Lactose deficiency in premature infants. Lactase deficiency: treatment and signs of lactose intolerance in infants

Lactase deficiency is one of the rare metabolic diseases. Insufficient activity of this enzyme is typical for every second newborn under the age of 1 year. As the baby grows and matures, this pathology goes away on its own, but in most cases the child needs qualified assistance medical specialists.

What is the role of lactase in the body

Lactose, or milk sugar, plays an important role in maintaining the functional well-being of the newborn baby's body. Milk sugar provides at least 45% of all energy needs of a newborn’s body.

The main source of this substance is mother's breast milk. Suction milk sugar in the intestine occurs in a split form, when under the action of the enzyme lactase, milk sugar breaks down into molecules of galactose and glucose. In addition, lactose creates favorable conditions to implement the following processes:

growth and reproduction of beneficial microflora of the large intestine;
absorption of manganese, potassium and magnesium in the body;
security child's body valuable galactose, which is necessary for normal development visual apparatus and brain in the first months after birth.

Lactase deficiency is the main cause of disruption of the breakdown and absorption of milk sugar through the intestinal wall.

An adult suffering from lactase deficiency can solve this problem by stopping the consumption of whole milk. For a newborn baby whose food consists only of breast milk, this problem is of a serious scale.

Classification of lactase deficiency

Lack of lactase in the body can be caused by various factors. Modern classification Lactase deficiency is divided into the following types:

primary type of failure;
secondary type of failure;
deficiency due to hereditary predisposition.

The primary type of the disease does not have characteristic manifestations during the neonatal period and childhood. Symptoms of deficiency, in this case, tend to appear as a person gets older. The pathology is caused by a gradual decrease in enzyme activity.

The secondary type of the disease occurs with equal frequency among populations of different age categories, starting from the moment of birth. Diseases of the gastrointestinal tract (colitis, gastroenteritis, rotavirus infection) can contribute to the development of secondary lactase deficiency.

Lactase deficiency of hereditary origin is a consequence congenital anomalies development. The symptoms of the disease tend to be rapid development and progression. In especially severe cases, the presence of milk sugar (lactose) in the urine is determined in newborn children. To eliminate signs of the disease, it is enough to exclude foods containing milk sugar from the baby’s diet.

Children born prematurely often experience transient deficiency of digestive enzymes. The body of such children is not able to produce the required amount of lactase. This problem disappears on its own as the child grows and develops.

Symptoms and signs of lactase deficiency

All clinical picture This condition is based on the symptoms of lactose intolerance. Every child may have these symptoms. varying degrees expressiveness. The main symptoms of lactase deficiency in newborns include:

increased gas formation in the intestines (flatulence);
loose stool having a foamy character;
intestinal colic, accompanied by restlessness and crying of the child;
symptoms of fluid loss (dehydration);
frequent regurgitation of food;
weight loss or slow gain.

There is no relationship between the degree of deficiency and the severity of symptoms. Some children may experience skin manifestations lactase deficiency. These include atopic dermatitis. The secondary form of lactase deficiency is characterized by constipation in children.

There are a number of signs, the appearance of which should alert a nursing woman. These signs include:

holding the baby in their arms, parents can hear the sounds of rumbling in the baby’s intestines;
during the feeding process, the baby abandons the breast, long before satiation;
there are fragments in the child's stool undigested food(lumps);
the baby's tummy is constantly tense and swollen;
the child becomes restless, often cries and is capricious for no apparent reason.

Only a pediatrician can make a diagnosis of lactase deficiency after examining the child and assessing the data obtained. laboratory diagnostics. The appearance of similar symptoms can be caused by improper organization of breastfeeding or violation of breastfeeding technique.

Diagnostics

With the aim of accurate diagnosis lactase deficiency, a newborn baby will need to undergo tests such as:

Analysis of a child’s stool for the presence of carbohydrate fragments. This study is uninformative and its use is not justified. It is difficult to decipher the results, since the analysis technique is not able to distinguish galactose from lactose and glucose.
Blood test and lactose curve analysis. To conduct the study, the baby is given lactose in a small dosage, after which blood is drawn and subsequently examined.
Epithelial biopsy small intestine. The information content of this method is 90-95%. The disadvantage of this method is the need to put the child under general anesthesia.
Hydrogen test of exhaled air. The technique answers modern standards informativeness and safety of diagnostics. Based chemical composition air exhaled by the child, a conclusion is made about the presence of lactase deficiency. The disadvantages of this method are the high cost and the impossibility of performing analysis in children under 3 months.
Determination of the level of lactose concentration in urine. The effectiveness of the method is in doubt.
Biochemical study of the microflora of the large intestine. This analysis comes in second place after a biopsy of the small intestinal epithelium.

