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

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 nutrition baby, like any carbohydrate, it is providing 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 immaturity 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 chemical composition ultimately contribute to 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 sour smell. It should be borne in mind that a water stain on a disposable diaper may not be noticeable due to its high absorbency;
• bloating and rumbling (flatulence), colic;
• detection of carbohydrates in feces (over 0.25 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 because of the lack of norms for children. early age.
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 intake of lactose in breast milk and allergens through knowledge of the mechanisms breastfeeding and 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 penetrate 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. Completely transfer the child to artificial feeding not recommended for 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 start with fruit puree industrial production in 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, carrot, pumpkin) with the addition 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 in the child's diet of sucrose (fruit juices, mashed potatoes, 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

Everyone probably knows that breast milk is the most suitable option to feed young children. Due to its balanced composition, it provides harmonious development and growth. Breast milk contains easily digestible protein, calcium and fat-soluble vitamins.

But there is a group of children who have a congenital intolerance even to breast milk. This so-called lactose intolerance of breast milk, the symptoms of the child in this case and the treatment of this condition, we will consider now.

Lactose, in other words milk sugar, is a carbohydrate, the main component of mother's milk. Thanks to him, it has a slightly sweet flavor. Lactose consists of two components, glucose, which supplies energy to the body, and galactose, which is responsible for the proper formation of the baby's nervous system.

The breakdown of lactose into these components occurs with the participation of a special enzyme lactase. For its production, the mucous membrane of the small intestine is needed, or rather its cells - enterocytes. If lactase is not produced enough in the body, lactose ceases to be absorbed normally, regardless of the amount of its intake.

Undigested lactose accumulates in the intestine, which leads to the entry of a large amount of water into its cavity. The child's stool becomes liquid, gas formation also increases. This condition of the body is called lactose intolerance.

In itself, milk sugar intolerance is not a serious and complex disease that requires a special approach to treatment. It manifests itself in infancy and persists for life, without bringing any further inconvenience, with the exclusion of whole milk products from the diet.

Children's lactose intolerance brings quite a lot of inconvenience, since in babies milk is the basis of nutrition. When such a disease is detected in infant treatment should be started immediately.

There are two types of lactose intolerance: primary and secondary.

Primary intolerance suggests a decrease in enzymatic activity against the background of normal whole enterocytes. A congenital disorder in the production of lactase is considered a fairly rare occurrence.

This type of intolerance often develops already by the age of three to five years and belongs to the adult type, since during this period breastfeeding no longer relevant. At the same time, a decrease in lactase production is considered within the physiological norm.

If primary intolerance occurs in infants, then most often it swings premature or insufficiently mature children. Their intestines are not sufficiently developed for adequate lactase production. Over time, the baby's intestines mature, and his work is normalized.

Primary lactose intolerance manifests itself as follows:

Rumbling in the stomach;

Increased gas formation;

Intestinal colic and abdominal pain;

Bloating and loose stools;

Restless behavior and sleep disturbances;

Little weight gain.

It is considered more common secondary lactose intolerance, which is characterized by damage to enterocytes due to intestinal infection, inflammatory process or reaction immune system for cow's milk.

It can also be the result of a food allergy to cow's milk or to foods that a nursing woman ate. In this case, lactose intolerance is a complication of the underlying disease that occurs in the baby's intestines.

Unlike cow's milk, women's milk contains much less lactose. Due to this, even premature babies can have very slight manifestations of intolerance.

Often the diagnosis can be made after observing the general clinical picture. If necessary, additional analyzes are carried out. If the analysis of the child's feces shows lactase deficiency, while not manifesting itself clinically, treatment is not indicated.

Basic approaches to the treatment of lactose intolerance in children:

Proper dietary nutrition with a low amount of lactase;

The use of lactose enzymes that do not affect the quality of breast milk. Most often, the enzyme is artificially added to expressed milk and used to feed the baby. In this case, the dosage should be selected purely individually, focusing on analyzes and schemes;

If it is necessary to establish an artificial or mixed feeding, it is worth choosing mixtures without lactose or with a low content of it.

For the greatest effectiveness of treatment, it should be carried out under constant medical supervision, focusing on the advice of highly qualified specialists. Modern medicine offers many means to help young patients.

