D0%BE%D0 %B7%D0%BD%D0%B8%D0%BA%D0%BD%D0%BE%D0%B2%D0%B5%D0%BD%D0%B8%D1%8F-%D1%81%D0% B8%D0%BC%D0%BF

4. M. Sorokina, GW consultant, member of AKEV. "Lactase deficiency" http://www.akev.ru/content/view/475/31/

5. N. Gerbeda-Wilson, Leader of the La Leche League. "Lactase deficiency? Do not treat tests!"
http://www.llli.org/Russian/lactoseintolerance.html

6. L. Kazakova, pediatrician, consultant on breastfeeding "Favorite diseases of a healthy newborn" http://akev.ru/content/view/47/52/

7. D. Newman "Colic in infants" http://breastfeeding.narod.ru/newman/colic.html

8. Technique for proper breastfeeding http://breastfeeding.narod.ru/latch.html

The concept of lactase deficiency is inextricably linked with general information about lactose as a component of breast milk, the transformations that it undergoes in the child's body and its role for proper growth and development.

What is lactose and its role in the nutrition of a child

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

Lactase deficiency in infants and its types

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

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

Clinical symptoms

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

• frequent (8-10 times a day) liquid, frothy stools that form on gauze diaper large water spot with a sour smell. It should be taken into account that on disposable diaper a water stain can be overlooked due to its high absorbency;
• bloating and rumbling (flatulence), colic;
• detection of carbohydrates in feces (over 0.25 g%);
• acid reaction of 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 malnutrition (protein-energy deficiency), which is expressed in poor weight gain, is possible.

The intensity of the manifestation of symptoms will depend on the degree of decrease in enzyme activity, the amount of lactose supplied with food, the characteristics of the intestinal microflora and its pain sensitivity to stretching under the influence of gases. The most common is secondary lactase deficiency, the symptoms of which begin to manifest themselves especially strongly by the 3-6th week of a child's life as a result of an increase in the amount of milk or mixture that the child eats. As a rule, lactase deficiency occurs more often in children suffering from hypoxia during prenatal state, or if next of kin have symptoms in adulthood. Sometimes there is a so-called "locking" form of lactase deficiency, when in the presence of liquid feces there is no independent stool. Most often, by the time of the introduction of complementary foods (5-6 months), all symptoms of secondary lactase deficiency disappear.

Sometimes symptoms of lactase deficiency can be found in children of "dairy" mothers. A large volume of milk leads to less frequent breastfeeding and receiving mainly "forward" milk, especially rich in lactose, which leads to an overload of it in the body and the appearance characteristic symptoms with no reduction in weight gain.

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

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

Dr. Komarovsky about lactase deficiency video

Tests for lactose intolerance

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

None of the currently existing diagnostic methods allows, in the case of its only use, to give an accurate diagnosis. Only a comprehensive diagnosis, combined with the presence of a complete picture of the symptoms of lactase deficiency, will give a correct diagnosis. Also, an indicator of the correctness of the diagnosis is the rapid improvement in the child's condition during the first days of treatment.

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

Treatment with breastfeeding

In fact, the treatment of lactase deficiency in this case can be carried out in two stages.

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

Natural regulation of lactose intake

Symptoms of lactase deficiency are quite common in healthy children and are not at all associated with insufficient activity of the lactase enzyme, but are due to improperly organized breastfeeding, when the child sucks out 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 means in this case:

• lack of pumping after feeding, especially with an excess of breast milk;
• feeding with one breast until it is completely empty, possibly using the breast compression method;
• frequent feeding with the same breast;
• correct grip on the breast by the child;
• night breastfeeding for more milk production;
• in the first 3-4 months, it is undesirable to tear the child from the breast until the end of her sucking.

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

It is also helpful to try pumping before feeding to prevent excess lactose-rich milk from entering the baby's body. However, it must be remembered that such actions are fraught with the occurrence of hyperlactation.

If symptoms of lactase deficiency persist, you should seek medical advice.

The use of lactase preparations and specialized mixtures.

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

Lactase Baby Lactase Enzyme
Lactazar

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

Treatment with artificial feeding

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

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 to carry out a course of treatment of dysbacteriosis in parallel with the treatment of lactase deficiency. Care should be taken with medications containing lactose as an excipient (Plantex, Bifidumbacterin), as the manifestations of lactase deficiency may worsen.

Important! Attention should be paid to the presence of lactose in medicinal preparations, since the manifestations of lactase deficiency may worsen.