As additional methods for secondary failure, the following studies are used:

diagnosis of gastroenteritis and celiac disease (gluten intolerance);
identifying allergies to proteins cow's milk.

Treatment

Drug correction of lactase deficiency gives a noticeable effect only in children born prematurely. For the secondary type of deficiency, the use of bacterial preparations that promote lactase production is recommended.

To restore the microflora of the large intestine, they are used bacterial preparations Bifidumbacterin and Bifiform. The drug Bifiform is indicated for children over 2 years of age. Bifidumbacterin is recommended for use in children from birth. Its effect is based on restoration normal balance intestinal microflora.

As replacement therapy Enzymes are used that are mixed with pre-expressed breast milk.

At severe course In case of illness, parents are advised to completely stop feeding their child whole milk. In such cases, the baby is recommended to:

soy milk with minimal milk sugar (lactose) content;
medicines containing lactase in an immobilized state;
artificial nutritional mixtures containing rice or buckwheat flour.

For mild cases of the disease, a fermented milk diet consisting of yoghurt, acidophilus and kefir is recommended for the baby. After preliminary consultation with a pediatrician or breastfeeding specialist, the child is prescribed mixed feeding, consisting of breast milk and nutritional mixture, with a low concentration of milk sugar.

Everyone knows that babies need milk for nutrition. This is the main and only product on which the growth, development and health of the baby depends. Unfortunately, a small organism is not always able to process it correctly. Approximately twenty percent of newborns are diagnosed with lactase deficiency. This is the name given to a deficiency of the enzyme that breaks down milk sugar. And this, in turn, entails various unpleasant consequences.

The danger of lactase deficiency is due to the symptoms and consists of the following:

diarrhea can quickly lead to dehydration;
indigestion causes low weight gain or loss;
lack of important and useful substances due to their improper absorption, it leads to an imbalance in metabolism and causes problems in the functioning of some organs;
incompletely digested lactose provokes dysbiosis, fermentation and flatulence;
in cases where the tactics of treating the disease require the cessation of breastfeeding, the child loses powerful natural protection in the form of vitamins, minerals, immunoglobulins and other valuable substances that he received from mother's milk.

In order not to miss important signals from the infant body and to take adequate measures in time, it is important to “know the enemy by sight.”

Causes and types of disease

Regardless of the type of feeding, the lack of lactase in the body is provoked by the following factors:

Genetic predisposition. If close relatives of a child suffer from this disease, it is highly likely that it will also manifest itself in him.
Diseases of the digestive system. In this case, lactase deficiency is one of the possible consequences past intestinal infections, helminthic infestation, enterocolitis or allergies.
Low birth weight and prematurity- serious risk factors. If a child was born prematurely (or on time, but the organs and systems are not fully mature), in the first months of life he may also experience an inability to process milk sugar. Usually, as the gastrointestinal tract matures, the symptoms gradually disappear.

There are 2 types of lactase deficiency:

alactasia (when the enzyme is completely absent);
hypolactasia (when the enzyme is produced in small quantities or is characterized by reduced activity).

It can also be primary or secondary. In the first case, there are 3 forms:

1. Congenital(passed on by inheritance). The reason lies in gene mutation. It is quite rare. Both alactasia and hypolactasia are possible. This form of the disease can be suspected in an infant by weight loss and the development of dehydration. The faster the diagnosis is made and implemented special food, the greater the chance that the child will survive and adapt to life without dairy products.

2. Transitional(or temporary) form of lactose intolerance - this is exactly what we talked about above. This is what is typical for low birth weight and premature babies. By the time they were born enzymatic system It simply does not have time to develop fully, as a result of which the baby develops lactase deficiency. However, this is a passing phenomenon: as the body grows and develops, the disease will disappear. Therefore, as a rule, treatment is not necessary.

3. Functional a form that is recorded quite often. Its causes are not in pathology or immaturity of the digestive system, but in external factors:

feeding defects, in particular overfeeding. This is a serious burden on the fragile body: the enzymes simply do not have time to break down the incoming lactose, there is too much of it.
Low fat breast milk. As a result, it passes through the gastrointestinal tract too quickly, which also unnecessarily loads the digestive organs.

Reason secondary Lactase deficiency is damage to intestinal cells that can be caused by:

In case of secondary lactase deficiency there is no need to interrupt natural feeding. Doctors usually recommend taking enzymes before feeding and a diet for the nursing mother.