1. Lactose overload. This is a condition similar to lactase deficiency, which can be corrected by changing the organization of breastfeeding. At the same time, the enzyme is produced in the baby in sufficient quantities, but the mother has a large volume of the "front reservoir" of the breast, so a lot of lactose-rich "front" milk accumulates between feedings, which leads to similar symptoms.
2. Primary lactase deficiency occurs when the surface cells of the small intestine (enterocytes) are not damaged, but lactase activity is reduced (partial LN, hypolactasia) or completely absent (complete LN, alactasia).
3. Secondary lactase deficiency occurs when the production of lactase is reduced due to damage to the cells that produce it.

Lactose overload more common in "very milky" mothers. Since there is a lot of milk, babies rarely feed, and as a result, at each feeding they receive a lot of "forward" milk, which quickly moves through the intestines and causing symptoms LN.

Primary LN found in the following cases:

• congenital, due to a genetic disease (rarely encountered)
• transient LN in preterm and immature babies at the time of birth
• LN adult type

Congenital LN is extremely rare. Transient LN occurs because the intestines of premature and immature infants have not yet fully matured, so lactase activity is reduced. For example, from the 28th to the 34th week of intrauterine development, lactase activity is 3 or more times lower than at the period of 39-40 weeks. Adult-type LN is quite common. Lactase activity begins to decline at the end of the first year of life and gradually decreases, in some adults decreasing so much that unpleasant sensation occur each time when eating, for example, whole milk (in Russia, up to 18% of the adult population suffer from adult LN).

Secondary LN occurs much more frequently. It usually occurs as a result of some acute or chronic disease, for example, an intestinal infection, an allergic reaction to cow's milk protein, inflammatory processes in the intestines, atrophic changes (with celiac disease - gluten intolerance, after a long period of tube feeding, etc.).

SYMPTOMS

You can suspect lactase deficiency by the following signs:

1. liquid (often frothy, with a sour smell) stools, which can be either frequent (more than 8-10 times a day), or rare or absent without stimulation (this is typical for artificially fed children with LN);
2. child's anxiety during or after feeding;
3. bloating;
4. in severe cases of lactase deficiency, the child gains weight poorly or loses weight.

There are also references in the literature that one of the possible symptoms is profuse regurgitation.

The baby usually has a good appetite, starts sucking greedily, but after a few minutes he cries, throws up his chest, draws his legs to his stomach. Stool frequent, thin, yellow, sour smelling, frothy (reminiscent of yeast dough). If you collect the chair in a glass container and let it stand, then the separation into fractions becomes clearly visible: liquid and denser. It must be borne in mind that when using disposable diapers the liquid part is absorbed into them, and then violations of the stool can be overlooked.

Usually symptoms primary lactase deficiency increases with an increase in the amount of milk consumed. At first, in the first weeks of a newborn's life, there are no signs of disturbances at all, then increased gas formation, even later - abdominal pain, and only then - loose stools.

It is much more common to encounter secondary lactase deficiency, in which, in addition to the symptoms listed above, there is a lot of mucus, greenery in the stool and undigested lumps of food may be present.

Lactose overload can be suspected, for example, in the case when the mother accumulates a large volume of milk in the breast, and the child has good gains, but the child is worried about pain, approximately as in primary LN. Or green sour stools and constantly leaking milk from mom, even with slightly reduced increases.

mom quotes
1
we begin to feed and after a couple of sips, the child begins to arch in pain - her tummy rumbles very noticeably, then she begins to pull the nipple, releases it, farts, grabs the breast again and again again. Weaning, massaging the tummy, we sip, we start feeding again and “again 25”
... From the very beginning, the child's stool is unstable - from bright yellow to brown or green, but always watery, with diarrhea, with white lumps and a lot of mucus
... Very severe pain when feeding. The rumbling of the tummy can be heard from a meter away.
weight loss, dehydration.

2
it all started with a roar when he ate my breasts and immediately screamed ... the milk in the stomach did not stop right away, it immediately jumped out in loose stools with mucus ... and we did not gain weight

3
We have also been diagnosed with this very lactase deficiency.
And it all started abruptly, there was a normal chair, and then once - and diarrhea.
She screamed so that my heart just broke. Pushing, writhing all the time.
…. the baby lost 200 grams in weight in three days (!).

comment: maybe this case lactase deficiency was the result of an intestinal infection and the resulting damage to the intestine.