Treatment with the introduction of complementary foods

Complementary foods for lactase deficiency are prepared on the same mixtures (lactose-free or low-lactose) that the child received before. Complementary foods begin with fruit puree of industrial production at 4-4.5 months or a baked apple. Starting from 4.5-5 months, you can begin to introduce or puree from vegetables with coarse fiber (zucchini, cauliflower, carrots, pumpkin) with the addition of vegetable oil. With good tolerability of complementary foods, after two weeks they introduce meat puree. Fruit juices in the diet of children suffering from lactase deficiency are introduced in the second half of life, diluted with water in a ratio of 1:1. Dairy products also begin to be introduced in the second half of the year, using at first 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 also characteristic of other types of carbohydrate intolerance.

1. Congenital insufficiency of sucrase-isomaltase (practically does not occur in Europeans). It manifests itself 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 in the child's diet ( fruit juices, puree, sweetened tea), less often starch and dextrins (cereals, mashed potatoes). As the child matures, the symptoms decrease, which is associated with an increase in the absorption surface area in the intestine. A decrease in the activity of sucrase-isomaltase can occur with any damage to the intestinal mucosa (giardiasis, cliac disease, infectious enteritis) and cause secondary enzyme deficiency, which is not as dangerous as the primary (congenital).
2. Starch intolerance. It can be observed in premature babies and children of the first half of the year. Therefore, starch should be avoided in mixtures for such children.
3. Congenital malabsorption of glucose-galactose. It is manifested by severe diarrhea and dehydration at the first feeding of the newborn.
4. Acquired monosaccharide intolerance. Presents with chronic diarrhea physical development. May accompany severe intestinal infections, celiac disease, intolerance to cow's milk proteins, malnutrition. Characterized by a low pH in feces and a high concentration of glucose and galactose in it. Acquired monosaccharide intolerance is temporary.

In contact with

Lactase deficiency, or hypolactasia, is a very common phenomenon among both infants and adults. This pathological condition forces breastfeeding mothers to stop breastfeeding ahead of schedule, transferring the child to artificial nutrition, which cannot but affect his health in the future. However, as practice shows, the “fashionable” diagnosis today “lactase deficiency” often has nothing to do with true milk intolerance, but is a common food allergy of a newborn to the mother’s diet or complementary foods. Knowing the causes, symptoms, tests, and treatment of true hypolactasia is important to avoid treating the underlying disease.

Lactose and lactase: why they should not be confused

Often on the Internet you can find the fundamentally wrong term "lactose deficiency". 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 the cells of the mucous membrane of the small intestine and is involved in the breakdown of lactose.

Hypolactasia: its types and causes

A decrease in lactase activity (and sometimes a complete absence of this enzyme) is called hypolactasia or lactase deficiency (LN). This condition entails the inability to properly digest milk sugar, which serves as a breeding ground for the reproduction of various microorganisms. Bacteria provoke strong gas formation, stool disorders, colic and many other problems.

Lactase deficiency is divided into two types.

Primary lactase deficiency

It implies low activity of lactase or its complete absence without damage to enterocytes - intestinal epithelial cells. Such hypolactasia happens:

• congenital (genetic anomaly);
• transient (temporary intolerance to breast milk, characteristic of premature babies);
• hypolactasia of the adult type (about 18% of adult Russians suffer from LN).

Secondary lactase deficiency

In this case, lactase deficiency is caused by damage to enterocytes. It occurs much more often than primary hypolactasia and is provoked by diseases such as:

• allergy to cow's milk protein;
• intestinal infection;
• intestinal inflammation;
• atrophic changes after prolonged tube feeding or with celiac disease (intolerance to the cereal protein gluten).

Lactose overload

In addition to these two types, there is a condition similar to the signs of hypolactasia - lactose overload. At the same time, the necessary enzyme is produced in the intestines of the baby in sufficient quantities, but due to the large volume of the "front reservoir" in the breast between feedings, too much "front" milk with a high content of lactose and other carbohydrates accumulates (more than 130).

Also, as noted by the famous pediatrician E.O. Komarovsky, lactose overload can occur due to the banal overfeeding of a child (details in the video below): this condition does not require treatment, but the correct organization of breastfeeding.

Symptoms of the disease

The following symptoms of lactase deficiency may indicate the disease in question:

1. Bloating.
2. Liquid stools (may be frothy and sour-smelling).
3. Restless behavior of the baby during or after feeding.
4. Poor weight gain or even weight loss (in severe cases of LN).

Sometimes profuse regurgitation is added to the symptoms.