Symptoms

Let's look at the main signs of lactase deficiency:

The baby willingly takes the breast, but soon abandons it, starts crying and kicking its legs? Restlessness during or immediately after feeding, signals abdominal pain and intestinal colic. This is definitely worth paying attention to. U infants colic is part of adaptation to the outside world, but it is also a constant companion to lactase deficiency.
Flatulence and rumbling in the tummy, which is clearly audible.
Regurgitation, vomiting.
Stool changes: This is usually frequent, loose, greenish stools, with or without foam. However, constipation is also possible. In general, the stool differs from normal: it is unstable, the consistency is uneven, there are lumps or impurities, the smell is predominantly sour.
The child’s weight gain is insignificant or not at all. It even happens that the baby loses weight instead of systematically gaining it.
A rash may appear on the skin.
Diarrhea may cause dehydration.

Be that as it may, these symptoms should be considered comprehensively, since individually they are characteristic of many other diseases digestive tract. When making a diagnosis, one should take into account not only complaints and symptoms, but also the results of laboratory tests.

Diagnostics

Adults should not try to make a diagnosis on their own; lactase deficiency can easily be confused with something else. The correct tactic is to contact a local pediatrician (or gastroenterologist), who:

will examine the baby, ask about complaints, find out how and what he eats;
will conduct a test in which dairy products are excluded from the child’s diet completely or partially (if the problem is lactase deficiency, the symptoms will subside);
will send you for a stool test to determine the amount of carbohydrates in it - a result of more than 0.25% at a pH less than 5.5 confirms the diagnosis.

These are the main examination methods. Genetic tests and other tests are performed in case of urgent need, not every one of them is desirable for infant.

At the moment, there is no method that will give 100% confirmation or refutation of the diagnosis if only one was used. It means that reliable result can only give comprehensive examination with the full range of symptoms. In addition, an important criterion for the correctness of the diagnosis is how quickly the baby recovers from the moment treatment begins.

How and how to help a child

Most difficult case- congenital alactasia, when the enzyme is not produced by the body at all. Complete removal of lactose from the baby’s diet is undesirable, because it is necessary for the formation healthy microflora in the intestines. This move is justified only in severe cases of the disease.

Functional and temporary lactase deficiency requires limiting the consumption of milk sugar. The permitted amount is determined and subsequently adjusted based on the results of an analysis of sugar content in stool.

Interrupting natural feeding and transferring the baby to infant formula is not required in all cases, so do not rush into this. Mother's milk - indispensable assistant in the formation of immunity and intestinal microflora, a storehouse of valuable substances necessary for the full development of a little person. Therefore, if there is even the slightest opportunity to maintain breastfeeding, it should be taken advantage of. But it is necessary to give the child an additional enzyme.

The drugs “Lactazar”, “Baby-doc”, “Lactase Baby” and similar are prescribed. The enzyme is diluted in expressed breast milk and given to the baby immediately before feeding. The drugs are used until the child reaches 4–6 months, until independent lactase production is established.

If the symptoms are pronounced, you can resort to mixed feeding (alternating breast milk and lactose-free infant formula). However, the mother needs to be prepared for the fact that the introduction of formula over time may provoke the child to refuse the breast.

If the baby is on artificial nutrition, it must be replaced with another one with low or zero lactose content (depending on the severity of the situation). It is worth keeping in mind that this option may have disadvantages. The first mixture chosen is not always suitable; an allergy to some of its components may occur. While the body adapts, changes in stool are likely. It is better to select the mixture taking into account the opinion of the pediatrician and individual characteristics child. And remember that it needs to be introduced gradually.

Another important point: you have to try do not overfeed the baby. It is better to reduce portions and feed more often. Sometimes this measure alone helps get rid of clinical manifestations lactase deficiency. After all, the body produces exactly as much enzyme as is required to process a normal portion of milk.

We must not forget about proper nutrition for a nursing mother. Whole milk is excluded from her menu. Question about the use of kefir and other fermented milk products is decided individually with the pediatrician.

If the mother has an excess of milk, it is better to express a little before each feeding. This way, the baby will receive a little less foremilk, which is rich in lactose, and will quickly reach hindmilk, which is more nutritious and fatty. The latter takes longer to digest, and during this time the milk sugar has time to be processed.
You should aim to feed only one breast at one feeding. This will also help your baby receive hindmilk regularly. You should not pump additionally after feedings.
Babies with lactase deficiency are given complementary foods with caution, carefully monitoring the reaction. Give dairy-free porridges; it’s better to start with buckwheat, rice and corn grits.
Children's kefir and yogurt are administered from at least 8 months, after consultation with a pediatrician. If adults notice that they are poorly absorbed, they should be excluded. Cottage cheese begins to be given in small portions from 12 months. The baby is not allowed whole milk, and neither is the mother (while she is breastfeeding).