TESTS FOR LACTASE DEFICIENCY

There are several tests that can more or less confirm lactase deficiency. Unfortunately, among them there is no ideal analysis that would guarantee the correct diagnosis, and at the same time be simple and non-traumatic for the child. First, we list the possible methods of analysis.

1. The most reliable way to confirm LN is biopsy of the small intestine. In this case, taking several samples, it is possible to determine the degree of lactase activity by the condition of the intestinal surface. The method is rarely used obvious reasons(anesthesia, penetration of the device into the intestines of the child, etc.).
2. lactose curve. On an empty stomach, a portion of lactose is given, a blood test is done several times within an hour. Ideally one would do a similar test with glucose as well and compare the two curves. To simplify the analysis, a lactose-only test is done and a comparison is made with average glucose values. The results can be judged on LN (if the curve with lactose is located below the curve with glucose, there is insufficient breakdown of lactose, i.e. LN). Again, the test is more difficult to apply to infants - it is necessary to give lactose on an empty stomach, while eating nothing but it, taking a few blood tests. In addition, in the case of LN, lactose causes unpleasant symptoms, pain, gas formation, diarrhea, which also speaks against this test. Foreign sources express certain doubts about the effectiveness of this test, due to the possibility of false positive and false negative results. Nevertheless, the information content of the lactose curve is usually higher than the information content of the analysis of feces for carbohydrates (in case of doubt, several of the listed methods can be used for a more accurate diagnosis).
3. Hydrogen test. The hydrogen content in the exhaled air is determined after the patient has been given lactose. The obvious drawback - again, when taking lactose, a whole range of unpleasant symptoms appears. Another disadvantage is the high cost of equipment. In addition, in children under 3 months old who do not have LN, the hydrogen content is similar to its content in adults with LN, and the norms for young children have not been determined.
4. The most popular method is analysis of feces for carbohydrates. Unfortunately, it is also the most unreliable. The norms of carbohydrates in feces have not yet been determined. At the moment, it is believed that the carbohydrate content should not exceed 0.25%, however, scientists from the Institute. Gabrichevsky suggest revising the norms for the content of carbohydrates in the feces of a child who is breastfed (up to 1 month - 1%; 1-2 months - 0.8%; 2-4 months - 0.6%; 4-6 months. -0.45%, older than 6 months - accepted and now 0.25%). In addition, the method does not give an answer, which carbohydrates are found in the child's feces - lactose, glucose, galactose, therefore, the method cannot give a clear guarantee that it is lactase deficiency that occurs. The results of this analysis can only be interpreted in conjunction with the results of other analyzes (for example, coprogram) and clinical picture.
5. Analysis coprograms. It is usually used in combination with other diagnostic methods. Normal stool acidity (pH) is 5.5 and higher, with LN the stool is more acidic, for example, pH = 4. Information on the content of fatty acids is also used (the more of them, the more likely LN).

TREATMENT

I want to emphasize that every time it is necessarytreat not the analysis, but the child. If you (or your pediatrician) have found one or two signs of lactase deficiency in a child, and an increased content of carbohydrates in the feces, this does not mean that the child is sick. The diagnosis is made only if there is both a clinical picture and a poor analysis (usually a fecal analysis for carbohydrates is taken, it is also possible to determine the acidity of the stool, the pH is 5.5, with LN it is more acidic, and there are corresponding changes in the coprogram - there are fatty acids and soaps). The clinical picture does not mean just frothy or mucus-laden stools, and more or less ordinary child, moderately restless, like all babies, but with LN, there are simultaneously bad frequent stools, and pain, and rumbling in the tummy during each feeding; Also important sign is weight loss or very poor gains.
It is also possible to understand whether LN is taking place if, at the beginning of the treatment prescribed by the doctor, the child's well-being improved significantly. For example, when they began to give lactase before feeding, the pain in the abdomen sharply decreased and the stool improved.

So, what are the possible treatments for lactase deficiency or a similar condition?

1. Proper organization of breastfeeding. In Russia, the diagnosis of "Lactase deficiency" is made to almost half of the 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. Indeed, in most cases, there is either a “treatment of tests” (in the normal state of the child, without pronounced anxiety, and good increases), or an incorrect organization of breastfeeding.