In primary hypolactasia, the first few weeks of a baby's life, LN does not appear at all, then flatulence appears, followed by abdominal pain and liquid feces.

A distinctive feature of secondary hypolactasia is the appearance in the stool a large number mucus, greens and undigested pieces of food.

In the case of an overload with lactose, the child gains weight well, but at the same time he is worried about pain, and the feces can be green and sour.

Hypolactasia or common allergy?

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 improper treatment. Food allergy to breast milk is provoked by the diet of a nursing mother, and its specific pathogens are:

1. Gluten. Even in the absence of celiac disease (gluten protein intolerance) in a child, a nursing mother should limit the intake of gluten-containing products in the first months of lactation.
2. synthetic additives. The diet of a nursing mother should exclude any canned food. Sweets are better to eat white - without dyes.
3. Spices and herbs.
4. Dairy products. Cow or goat milk is markedly different in terms of chemical composition from human. Proteins of cow and goat milk often act as a strong allergen for a newborn.

Instead of treating LN and switching to artificial formulas, it is better for a nursing mother to start by adjusting her diet by excluding milk protein and other food allergens from it.

The first meal should be vegetable puree(zucchini, potatoes, cauliflower). This is the only way to determine the presence or absence of hypolactasia for sure.

Against ordinary infantile colic, dill water will suffice.

Diagnosis of lactase deficiency

There are several different tests that can be used to confirm LN:

1. 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 the newborn.
2. Hydrogen test. Measurement of the amount of hydrogen in the air exhaled by the patient.
3. Lactose curve (blood test).
4. Analysis of feces for carbohydrates. The most popular, but the least reliable method, since there are still no exact instructions with the norms of carbohydrates in feces.
5. Coprogram analysis.

Treatment

It must be remembered that the presence of one or two signs of hypolactasia does not at all mean that the child is sick. Only the combination of all of the above symptoms with a poor analysis can indicate a true 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;
• you can change the breast only after the baby has emptied it completely;
• try to breastfeed with one breast, but more often;
• it is advisable not to skip night feedings;
• it is not recommended to take the baby from the breast if he has not yet had enough;
• correct attachment to the chest.

Refusal of food allergens

Especially dangerous are cow and goat milk proteins, because of which children are allergic to mother's breast milk.

Use of lactose-free foods as complementary foods

Expressing a small portion of milk before feeding

This is the last of the "home" treatments.

Doctor prescribing lactase enzyme

A typical example is the drugs "Lactase Baby" and "Lactazar" in capsules or "Baby Doc" in the form of drops. Usually, the course of using the enzyme is canceled at 3-4 months of the life of the baby, when the production of its own lactase begins in its intestines. Enzymes from drugs are very effective and relatively safe, which is confirmed by many reviews. Care must be taken when purchasing such enzyme supplements, as there have been cases of counterfeiting of the Lactase baby drug.

Treatment of "dysbacteriosis"

It implies the restoration of both the microflora and the very condition 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 Doc" or other drugs with lactase.
Attention moms! In the treatment of dysbacteriosis, the baby may be prescribed drugs such as bifidumbacterin, plantex or analogues. It is important to know that they contain lactose and should not be taken with LN.

Feeding lactase-fermented breast milk, low-lactose or lactose-free formula

It is practiced only in the most extreme and rare cases, when milk intolerance is congenital, and the enzyme deficiency manifests itself extremely strongly (this is observed in one child out of 20 thousand). Such supplementary feeding is usually a temporary measure. Long-term use of lactose-free formulas can cause the baby to completely refuse breast milk. In addition, the long-term effects of artificial feeding in infancy. Of the immediate side effects, the child is threatened with an allergy to soy protein, and soy includes most of these mixtures. Even more common is allergy to cow's or goat's milk protein, the second major component of lactose-free formulas.

As noted by the same E.O. Komarovsky, there is a clear commercial connection between the appearance in the country of low-lactose and lactose-free mixtures 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 unreasonably) recommend that they abandon breastfeeding in favor of artificial nutrition.

Conclusion

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 appointment of lactose-free or low-lactose mixtures is justified only in congenital pronounced LN, which must be confirmed and clinical picture, and "bad" analyses. In other cases, it is enough to wait until the baby’s own lactase “ripens” in the intestines, helping him ferment milk with the help of dietary supplements (“Lactase Baby”, “Baby Doc”, “Lactazar”, “Tylactase”, “Lactraza”, etc.), changing the diet of a nursing mother (during the period of breastfeeding, there are no products containing milk protein and other allergens), taking dill water against colic, proper organization of breastfeeding and proper complementary foods.