When something bothers the baby, the pediatrician prescribes symptomatic treatment. In addition to enzymes, these can be:

probiotics (Bifiform Baby, bifidumbacterin, linex) to bring the microflora into balance;
dill water or simethicone preparations for increased gas formation;
medicines for spasms (papaverine) for severe intestinal colic.

In case of secondary lactase deficiency all efforts should be aimed at combating the underlying disease that provoked hypolactasia.

Prevention

The congenital form cannot be corrected; there are no preventive measures against it. However, in this case, adults usually assume in advance that this is possible, know how to help and what to do. Prevention for the secondary form of the disease is to avoid gastrointestinal infections. And for this it is necessary to follow the rules of sanitation and hygiene, avoid contact with sick people, and strictly monitor the quality of food that ends up on the family table.

So, if the doctor has concluded that the baby has lactase deficiency, parents should not panic and urgently stop breastfeeding. IN Lately Unfortunately, this diagnosis has become very common and not always justified.

But even if your child does have a disease, keep in mind that only congenital complete absence enzyme poses a danger to his life and health. Other forms of pathology make it possible to cope with the problem by changing the diet of the nursing mother and baby, properly introducing complementary foods and using special medications. These measures will help provide the baby with the substances necessary for harmonious growth and development. Parents are required to be vigilant in case of any manifestation of anxiety in combination with alarming symptoms Find out the cause together with your pediatrician.

Health to you and your children!

Milk, especially breast milk, contains many useful microelements and vitamins, without which it will be difficult for the body to grow and develop. But some people are intolerant to dairy products due to the absence or insufficient amount of enzymes in their digestive system that break down lactose. Lactase deficiency is the inability to fully digest milk sugar; symptoms of the disease can manifest in both infants and adults.

What is lactase deficiency

Enzymes are responsible for the digestion of food in the stomach, which act on food in a certain way, breaking it down into its constituent elements, which are then absorbed and used by the cells of the body. Violation of the production of the enzyme that breaks down the carbohydrate contained in milk leads to the indigestibility of lactose, which negatively affects the condition of the body.

Symptoms

Often the diagnosis of “lactose intolerance” is made without any reason, almost based on a photo of stool. A newborn's intestines work differently than those of an adult, and characteristic symptoms, which make parents suspect that their child has lactose intolerance, are the norm for an infant:

intestinal colic and bloating;

frequent regurgitation;

frequent loose stools with undigested lumps of milk;

baby crying during and after feeding.

Although these signs worry parents, they are not symptoms of lactose intolerance. Worth checking out general state the baby’s body - is he gaining weight and height well, are there any rashes on his skin? allergic nature, are there any particular difficulties with excreting feces? In addition, parents should be alert to a decrease in hemoglobin and other abnormalities in the blood test.

In a baby

Lactose intolerance significantly affects the digestion process, preventing the body of newborns from receiving the necessary microelements, which affects its general development. It is worth paying attention to the following signs:

poor weight gain, developmental delays;

loose stools appear in combination with poor weight gain;

skin dermatitis;

lack of iron in the body, which cannot be treated;

very strong stool, difficulty with bowel movements.

Stool with lactase deficiency

At breastfeeding chair healthy child may have a slight sour smell, uneven consistency and undigested lumps of milk are allowed. When feeding with formula, the stool has more bad smell and dense consistency. With lactose intolerance, babies experience a green tint to their stools due to the fact that food is not absorbed by the intestines, foam appears due to increased gas formation.

In adults

After about a year, the number of enzymes that digest lactose decreases. Other foods are added and the amount of milk consumed is reduced. Sometimes symptoms of lactose intolerance in adults appear due to certain diseases. After consuming dairy products:

increased gas formation;

diarrhea (liquid foamy stool);

colic in the abdomen;

allergic skin rashes;

unpleasant belching;

general malaise and constant fatigue.

Causes

There are several causes of milk intolerance, which can occur at any age. Primary or congenital lactose indigestibility develops in the womb. In this case, hereditary lactase deficiency is often observed in close relatives - mother, father, grandparents. At bad heredity genetic diseases, special attention should be paid to possible symptoms diseases.

Secondary lactase intolerance may manifest itself as one of the symptoms the following diseases:

intestinal infections - rotavirus, dysentery, giardiasis, enteritis;

diseases of the gastrointestinal tract;

celiac disease;

intestinal dysbiosis;

Crohn's disease;

chronic pancreatitis;

food allergies;

rehabilitation after resection of the small intestine;

Classification

There are several types of lactose intolerance syndrome:

primary (congenital lactase intolerance) - formed at the genetic level when the enzyme that breaks down milk sugar is completely absent. It is inherited, found among residents of the Far North and some peoples in North Africa;

secondary - caused by some acquired or congenital diseases, when the underlying disease is treated, the signs of the disease disappear;

functional - the body does not have time to absorb lactic acid, although there is enough enzyme;

transient - typical for premature babies whose digestive system. As a rule, it is temporary and goes away by three to four months.