And what about the organization of breastfeeding?
The fact is that for most women, the composition of milk released from the breast at the beginning and at the end of feeding is different. The amount of lactose does not depend on the mother's diet and does not change much at all, that is, at the beginning and at the end of feeding, its content is almost the same, but the fat content can vary greatly. More watery milk comes out first. This milk "flows" into the breasts between feedings when the breasts are not being stimulated. Then, as the breast sucks, more fatty milk begins to flow out. Between feedings, fat particles stick to the surface of the mammary gland cells and are added to milk only at hot flushes, when the milk is actively moving, it is ejected from the milk ducts. More fatty milk moves from the stomach to the intestines of the child more slowly, and therefore the lactose has time to be processed. The lighter, foremilk moves quickly, and some of the lactose can enter the large intestine before it can be broken down by lactase. There it causes fermentation, gas formation, and frequent sour stools.
Thus, knowing the difference between foremilk and hindmilk, one can understand how to deal with this type of lactase deficiency. Optimal if this is for youadvice from a lactation consultant(at a minimum, it makes sense to get advice on the forum or by phone, but better in person)

a) Firstly, you can not express after feeding, because. in this case, the mother pours or freezes fatty milk, and the child, breast sucker, gets just less fat milk with a high content of lactose, which can provoke the development of LN.
b) Secondly, it is necessary to change the breast only when the child has completely emptied it, otherwise the child will again receive a lot of foremilk and, not having time to suck out the hindmilk, will again switch to foremilk from the second breast. Perhaps a more complete emptying of the breast will help the compression method.
c) Thirdly, it is better to feed on the same breast, but more often, since with large breaks, a larger amount of foremilk flows into the breast.
d) It is also necessary to properly attach the baby to the breast (if it is not attached correctly, it is difficult to suck out milk, and the baby will not receive back milk), and also make sure that the baby does not just suck, but also swallows. In which case is it possible to suspect improper application? In case your chest is cracked and/or breastfeeding is painful. Many people think that breastfeeding pain is normal in the first few months, but it is actually a sign of a bad latch. Also, feeding through pads often leads to improper grip and inefficient sucking. Even if you think the attachment is correct, it's best to double-check it.
e) Night feedings are desirable (more hindmilk is produced at night).
f) 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, until the lactase is fully matured).

So, we have the right grip, we don’t express after feeding, we change breasts every 2-3 hours, we don’t try to feed less often. We give the child a second breast only when he has completely emptied the first. The baby suckles at the breast for as long as he needs. Night feeding is recommended. Sometimes only a few days of such a regimen are enough for the child's condition to normalize, the stool and bowel function to improve.

Please note that infrequent breast alternation should be used with caution, as this usually leads to a decrease in the amount of milk (so it is advisable to ensure that the child pees about 12 or more times a day, this means that milk is likely to be enough). It is possible that after a few days of this regimen, the amount of milk will already be insufficient and it will be possible to switch to feeding from two breasts again, while the child will no longer show any signs of LN. If your baby hashigh raises, but there are symptoms similar to LN, perhaps it is a decrease in the alternation of the breast (every 3 hours or less) in order to reduce the total volume of milk, which will lead to a decrease in colic. If all this does not help, perhaps it is really a lactase deficiency, and not a condition similar to it, which can be corrected with proper organization feedings. What else can be done?

2. Exclusion from the diet of allergens. Most often we are talking about cow's milk protein. The fact is that cow's milk protein is a fairly common allergen. If a mother consumes a lot of whole milk, its protein can be partially absorbed from the intestines into the mother's blood, and accordingly into milk. In the event that cow's milk protein is an allergen for a child (and this happens quite often), it disrupts the activity of the child's intestines, which can lead to insufficient breakdown of lactose and to LN. The way out is to exclude from the mother's diet in the first place whole milk. You may also need to exclude all dairy products, including butter, cottage cheese, cheese, dairy products, as well as beef, and everything cooked with butter (including pastries). Another protein (not necessarily cow's milk) may also be an allergen. Occasionally it is necessary to exclude sweets as well. When the mother eliminates all allergens, the child's bowel activity improves and the symptoms of LN stop.

3. Pumping before feeding. If changing breasts less often and eliminating allergens is not enough, you can try to express some carbohydrate-rich 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 fails and the child is still suffering,it makes sense to see a doctor!

