The human body has a miraculous mechanism of digesting and assimilating food. Various enzymes and digestive juices work together at the molecular level during the process of digestion, helping us gain the necessary nutrients. The absence of smaller enzymes or chemicals can lead to intolerance of specific substances. Lactose intolerance is a very common condition where infants, children, and even adults are not able to digest lactose, a very common form of sugar.

What is Lactose?

Lactose is a type of sugar that is found in milk and milk products.

What is Lactose Intolerance?

Lactose intolerance is the inability of the body to digest lactose.

Yes! You read it right! Some people including babies and children are incapable of digesting this simple sugar lactose found in milk and milk products.

What happens when someone suffers from Lactose Intolerance?

In a normal scenario, whenever we consume products containing lactose, it reaches the small intestine where it is broken down into smaller pieces by an enzyme called lactase. These products are then absorbed as nutrients and give us energy. In lactose intolerance, the body doesn’t make enough lactase and thus the lactose is not digested. This lactose which remains undigested in the small intestine, then passes to the large intestine- the colon, where it sits and accumulates. In the colon the lactose is broken down by the bacteria, resulting in gas, bloating, stomach ache, etc.

What are the symptoms of lactose intolerance?

Anyone who has lactose intolerance experiences the symptoms below after consuming products containing lactose.

• Bloating or distention of the abdomen- This is a feeling of fullness or tightness in the belly
• Pain abdomen- Due to undigested lactose, one experiences cramps and pain in the stomach region
• Burping- While one may experience burping normally after eating a good meal, burping in case of lactose intolerance is excessive
• Excess gas- One may notice this as an excess burp, fart, or stomach ache
• Diarrhoea- Loose stools which may be accompanied by nausea are also a symptom one may experience
• In lactose intolerant infants, excessive perianal excoriation (painful red skin around anus) can develop due to acidic stool. This may lead to excessive irritability and pain while passing stool.
• Besides the above, there may be a sudden urge to use the toilet after consumption of lactose, and one may also be able to hear loud bowel sounds.

The above symptoms can vary in severity and presentation depending on the amount of lactose one has consumed.

Can babies be born with lactose intolerance?

Though lactose intolerance usually shows up later in life, very  rarely some infants are born with lactose intolerance.

Primary lactase deficiency-

Babies who have lactose intolerance at birth can have primary lactase deficiency. This means that due to genetic abnormality, these babies do not produce lactase enzyme at all. In this case, they have to be fed on special lactose-free baby formulas. This is a rare, easily treatable but life-threatening disease if diagnosis is delayed.
What are the other types of lactose intolerance?

In individuals who have adequate lactase at birth, its production can be affected by factors such as infection, disease and age.

Secondary lactase deficiency- In this type of lactose intolerance, the small intestines stop producing lactase due to infection or disease. This is the most common type of lactose intolerance in small children and infants and is temporary. Viral/bacterial infections and diseases such as Celiac and Crohn’s disease (an immune-mediated gastrointestinal disorder) can lead to this type of lactose intolerance. Early diagnosis by a pediatric gastroenterologist can help in regaining lactose tolerance in such cases.

Since children commonly develop viral infections and other infections of the gastrointestinal tract, secondary lactose intolerance occurs in most kids. Diarrhoea and pain in such cases is a common cause of concern for parents and thus this requires to be identified and addressed at the earliest.

Acquired lactase deficiency- Adults may also get lactose intolerant with age. This is due to a reduction in the enzyme lactase with age.

How can a parent confirm if their baby is lactose intolerant?

Parents should look out for the symptoms listed above to know if their baby can be lactose intolerant. In case of doubt, they should consult a pediatric gastroenterologist at the earliest, as lactose intolerance can lead to painful symptoms and can affect the growth of your child. Most of the times diagnosis can be made clinically, however, your doctor may ask for few tests in case of doubt.

Hydrogen breath test- Suspected lactose intolerance is confirmed by a simple breath test. The doctor introduces lactose in the child after overnight fasting and checks for rising hydrogen levels in the breath by making the child exhale in a bag. The symptoms of lactose intolerance if occur are also confirmed during this test which requires 3-4 hours. This test is not commonly performed very commonly, and may not be required in simple cases of lactose intolerance.

Stools tests:Your doctor may also employ other tests as stool tests if required.

In severe cases, when the diagnosis is unclear, endoscopy as performed by a pediatric gastroenterologist can help in getting a biopsy of the small intestine and the lactase levels can be measured directly.

Your child has to be kept on low  lactose or lactose-free diet in case they develop lactose intolerance.

Which are products that contain lactose?

Lactose may be a part of many products. Some of these include:

-Milk (All types including breast milk)

-Cheese and Butter

-Yogurt and Curd

-Ice-creams

-Custard

-Milk chocolates

-Bread and pancakes

Additionally, lactose may also be a part of many other processed foods. One is suggested to check the label of the food mentioning nutrition facts to know the presence of lactose in it.

In most of the children where symptoms are not very serious, only decreasing lactose content of diet, or opting for low lactose containing foods may help. In case of uncontrolled symptoms, your doctor may advice for complete cessation of lactose containing food.

What are the alternative foods a parent can offer their child in case of lactose intolerance?

If a child is lactose intolerant parents may worry about the nutrition of the child. Below are some foods that can help in providing your child with adequate calcium:

• Lactose-free dairy products, including lactose-free milk, cheese, etc.
• Plant-based milk alternatives- These include almond milk, soy milk, coconut milk
• Calcium-rich foods- Dark green leafy vegetables, and nuts such as almonds, beans, and fish are some foods with good calcium content
• Fruits and vegetables- Ensuring your child consumes fruits and vegetables makes sure they get adequate minerals and vitamins

Please note, that for babies less than six months of age, only lactose-free or minimal lactose-containing milk formulas are suggested, and should be taken as advised by your doctor.

In case of need, your doctor may also provide your child with calcium supplements. Discussion of a detailed diet plan with a dietician and pediatric gastroenterologist helps parents make sure that their lactose-intolerant child is receiving adequate calcium from other sources.

Is Lactose Intolerance treatable?

Most cases of lactose intolerance are temporary, due to infections and take 3-4 weeks to resolve. Your doctor diagnoses and treats the child of the primary infection, which helps in the resolution of lactose intolerance in them. If it’s due to a disease like Celiac and Crohn’s disease then too with the right diagnosis and treatment this condition is resolved.

In rare cases when the disease may be due to primary intolerance, it may require a lifelong change in diet.

Is Lactose intolerance the same as milk allergy?

No. Lactose intolerance is the inability to digest lactose and does not lead to the symptoms of allergy. The two are different conditions.

Though lactose intolerance can be a common cause of concern, with timely diagnosis it can easily be tackled. Parents should stay aware, to help their little children deal with lactose intolerance.

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