Diagnostics

Diagnostics insufficient production The use of enzymes for the breakdown of lactose is very difficult, because the clinical picture (intestinal upset, flatulence, allergies, general malaise) can manifest itself in other serious diseases. The simplest and most common way to put correct diagnosis- gradually eliminating foods containing lactose and monitoring for differences in symptoms. In addition, a number of tests are done to confirm the diagnosis.

Analysis for lactose intolerance

To determine the diagnosis, it is advisable to do several tests that help determine intolerance to dairy products in adults and children:

identifying an increase in carbohydrate levels in feces;

analysis to determine the degree of acidity of stool - increased acidity(above 5.5) appears when there are problems with digesting lactose;

genetic test;

breath test - when lactose breaks down in exhaled air, it is detected increased content hydrogen and methane;

taking a sample (biopsy) of the mucous membrane of the small intestine.

Treatment

The peculiarity of the disease is that treatment methods vary depending on the age of the patient. Pediatricians do not recommend interrupting breastfeeding for premature babies; it is better to express the first 10-15 grams of “fore” milk and feed the “second” milk, which is fattier and contains less lactose. In newborn children the situation is different, it all depends on the type of disease.

If congenital lactose intolerance is detected in infants, they should be switched to lactose-free formulas. Otherwise, treatment of the underlying disease that caused insufficient enzyme activity should be started, and lactase preparations should be added. Stopping breastfeeding is a last resort. Children growing up on artificial formulas also need to identify the cause of lactose intolerance and prescribe therapeutic ones (lactose-free, gluten-free or soy formulas).

When the disease manifests itself at an older age, parents rush to give up foods that cause lactase production, but doctors recommend this only when the syndrome is congenital. In other cases, therapy with lactase drugs is carried out; the intestinal microflora is improved with probiotics, which help the body better absorb lactic acid. Depending on how lactose intolerance manifests itself in adults, specific therapy is selected.

Medications

When there is a lack of enzymes to break down lactose, it is the intestines that suffer first, so it is recommended to take medications that improve its microflora:

Bifidumbacterin is a probiotic containing at least 500 million prepared colonies of microorganisms. One of the most effective drugs for digestive disorders. The downside is the long course of treatment.

Bifidum Bug is a liquid concentrate of bifidobacteria, does not contain lactose.

Acipol - live acidophilic bacteria, used for acute intestinal infections to restore intestinal cells.

Lactase preparations

There are drugs that promote the absorption of lactose. Some act in acidic environment, others in slightly alkaline and neutral.

Lactazar - contains 700 units of lactase enzymes. Minus - like any dietary supplement, it is not considered a medicine.

Lactrase - active substance Thylactase is added to dairy products. The disadvantage is the high price.

Lactase Baby - for infants and toddlers, promotes the production of the enzyme that breaks down lactose, can be added to breast milk or formula. The downside is the high cost.

Diet for young children

Infants are prescribed a diet according to their condition: if weight gain is normal, but frequent and loose stools, then drugs containing lactase are used, but breastfeeding is maintained. The baby should be fed with hind milk, it is less rich in lactose, night feedings are recommended, and it is better to change breasts more often. If the situation worsens, it is suggested to replace breast milk artificial feeding mixture with reduced lactose content or lactose-free mixtures. When introducing complementary foods, emphasis should be placed on vegetable purees (carrots, zucchini, cabbage).

Diet for older children and adults

consuming lactose with other foods;

replacing cow's milk with goat's milk;

separation daily value lactose for several meals;

the higher the fat content, the less lactose in the product;

replacing milk with heavy cream;

use of products with live lactic acid bacteria;

Mom's diet for poor lactose absorption in infants

Doctors don't have consensus, what diet should a nursing mother follow if her child suffers from lactase intolerance. In general, it is not recommended to go on a completely lactose-free diet; it is better to reduce your intake. A strict recommendation is to limit gas-forming foods - it is necessary to exclude black bread, grapes, pastries, and legumes from the diet.

Forecast

Is it possible to cure lactose intolerance and how long should you follow the diet? The most disappointing prognosis is for those with primary lactase intolerance. They will have to stick to the diet for the rest of their lives. In case of an acquired disease, you must wait for the onset of remission and the absence of signs of manifestation of the disease, then gradually introduce dairy products, starting with cheese, kefir, cottage cheese - that is, fermented milk products.