4. Enzyme lactase.If the above methods do not help, usuallydoctorprescribes lactase. Exactlydoctordetermines whether the child's behavior is typical for a baby or whether there is still a picture of LN. Naturally, it is necessary to find as friendly as possible to the GW, advanced, familiar with modern scientific research doctor. The enzyme is given in courses, often they try to cancel it after 3-4 months of the child, when the maturation of the lactase enzyme ends. It is important to choose the right dose. At too low a dose, the symptoms of LN may still be severe, at too high, the stool will become excessively thick, similar to plasticine; blockages are possible. The enzyme is usually given before feeding, diluted in some breast milk. The dose, of course, is determineddoctor. Usually the doctor recommends giving lactase every 3-4 hours, in which case it will most likely be possible to feed on demand in the intervals.

5. Lactase-fermented breast milk, low-lactose or lactose-free formula.In the most extreme cases, the child is transferreddoctorslactase-fermented expressed breast milk or lactose-free formula. It may be sufficient to replace only part of the feedings with lactose-free formula or fermented milk. If these measures become necessary, it is advisable to remember that supplementing a baby is usually a temporary measure, and the use of a bottle in this case may lead to refusal of the breast. For feeding the baby, it is better to use other methods, such as a spoon, cup, syringe.
The immediate and long-term effects of feeding healthy babies lactose-free formula from birth is unknown, so lactose-free formula is usually only recommended as a temporary treatment measure. There is also always a risk of developing an allergy to this mixture, because. soy (if it is a soy mixture) is a common allergen. Allergies may not start immediately, but after a while, so it is advisable to keep breastfeeding as much as possible, which is preferable. This method treatment is primarily applicable to genetic diseases associated with the non-cleavage of lactose or its constituents. These diseases are extremely rare (approximately 1 in 20,000 children). For example, this is galactosemia (violation of the breakdown of galactose).

in the case of secondary LN, all the above methods of treatment can be added

6. Treatment of the so-called. "dysbacteriosis", i.e. restoration of intestinal microflora and intestinal condition. In the case of treatment of primary LN, correction of intestinal dysbacteriosis accompanies the main treatment. In the case of secondary LN (the most common), usually the focus should be on the treatment of the underlying disease that caused damage to the intestinal walls (for example, gastroenteritis), and reducing the amount of lactose in the diet or lactase fermentation should be considered a temporary measure necessary until the surface condition is restored. intestines. In mild cases, it may be enough to give the enzyme lactase for a while, and the intestines will recover without additional treatment. Treatment again prescribesdoctor.

Beware of lactose!During treatment, drugs such as Plantex, Bifidumbacterin, etc. can be prescribed. Unfortunately, they contain lactose! Therefore, with lactase deficiency, they can not be used. In the event that the child does not show symptoms of LN, however, one must be careful with medicines containing lactose so as not to provoke diarrhea, frothy stools and similar symptoms of LN.

Breast milk is the main source of nutrition for a newborn baby in the first six months of his life. But what if the baby has lactase deficiency, due to which he cannot absorb milk? Is it worth it to transfer the child to mixtures in this case, or can I continue to breastfeed him?

What is lactase deficiency?

Lactose intolerance is a disease that prevents a child's body from absorbing the protein found in milk. The diagnosis is made in the very first months of the baby's life, since the baby during this period eats only breast milk. It is important to know that the symptoms become more pronounced depending on the amount of milk - the more it is, the more severe the consequences of such a diet. Lactase deficiency can persist into adulthood.

What's the matter? Lactase is an important enzyme produced by intestinal cells. It is he who breaks down lactose, which is the basis of milk of any origin. Latkaza breaks down complex sugars into simpler ones, which are quickly absorbed into the walls of the baby's intestines. These are glucose and galactose. Sugar is very important for the body - it is one of the main sources of energy. If too little lactose is produced in the intestines or its synthesis has completely stopped, then undigested milk leads to. In the dairy environment, bacteria quickly start up, the waste products of which are gases - the main one and bloating in the abdomen.

Deficiency types

According to its type, lactase deficiency is divided into primary and secondary.

First type

In the first case, lactase is synthesized in the intestine, its amount is normal, but its activity is at a low level, so milk is not absorbed by the body. Cases where the enzyme is not produced at all are extremely rare.

