Parent’s Guide: Lactose Intolerance in Children

Lactose Intolerance

If your child complains of stomach ache and an upset stomach following milk intake, or after eating ice cream, you could wonder if lactose intolerance is to be blamed. But what exactly is lactose, and what causes its intolerance to develop in the body. Read on to know more about it:

What is lactose?

Lactose is the disaccharide sugar, found in dairy products like cheese, milk, and yogurt. The enzyme in the digestive system, lactase degrades and breaks down the lactose sugar to its simple components glucose and galactose for absorption into the bloodstream.

What happens in lactose intolerance?

In lactose intolerance, the body lacks the enzyme lactase or the lactase enzyme is ineffective in digesting and absorbing lactose sugars. Consequently, the undigested lactose passes to the large intestine whereby it is fermented by the gut bacteria. The byproducts of the latter reaction—majority of which is carbon dioxide and hydrogen, have a laxative effect, and result in diarrhea and flatulence on consumption of lactose-based products.

What are the symptoms of lactose intolerance?

In children, the symptoms of lactose intolerance can begin as early as two years of age. They can start half-hour to two hours after intake of lactose-based products like milk. While symptoms may be different for every child, there is commonly: upset stomach and diarrhea. Invariably, there can be cramps, bloating, nausea, and abdominal pain. In older children, vomiting is more common.

What are the types of lactose intolerance?

The following are the types of lactose intolerance that an individual may have. They can be acquired or a person can be born with the deficiency of lactase.

Acquired lactose intolerance: after childhood, there is a natural decline in the lactase activity in the intestines. According to an estimate by the National Institutes of Health, almost two-thirds of people with lactose intolerance have acquired intolerance.

Primary lactose intolerance—lactase deficiency: this is the name given to complete absence of lactase enzyme in babies. On given breast milk, such babies develop severe diarrhea and have to be shifted to lactose-free formulas.

Secondary lactose intolerance: following severe gastric infection, such as those of rotavirus or giardiasis, sometimes there is temporary intolerance of lactose as the intestinal villi are affected. As the infection clears and the villi regrow, the enzymatic activity returns. During this period the patients have nausea, most often followed by diarrhea and vomiting if they consume lactose-rich foods. 

How to diagnose lactose intolerance?

For lactose intolerant children, a physical examination, complete history of disease combined with a few investigations by the healthcare provider form a concrete diagnosis. Commonly, the investigations include:

Lactose intolerance test: this investigation checks the level of lactose absorbed by the digestive system of the fasting patient when given a lactose rich drink. In the next 24 hours, the stool is tested for the presence of lactose and a percentage is obtained of the lactose given and the lactose absorbed. In lactose intolerance, there is a high amount of stool lactose content as the body is unable to absorb it.

Biopsy: this investigation involves viewing the cells of the small intestine after retracting a small sample. An upper endoscope is used to get the sample. In lactose intolerance, biopsy sample will show intestinal villi with lack of the enzyme lactase.

Hydrogen breath test: the patient is given a lactose-rich liquid and thereafter hydrogen level is tested in the breath at regular intervals. In lactose intolerance, the hydrogen levels are high. This hydrogen is the result of fermentation reactions by the gut bacteria in the large intestine.

Who is at the risk of lactose intolerance?

Some babies are at higher risk for lactose intolerance, including those that are born earlier than their due date—premature babies. The intolerance, however, in such babies is temporary and goes away after a short period of time. The incidence of lactose intolerance is higher in babies with a positive family history as well. Naturally, the genetic trait of lactose intolerance in such babies is passed on from one or both parents and the symptoms can present early or later in life—during adulthood or teenage.

How to manage lactose intolerance in children through dietary changes?

Here are some tips to manage lactose intolerance in children:

Limit the intake of lactose containing foods in your child. Thereafter, slowly add milk and milk products in their diet and check for any symptoms. Maintain a food diary and see which foods are tolerated by the child, and which foods cause worsening. Start with foods containing lower lactose content; these include yogurt and hard cheeses.

Try giving your children milk and milk-based products with other foods; this can lessen the intensity of symptoms. For instance, you can give the children cheese with crackers, or milk with cereal. If this is not tolerable, shift to lactose-free milk and milk-based products. In such products, the lactase enzyme is added to digest the lactose sugars.

Ask your healthcare provider about lactase enzymes. Lactase is available as pills and drops that can be taken with milk and other lactose-based products. Lactase enzyme can lessen and prevent the symptoms through digestion of lactose.

In lactose intolerant patients, there are high chances of calcium deficiency as products like milk and cheeses have a high calcium content. Avoiding milk and milk-based products can result in less calcium intake and consequently weaker bones. Be sure to supplement the calcium through other sources based on their age and recommended dietary amount (RDA). In children up to six months of age the RDA is 200 mg; from six months to one year, the RDA is 260 mg; from 1 to 3 years, the RDA is 700 mg as the calcium is needed for bone growth. The RDA increases to 1000 mg during the ages 4 to 8, and to 1300 mg per day between ages 9 to 18 years.

Opt for a varied and nutritious menu for yourself and your family to ensure proper health; book an appointment with top nutritionists in Lahore, and Top Nutritionists in Rawalpindi through, or call our helpline at 042-3890-0939 for assistance to find the RIGHT professional for your concerns.