With transient lactase intolerance in premature babies born prematurely, the disease proper treatment passes by three to four months. Infants and children growing up on formula milk also have a high chance of correcting lactase deficiency. With the introduction of complementary foods, in the presence of appropriate therapy and compliance with feeding rules, the symptoms disappear.

Video

Mother's milk is an irreplaceable source of vitamins, minerals, amino acids, proteins, carbohydrates, the content of which is the most balanced for the full formation, growth and development of the child. It has a unique composition, as it is enriched with more than 400 elements. The highest quality artificial formulas are unable to replace breast milk. Main carbohydrate human milk- lactose or milk sugar.

Lactose gives milk a pleasant, sweet and refreshing taste. However, this carbohydrate, essential for the body, can become the culprit of such an unpleasant disorder as lactase deficiency (LD) in infants. It may entail serious consequences and health problems for the baby. To help the baby, it is necessary to recognize the signs of the disease in time, consult a doctor who will help determine the cause of the disease and choose effective treatment. According to statistics, lactase deficiency occurs in newborns in 6–10% of cases. Adults also suffer from this disease.

The beneficial carbohydrate lactose is present in the milk of all mammals, but the concentration of this substance varies and depends on the species. It is the woman's milk that contains more lactose than the milk of other mammals. The second place in lactose content is occupied by the female dolphin - the most “intelligent” animal in the world.

For infants, FN is more relevant, because in the first year of life mother's milk the basis of their nutrition, and acidity gastric juice and enzymatic activity in children of the first year of life is very low. Gradually, after overcoming the age of six months, it increases and problems with the gastrointestinal tract leave the baby.
Lactose is needed for normal brain development. In addition, it provides 40% of the baby's energy needs. The substance breaks down into small intestine under the influence of the enzyme lactase. Because of this, one large molecule breaks down into two smaller ones - glucose and galactose.

The biological benefits and functions of lactose are difficult to overestimate. It is necessary for the normal absorption of calcium by the body. Another substance improves metabolic processes. Breast milk sugar is also used to feed and reproduce lactobacilli in the gastrointestinal tract, which, in turn, are responsible for normal stool and form immunity.

Lactose is found not only in the milk that a child receives during breastfeeding. The baby will receive the substance through the introduction of complementary foods such as cheese, cottage cheese, kefir and other fermented milk products.

Lactose molecules are necessary for the balanced and harmonious functioning of the central nervous system. Also, its constant synthesis in the body helps prevent diseases. of cardio-vascular system. The baby must eat mother's milk, because it is the main source for his growth, development, and energy.

The essence of lactase deficiency

If the lactase enzyme in the small intestine is not produced enough, undigested lactose moves further along the gastrointestinal tract. Lactose reaching the large intestine is a breeding ground for the development of lactic acid bacteria. At the same time, fermentation processes intensify, which manifest themselves in the form of colic and increased gas formation. The child has a tummy ache, he is capricious, often cries, and the mother cannot understand what caused the anxiety. In addition, lactose in the large intestine causes the accumulation of water in it, as a result of which the baby suffers from loose stools.

Lactase deficiency should be distinguished from lactose intolerance and lactose allergy.
Lactose intolerance is a condition when the body completely does not accept dairy products. In the case of LN, the body simply does not have enough of the necessary enzyme to break down lactose, and with proper treatment, the balance can be restored.

Intolerance can manifest itself in the form of diarrhea, constipation, pain and cramps in the intestines, and rash. The resulting acidic stool causes damage to the intestinal walls. They become irritated, which leads to problems with the absorption of nutrients.

One more problem - allergic reactions when drinking milk. When a person has a lactose allergy, consuming dairy products may cause anaphylactic shock and even without timely medical care, cause death. It is important to identify allergies as early as possible. To do this you need to go through clinical tests and examination.

Types and causes of lactase deficiency

The pathogenesis (causes of occurrence) is quite wide. Children born prematurely are predisposed to the disease. This is due to the fact that the lactase enzyme begins to be produced in the fetus at 34 weeks intrauterine development. Every month its quantity increases, production becomes more active.

Another reason for the development of LN is genetic predisposition. If the disease is provoked hereditary factor, the chances of completely curing it are minimal. Very rare.

Depending on the root cause of the decrease in enzyme activity, LN can be primary or secondary. In the first case, the cells of the small intestine (enterocytes) are not damaged, but lactase activity is reduced or completely absent. Primary or congenital deficiency is often associated with congenital mutation genes and may be a sign of a genetic disorder. Congenital defects are divided into types:

Transitional. Typical for babies born prematurely. Premature babies are more susceptible to lactase deficiency. It is associated with underdevelopment of the infant's intestines. This type often develops in children born at 30, 34 weeks of pregnancy, when the concentration of lactase in the fetal gastrointestinal tract is reduced. Transient lactase deficiency is temporary and goes away after some time.
Functional. The enzyme is produced in normal quantity, but other dietary habits lead to the fact that food quickly enters the large intestine and lactase does not have time to act.