Primary lactase deficiency has one subspecies - transient. This is often found in premature babies and is due to the fact that lactase is actively produced only from 37 weeks, while at a period of 34 weeks the enzyme is just beginning to be synthesized by the body. Transient insufficiency usually resolves quickly a few weeks after birth, when the premature baby grows and gets stronger.

Secondary insufficiency

With secondary lactase deficiency, enterocytes are damaged, which disrupts the production of the enzyme. Very often the cause of this form of the disease are various inflammatory processes in the gastrointestinal tract and allergic reactions in the intestine. Timely diagnosis and treatment will help to quickly cope with the disease.

Symptoms of the disease

Here are the most common symptoms of lactase deficiency in infants:

1. Severe bloating after each feeding is one of the most noticeable and main symptoms of the disease;
2. Bloating is often accompanied by rumbling in the intestines, seething and gases;
3. Because of the air in the intestines, painful colic occurs;
4. The child may experience pain during bowel movements;
5. Less often, a baby has contractions, this is impossible to miss. The child begins to bend with his whole body, becomes capricious. The baby will try to pull his legs up to his stomach, crying a lot at the same time;
6. Pay attention to the child's chair. With lactose deficiency, the stool smells of sour milk. If there are lumps or mucus in it, most likely you are dealing with secondary lactase deficiency;
7. The baby begins to spit up more often, he constantly vomits;
8. The child behaves sluggishly and does not show interest in the world around him;
9. Due to constant regurgitation, the baby begins to quickly lose weight. In less severe cases, the growth of the baby simply stops in place;
10. The baby does not sleep well;
11. The child's body is severely dehydrated - this symptom manifests itself already in the first days of the baby's life in cases of a pronounced lack of lactase.

Despite these signs, lactose deficiency in newborns does not at all negative impact for appetite. The baby can literally pounce on his chest, but soon he begins to cry, tucking his legs to his stomach.

In the early days, a lack of lactase rarely makes itself felt - the symptoms are cumulative and appear on the rise. First, bloating makes itself felt, then the baby feels pain in the tummy, the last stage is stool disorders.

Important: most of the listed symptoms are primarily characteristic of primary lactose intolerance. Secondary lactase deficiency, among other things, is expressed in the green color of the stool, lumps and.

How is the disease diagnosed?

Some symptoms are not enough to accurately diagnose the disease. For a correct diagnosis and correct treatment, it is necessary to carry out several laboratory research. More often, the therapist gives direction for tests.

Carbohydrate analysis of feces

Needed to determine the concentration of carbohydrates. This is the fastest, easiest, and cheapest way to find out how many carbs are in your stool. From these results, you can determine whether lactose is digested sufficiently. Normally, in babies under 1 year old, the carbohydrate content is not more than 0.25%. Small deviations of 0.5% are considered normal, but if this number exceeds 1%, then this is already serious. Such an analysis has disadvantages - the results can determine the presence of lactose intolerance, but it is impossible to find out the cause of the disease.

Biopsy of the small intestine mucosa

Allows you to determine the activity of lactase in the digestive tract. This is a classic method for detecting the presence of milk protein intolerance.

Analysis of feces for dysbacteriosis

If an allergic origin of the disease is suspected, the child may be sent for an additional blood test.

Dr. Komarovsky cited statistics as an example, according to which 18% of the total number of newborns suffer from lactose intolerance. This is almost every fifth child born in our country. At the same time, adults tolerate this disease more easily - they do not need to eat milk alone, and they can afford to go on a lactose-free diet. This will not work with babies, because mother's milk is the basis of their nutrition. Therefore, it is better to diagnose the disease and take all necessary measures as early as possible so that the baby can adapt.

Treatment Methods

If the baby's diagnosis is confirmed, this does not mean that you will have to give up mother's milk in the diet. Mom can safely continue to breastfeed the baby, giving him preparations containing lactase before each feeding (for example, or Lactase Enzyme). The disease should be treated as quickly as possible, so it will be possible to avoid complications in the future.

Doses prescribed by a doctor are strictly individual. As the infant's enzymatic systems develop, the dosage of medications will gradually decrease. What you need to do to prepare the medicinal mixture before you start feeding:

1. Whichever brand of drug you choose, the steps are often the same. Express some milk - 10-15 ml is enough;
2. Pour the required amount of powder into the milk. Note that Lactase Baby is easier to dissolve in liquid faster than Lactase Enzyme;
3. Let the mixture brew for fermentation for 3-5 minutes. During this time, lactase will break down the milk carbohydrates that are contained in liquid foremilk;
4. Give the formula to the baby before feeding, and then continue to feed him as usual;
5. Give the baby a drug diluted in milk before each feeding.

