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Lactose Intolerance In Children Less Known And Cause For Concern

In general, primary lactose intolerance does not manifest in children before five years of age.

Children showing signs of lactose intolerance should only be fed dairy products with naturally lower lactose content, and after a period of limiting food with lactose, the child can consume small amounts of food and drinks containing lactose. Picture courtesy of Sunway Medical Centre.

KUALA LUMPUR, Dec 11 – From the day a child is born, it is pertinent that the baby is fed with the most essential nutrient — milk.

It is the one thing that will help the child grow up healthy and wise with all the necessary vitamins, minerals and nutrition.

However, if a baby starts experiencing diarrhoea, constant crying and restlessness, as well as a loss of appetite after milk feeding, parents will need to be wary as the child may be suffering from lactose intolerance.

According to Sunway Medical Centre paediatric gastroenterology and hepatology consultant Dr Ong Sik Yong, lactose intolerance is a common gastrointestinal condition caused by the inability to digest and absorb dietary lactose.

Understanding Lactose And Its Benefits

Lactose is actually the main carbohydrate in human breast milk, as well as cow’s milk. It is also present in many other dairy products such as cheese and yoghurt.

The lactose that is ingested by humans needs to be broken down through hydrolysis by the lactase that is bound to the small intestine membrane before it is absorbed.

For young infants, they actually do not absorb all of the ingested lactose from breast milk (physiological lactose malabsorption).

This malabsorbed lactose is then fermented in the colon into short-chain fatty acids, hydrogen, carbon dioxide, and methane.

It is also converted into lactic acid by enteric bacteria (streptococcus lactis and others) and becomes prebiotic in our gut.

The increased counts of Bigidobacteria (good gut bacteria) and increased concentration of short-chain fatty acids provides considerable protective effect on colonic mucosal integrity and are beneficial for early immune development.

Number Of People Affected By Lactose Intolerance

“Newborn infants naturally express sufficient lactase to digest about one litre of breast milk daily, and in many populations, lactase levels will decline after weaning period (also known as lactase non-persistence).

Approximately 70 per cent of the world population are affected by lactase non-persistence, which causes the condition of primary lactose intolerance,” Dr Ong shared, adding that in general, primary lactose intolerance does not manifest in children before five years of age.

Furthermore, lactose intolerance in young children is said to be typically caused by underlying gut conditions such as gut infection, cow’s milk allergy, celiac disease, or inflammatory bowel disease.

It is also mostly transient and improves with resolution of the underlying gut pathology.

According to a study, the estimated prevalence figures for primary lactose intolerance due to lactase non-persistence are 2 to 5 per cent in Scandinavia, Germany, and the United Kingdom, 17 per cent in Finland and France, about 50 per cent in South America and Africa, while Southeast Asia charts between 90 to 100 per cent.

Symptoms Of Lactose Intolerance

Children with lactose intolerance have one or more intestinal or extraintestial symptoms upon consumption of food containing lactose, which include:

  • Develop abdominal discomfort, bloating, flatulence, and/or diarrhoea. Usually, symptoms begin about 30 minutes to two hours after consumption.
  • Their stools would have low faecal pH (less than 5.5) and may cause perianal skin irritation and excoriation (raw irritated lesions on skin surrounding the anus).

Such incidences usually happen after an episode of acute gastroenteritis, when a child transiently loses the ability to digest lactose. However, in most circumstances, a baby can continue with breastfeeding.

“Only when there are symptoms that are progressive or troublesome such as perianal excoriation, the child may need to temporarily stop breastfeeding, but the mother can continue to express breastmilk to maintain lactation.

“Babies with transient lactose intolerance can be given lactose free formula or soy formula for one to two weeks until the child recovers,” Dr Ong advised.

As for primary lactose intolerance in children, this condition usually only happens after the child turns five, but it can also present as early as two years old.

When this happens, the symptoms can only be managed by limiting lactose in their diet, thus, parents are advised to keep a vigilant eye on their child’s dietary needs.

Managing A Lactose Intolerant Diet

Children showing signs of lactose intolerance should only be fed dairy products with naturally lower lactose content, and after a period of limiting food with lactose, the child can consume small amounts of food and drinks containing lactose.

Symptoms should be observed throughout this trial period and overtime, the parents or even children themselves would be able to tell how much of lactose they can take.

Besides that, parents can also consider using lactase enzyme, which can be taken prior to consumption of dairy products to reduce unwanted consequences from consuming lactose.

“Children with lactose intolerance may have a little dairy product in their diet as milk and other various dairy products are a major source of calcium and vitamin D.

“Hence, it is important to make sure children who has limited dairy product intake to have other non-dairy food which are rich in these nutrients, like fish with soft edible bones (i.e. salmon and sardines) as well as green leafy vegetables.

“They may also require calcium or vitamin D supplement for their growing bones,” Dr Ong concluded.

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