Secondary LN develops when enterocytes are damaged. It is because of malfunctions in their work that the necessary enzyme is not produced. The disease is acquired in nature, that is, it develops against the background of another disease. Cell damage can occur under the influence of immune and infectious diseases, as well as inflammatory processes.

Only an experienced doctor can detect the disorder, its causes and the type of disease. If the baby has become restless, cries a lot, or has problems with the intestines, you should consult a pediatrician to learn more about diagnostic methods.

Many medicines contain the component lactose. Therefore, it is very important for children with lactase deficiency to replace them with alternative pharmacological agents. Parents need to carefully study the composition of all medications and food products used.

Symptoms

Symptoms of FN are similar to those of other gastrointestinal diseases. Pronounced signs of pathology are:

with foam and mucus;
during or after feeding, the baby becomes restless;
the child has bloating;
he is not gaining weight;
he has increased gas formation;
stool analysis shows high acidity and high sugar content.

The appearance of these signs is a reason to consult a doctor and not self-medicate. Symptoms of gastrointestinal diseases in infants are very similar to each other. Only a competent specialist can make a diagnosis.

Lactose overload

Sometimes LN symptoms are caused by lactose overload. It is associated with the fact that the mother has excess quantity milk (hypergalactia). Lactose in large quantities contained in foremilk, which is 90% water, so it easily and very quickly passes into the intestines. Even if the enterocytes are not damaged and work at full capacity, they do not have time to cope with the resulting volume of carbohydrate. It turns out that the child is healthy, but lactose does not have time to break down. This is what causes the symptoms of LN.

Also this state may occur when a nursing mother offers her baby both breasts at one feeding. The baby receives only lactose-rich foremilk. In this case, the baby may experience a deficiency of proteins and fats, which hind milk is rich in.

You can get rid of the problem if you stick to simple recommendations. The main principle is to establish breastfeeding processes. You should not allow your child to overeat. It is necessary to feed him with one breast, making sure that the baby completely empties the mammary gland.

The required interval between feedings should be maintained, taking into account the baby’s age. Usually the feeding process lasts no more than 20 minutes, but this criterion is relative and depends on the individual characteristics of the baby.

Diagnostics

LN can become a serious problem. Your pediatrician will tell you whether it is necessary to stop lactation based on the severity of your symptoms. The specialist draws conclusions and prescribes treatment only after testing. Unfortunately, there is no single test that can be used to make a diagnosis. Many tests are quite unpleasant and painful. Most often, the following studies are used to diagnose LN:

Biopsy of the small intestine. Several cells will be taken using a special probe for research to determine the level of the lactase enzyme. The technique is rarely used due to its traumatic nature and the need to use general anesthesia and penetration into the infant's intestines, high cost.
Lactose curve. The test consists of giving the child a portion of milk on an empty stomach. Then blood is drawn within an hour. Based on the results of changes in indicators, the doctor can conclude that there is an enzyme deficiency. Some experts say there are false positive results from this test. Therefore, it is better to conduct it in conjunction with another type of research.
Hydrogen test. This method is to ensure that the child receives the required portion of protein. Then, using special equipment, the healthcare worker determines the level of hydrogen in the exhaled air. The negative point is the high cost of the equipment and procedure. In addition, the minimum limit for indicators in children has not been established.
Stool analysis for carbohydrates. The technique is not the most reliable, but remains popular. The presence of false positive results is associated with the lack of uniform carbon standards. Also, the method does not answer which carbohydrates are found in feces. Correctly deciphering the data can only be done in conjunction with data from other studies and after collecting an anamnesis.
Coprogram. It is used to determine the acidity of a child's stool. The method is used in combination with other diagnostic measures. The pH norm is 5.5 and above.

Examining a baby is not easy. Many procedures and tests are painful or require extensive intervention in the body. It is worth considering that if the problems are truly caused by LN, taking lactose for tests may provoke additional painful sensations, increased other symptoms.

Dr. Komarovsky notes that congenital lactase deficiency is extremely rare. In most cases, LN, as a diagnosis, is made in the case of a transient form, i.e. the baby has the enzyme, but there is much more food and lactose than he can digest. Sometimes LN develops against the background of viral intestinal infections. The way out of this situation is simple - limit the amount of food you eat, switch to lactose-free formulas, or take the lactase enzyme prescribed by your doctor.

Treatment

Therapy for lactase deficiency is a set of measures that also includes diet therapy, the use pharmacological agents. It is important to understand that there is no single panacea for this problem.