Features of complementary foods for lactose intolerance

Children diagnosed with lactose intolerance are introduced to complementary foods much earlier. At the same time, it is important to ensure that the diet is varied and balanced in terms of nutrients.

What to feed such a child?

Important: cook cereals and vegetable puree without milk, use lactose-free mixtures for dilution.

Milk and dairy products in the diet of a child at an older age (from 1 year old) should be replaced with low-lactose meals. If it is not possible to purchase them, give your child lactase capsules.

With milk protein intolerance, children should not eat any food containing condensed milk and milk fillers. Most of the sweets will have to be forgotten.

Goat milk

Lactase deficiency in newborns is also a contraindication to use, no matter how useful it may be. Goat milk and mixtures based on it are useful for preventing allergies to milk protein, improving digestion and strengthening immunity, but with an insufficient amount of the lactase enzyme, it will only harm the health of the child.

What diet should mom eat?

In order to prevent lactase deficiency and allergy to lactose protein in a child, a nursing mother should take her own nutrition more seriously. For this, a balanced diet for mothers with lactose deficiency in infants has been developed. First of all, you should reduce the amount of protein consumed. Avoid whole cow and goat milk.

Protein from milk consumed in pure form, is easily absorbed into the mother's blood, and from it enters breast milk. If your baby is allergic to protein in cow or goat milk, it may disrupt the work of the not yet fully formed digestive system. This leads to lactase deficiency, and with it lactose intolerance.

Try not to use not only whole milk, but also other products based on it - butter, cottage cheese, yogurt, kefir, cheese. Do not eat baked goods that are made with butter. Limit your intake of beef - this meat contains the most proteins, unlike pork or poultry.

An allergic reaction in a baby can also occur to other proteins. In rare cases, sweets should be excluded from the diet of a nursing mother. Once the allergens in the diet have been eliminated, work digestive organs the baby will gradually return to normal, and the symptoms of lactase deficiency disappear.

What else should be excluded from the diet?

Minimize or eliminate:

• dishes with a lot of hot spices, as well as pickles - mushrooms, cucumbers, etc .;
• no matter how insipid the dishes without seasonings may seem - for the time of breastfeeding, you will have to give up spicy herbs when cooking;
• do not drink alcohol, regardless of its strength;
• eliminate caffeine from the diet, do not drink coffee and tea, which also contains this substance;
• carefully read the labels on products purchased in stores, do not eat products with preservatives and dyes (this item can be the most difficult to complete, since most products on grocery shelves in stores contain all of the above);
• do not eat anything that can cause allergies in a child - exotic fruits and berries for our latitudes, as well as any red vegetables.

Temporarily reduce your intake of foods that lead to gas formation. This:

• sugar;
• bakery;
• yeast bread;
• legumes;
• grape.

What can you eat if your baby is lactose intolerant?

Eat more:

• fresh vegetables and berries (with the exception of allergens), vegetables can be boiled, stewed or eaten raw;
• get into the habit of regularly drinking compotes from and (it is better to start with the first one, since dried apricots are more allergenic);
• if you want something tasty, you can eat almonds, jelly and marshmallow, but in small quantities;
• eat more grain cereals, germinated wheat germ is ideal;
• when the baby is six months old, you can gradually return fried foods to the diet with a small (!) Amount of vegetable oil;
• from 6 months you can eat exotic fruits in moderation, it is permissible to eat some chocolate in the morning, but always black - it has the least milk and sugar.

Successful treatment of the disease largely depends on the diet of the mother and child, as well as on the intake of drugs containing the required amount of lactase.

Lactase deficiency is a deficiency of the enzyme lactase, which is necessary for the digestion of milk sugar - lactose. Lactose is found in large quantities in breast milk, in milk mixtures, slightly less in cow's milk, and in fermented milk products its content is significantly reduced.

