The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
The main component of breast milk is lactose, which is necessary for infants as it provides about 40% of the energy and nutritional needs of the child. This substance is involved in the absorption of iron and calcium, it stimulates the growth and development of normal intestinal microflora.
In the body it splits lactose to galactose and glucose, which occurs under the action of the enzyme - lactase.
About lactose (or rather, lactase) deficiency say when this enzyme in the body is missing or is not produced in sufficient quantities. This causes difficulty in digestion of milk and dairy products, or their inability to digest (lactose intolerance).
Kinds
By origin lactase deficiency may be
- primary
- or secondary.
Primary lactase deficiency, in turn, is divided into congenital and transient. Congenital due specific gene set, whereas transient (temporary) lactase deficiency occurs in premature infants
and full-term babies with immature intestinal enzyme system. After the first year of life, the intestine begins to function normally, and such problems disappear.On secondary lactase deficiency is said in case of damage intestinal cells involved in the development of enzymes which have occurred due to intestinal infections, parasitic infestations, food allergies.
Depending on the degree of formation of lactase isolated
- partial (hypolactasia)
- and complete (alaktaziya) its failure.
Causes
The reasons of occurrence of lactose intolerance include:
- prematurity;
- heredity;
- failures at the genetic level;
- the child's age more than 5 years (from three to five-year olds lactase activity decreases, and it continues to get older);
- intestinal mucosal disease (rotavirus infection, worms, giardiasis,enteritis other origin).
Symptoms of lactose intolerance
The disease has a fairly typical pattern.
One indication is flatulence (flatulence) at which clearly audible swirling abdominal bloating and noticeably. This is explained by the fact that lactose in the intestine is cleaved by bacteria to gases: CO2, CH4, H2. The child feels discomfort in the abdomen, cramps and colic, which do not disappear after application of proven tools (such as stroking the belly). Baby can twist legs, pull them to the stomach, crying and capricious.
Another characteristic symptom - liquid stool (diarrhea). Normally, an infant reaches the number of bowel movements to 6-8 times a day. As a rule, each feeding accompanied by defecation. Diarrhea due to the large amount of undigested lactose in the intestines, as well as lactose - osmotically active substance, it "pulls" the liquid in the intestinal cavity. A chair liquid, a sour odor, foaming or bubbling and the secondary lactase deficiency stool may have impurities mucus, food particles, have a greenish color.
Often, instead of marked diarrhea and constipation. About constipation say, when the chair is absent in a child one day or more.
In severe lactose intolerance, children do not gain weight and even lose it, which indicates dehydration. Undigested lactose and acidic intestinal contents leads to growth of pathogenic organisms and Development dysbiosis bowel.
All of these symptoms are associated with taking milk and appear immediately after the start of feeding or shortly after it.
Diagnostics
Diagnose lactase deficiency is not difficult. Characteristic symptoms allow the correct diagnosis right away.
Additional studies include:
- dietodiagnostika - from baby food diet excludes milk and dairy products, followed by all the symptoms disappear. When administered in the diet of milk signs of distress come back again.
- pH determination feces - the environment becomes acidic intestinal contents, i.e. below 7.0.
- definition carbohydrates in feces (Benedict's test) - in children under one year rate is 0.25%, and in older children and adults there are no carbohydrates. In case of an increase of their content in feces to 0.5% or higher, the sample is considered positive.
- definition of the content of hydrogen in the breath - this method is used for older children. When the content of hydrogen more than 20ppm, and blood sugar levels - less than 20mg / dL indicate lactase deficiency.
Differential diagnosis is necessary so as not to confuse the disease with intestinal infections, gastroenteritis, and allergic reaction to milk protein - casein.
Treatment lactase deficiency
The treatment takes a pediatrician.
First of all, it is necessary to establish the cause that caused the lactose intolerant, and try to resolve it.
In the case of secondary lactase deficiency spend treatment of infectious and non-infectious enterocolitis, helminthiasis, giardiasis and other. Duration of treatment secondary lactase deficiency corresponds to the period of the main disease therapy: from 14 or more days.
mothers diet during breastfeeding
In primary lactose intolerance mother recommended to limit or completely abandon the whole milk, but keep in diet dairy products, butter and cheese, as they are the source of calcium needed baby. Also, breastfeeding women should reduce the consumption of sugary foods. However, it is important to have a balanced diet itself.
In any case should not give up breastfeeding because breast milk in addition to nutrients and vitamins contained antibodies that the immunity of the child, and lactase. Most of the enzyme is present in the posterior milk, so the baby should breastfeed for at least 20 minutes. Night feedings and should not be stopped, because it is produced in the milk back more night.
In patients with moderate lactose intolerance should be added to breast milk "Lactase enzyme", "Lactase baby" or "Laktazar". To this should be before feeding decant about 50 ml of milk and dissolve in it one of the following drugs. A minute later to give the child a mixture with a spoon and continue breastfeeding. The enzymes should be added to each feeding without missing, the dose volume depending on the level of carbohydrates in feces.
Cancel lactase should occur gradually as reducing breastfeeds in connection with the introduction of complementary foods.
A diet of children on artificial feeding
For children who are bottle-fed, you should choose lactose-free, Low-or soy mixture.
Lure children with lactase deficiency is administered before, vegetable purees and cereal cooked on lactose-free or low-lactose bases. Fruit juices, on the other hand, are added to the menu later. Children need to give yogurt, sour milk mixed with live biobakteriyami, cheeses.
The product's name |
The company, country of origin |
ingredients |
Energy value, kcal |
|||
proteins |
fats |
carbohydrates |
||||
Total |
lactose |
|||||
lactose free mixture | ||||||
Nutrilak lactose-free |
Nutritek Group, Russia |
1,6 |
3,5 |
7,3 |
0 |
66,3 |
NAS lactose-free |
Nestle, Switzerland |
1,7 |
3,3 |
7,6 |
0 |
67 |
Enfamil Laktofri |
Mead Johnson, USA |
1,42 |
3,7 |
7,2 |
||
Low-mix | ||||||
Nutrilak low-lactose |
Nutritek, Russia |
1,6 |
3,5 |
7,3 |
0,9 |
66,3 |
Nutrilon low-lactose |
Nutricia, The Netherlands |
1,4 |
3,6 |
7,1 |
1,33 |
66 |
Humana-LP |
Humana, Germany |
1,8 |
2,0 |
9,2 |
1,1 |
62 |
Humana MCT-LP + |
Humana, Germany |
1,9 |
2,0 |
8,9 |
0,5 |
61 |
Table. The chemical composition and energy content of low-lactose and lactose-free milk mixtures (100 ml of a ready mix)
In older children and adults lactase deficiency is expressed moderately and poorly. They recommended that life to abandon the whole milk, condensed milk and ice cream. Dairy products and cheeses are not limited.
Forecast
The prognosis for sufferers of lactase insufficiency, children-friendly.
In secondary form after the treatment of the underlying disease it disappears. Initial transient lactose intolerance diminishes to 6-7 months and gradually eroding.
In congenital deficiency of the enzyme recommend people only minor dietary restrictions. Despite the absence of the body, lactase in the small amount still produced by intestinal bacteria, which allows even people with this diagnosis, use a bit of whole milk.
* This article is written in accordance with the "national program optimization of the first year of infant feeding life ", approved by the Russian Union of pediatricians in 2011.