Women's milk– richest in lactose content, because it is necessary for the development of the child's brain and satisfies about 40-45% of the energy needs of the baby. In the human body, lactose is broken down into sucrose and galactose. Milk sugar not split by lactase enters the intestines, where it promotes the growth of the child's own microflora, namely bifidobacteria and lactobacilli. If the amount of unsplit lactose is large, then fermentation occurs in the intestines, which causes excessive gas formation, and as a result, loose stools, abdominal pain, and the wrong consistency and composition of feces.

Lactose intolerance can be primary or secondary.. Primary lactase deficiency is congenital (occurs in 1 out of 20,000 children), transit - occurs as a result of underdevelopment of the enzymatic system of the child (most often occurs in premature babies, since lactase activity increases from the 36th week of pregnancy). Adult lactase deficiency is due to the fact that after a year the amount of lactase produced decreases and already an adult may experience milk intolerance, which is quite common nowadays (18% of the adult population have adult-type lactase deficiency). Type 2 lactase deficiency is associated with an increase in the number of allergies suffered intestinal infections and other gastrointestinal tracts.

Very often, lactase deficiency is diagnosed in breastfed infants.. Many doctors advise at the same time to transfer the child to a lactose-free or fermented milk formula, arguing that this is the only way to solve the problem. But is it always like this?

The main indicators of lactase deficiency in an infant:

1. The baby is crying, arches when feeding, he has increased gas formation, he does not gain weight well.

2. Some children, even with external health and good weight gain, have irregular loose stools with foam, mucus, greens, undigested lumps.

3. Stool tests show high sugar content in stools, high acidity and the presence of fatty acids.

The first thing I want to say is that the norms for analyzes are mainly taken for artificial children, and therefore they do not determine the complete clinical picture, the diagnosis should be made with a combination of several of the above signs. In addition, before transferring the child to the mixture, you need to try to establish correct mode, as it is the cause of 90% of diseases.

The main reason is the imbalance in feeding the baby with foremilk and hindmilk.. It turns out that the higher the fat content of a dairy product, the lower its lactose content, for example, in cream, its content is very small compared to milk. That is why babies experience little to no tummy pain when they are fed with fatty colostrum, which contains a low amount of sugars. When the milk becomes mature (2 weeks after birth), the number of complaints of bloating and intestinal problems in infants increases significantly. This is due to the fact that the immature enzymatic system of the child does not digest a large number of lactose, it enters the intestines, where fermentation occurs, the stool becomes sour, has a yeasty smell. In addition to bifido- and lactobacilli, lactose is food for pathogenic flora, which can lead to intestinal dysbacteriosis, as evidenced by weight loss, greens and mucus in the stool. The reason for this is that the baby is getting a lot of lactose-rich foremilk and not sucking out the fatty and more nutritious hindmilk. There may be several reasons for this.

How can a child get too much lactose?

1. and receives milk from two breasts at once. It turns out that, without completely sucking out the hind milk from one breast, he again receives a portion of the foremilk from the second. Its enzymatic system is unable to digest this amount of lactose. The regulation of the feeding regime in this case consists in the fact that the mother puts the baby to the breast more often, while making sure that the breast is completely emptied. Pumping in this case must be canceled.

2. The child is fed 6-7 times a day, at one time from one breast, but the mother regulates the feeding time for 15-20 minutes. A small, sluggish baby cannot empty the entire breast during this time. As a result, he gains little weight, and mom is told that she is non-dairy. Such children need to be fed for a long time, some babies suckle for 1-1.5 hours and this is normal, during which time he completely empties his chest and receives a sufficient portion of rear fat and nutritious milk. Be sure to feed your baby at night when more fatty milk is produced.

3. The child is attached often and briefly, and the mother each feeding gives different breasts. In this case, you need to feed the baby each time with one breast, and change only after 3 hours. Of course, such a situation can lead to a lack of milk, but usually all symptoms disappear quickly, and milk begins to arrive in the amount the child needs.

4. Mothers are sometimes advised to express the foremilk and feed the baby with the hind milk.. In this case, hyperlactation is possible. But after improving the situation - gradually eliminating pumping, you will reach normal lactation.

In the case when changing the regimen and principle of feeding does not help, the doctor may suggest introducing lactase in the form of a drug, or expressing breast milk, fermenting it artificially, and then giving the baby from a bottle or cup. If a child has congenital lactase deficiency, and the above methods of treatment did not help, then you will have to stop breastfeeding and transfer the baby to a lactose-free mixture, but we remind you that such a diagnosis is very rare.