Catering

The following recommendations will help you get rid of the disease:

Compliance with breastfeeding regimen. Organization of nutrition includes the correct schedule, the position of the child, latching on the breast, and normalizing the amount of milk. Experts insist that after feeding you should not express your breasts, because healthy fatty milk is simply poured out or frozen, and the baby receives watery first milk, which does not have time to be digested due to the rapid progress. It is better to feed from one breast; you can change it only if the baby has completely emptied the first. Never take your baby away from sucking; let him eat as much as he needs. It is recommended to continue night feedings.
Another step towards treating LI is a hypoallergenic diet. Dairy products should be excluded from the mother's diet. How long diet therapy lasts depends on the success of its use (disappearance or weakening of the child’s symptoms) and is regulated medical specialist. In addition, along with medical worker It is better to create a diet for a young mother taking into account the replenishment of the deficiency of substances that she will lose if she excludes dairy products. As prescribed by a doctor, a woman can take vitamin and mineral complexes that contain calcium.
If unpleasant symptoms appeared in the baby due to overeating, the mother is recommended to express breast milk before feeding, so the baby will receive hind milk, which is more useful. However, the technique should be used with caution, after consulting with a breastfeeding expert.
Fermentation of breast milk allows you to continue breastfeeding with LI. In this case, the enzyme deficiency is compensated by adding its synthetic analogue to expressed breast milk. The use of this method involves the use of finger feeding, through a syringe, from a cup, or a spoon. The use of bottles with a nipple is not recommended due to the increased risk from the breast when full contact breastfeeding is restored.
The use of low-lactose and lactose-free mixtures. This therapeutic baby food made from protein hydrolysates using triglycerides. Most often, these artificial mixtures are recommended for severe forms diarrhea when readily available sources of energy are needed.
Application of medical nutrition products based on soy protein isolate.

Drug therapy

Preparations with lactase enzymes. Prescribed only by a medical specialist, name, dose, how long the course of using the funds will last. Special attention the young mother must pay attention to precision when dosing. It is important to understand that this remedy It only acts to alleviate the symptoms of the disease without affecting the cause of the disease.
It is very important to restore the intestinal microflora. For this, the baby may be prescribed prebiotics. This medications, which contain active lacto- and bifidobacteria. By adjusting the functioning of the intestines and restoring damaged tissues and cells, it is possible to eliminate the manifestations of LN.
Symptomatic treatment is reduced to the use of drugs to relieve infant colic (Espumizan, Bobotik), antidiarrheals (Loperamide, Smecta), vitamin-mineral complexes, antispasmodics.

If the general condition of the gastrointestinal tract is positive, and the child is diagnosed with primary LN, after a few months the disease may go away on its own as soon as the enterocytes start working on their own. Therapy is mixed. It is important to influence the disease on several levels at once. Only an attentive and responsible approach will help eliminate unpleasant symptoms and save the child from problems in the future.

Breastfeeding is a natural and necessary process for a newborn baby. The longer it lasts, the more complete the baby’s development will be. However, it happens that a child cannot digest mother's milk or artificial formula based on cow's milk. The number of such children reaches 20% of all newborns. In this case, they talk about lactose intolerance - milk sugar. If such a problem exists, then symptoms of lactose deficiency in newborns and infants appear very quickly. It is impossible not to notice them. The main thing is to quickly establish proper nutrition baby.

First, you need to understand the terminology so as not to confuse what the baby still has enough and what he does not have.

Lactose is a component of breast milk, the content of which reaches 85%. It is necessary for the proper absorption of microelements, the formation of the immune system, and intestinal microflora.

In the baby's body, lactose (milk sugar) breaks down into glucose and galactose. Glucose provides 40% of the energy needs of a newborn. Galactose is involved in the formation of retinal tissue and the development of the central nervous system.

Lactase is an enzyme that is synthesized in the small intestine of a child. It is he who breaks down the lactose that enters the baby’s body along with milk.

It turns out that the lactose contained in milk is always enough for the baby, but there can be problems with lactase if for some reason the baby does not produce the enzyme.

It is common to talk about lactose intolerance or lactase deficiency.

Where does lactose intolerance come from and its types?

There are three reasons why milk sugar is not absorbed by a child, and it does not matter whether the child is breast-fed or bottle-fed:

Heredity is a genetic failure due to which lactase production centers do not function properly. This is primary lactase deficiency
Diseases of the gastrointestinal tract - in this case, the production of lactase in infants is suppressed by the current disease: infectious diseases, enterocolitis, allergies, worms. This is secondary lactase deficiency
Underdevelopment of the digestive organs is observed in premature or weakened children born on time. This type of disease is called transient

The disease occurs in two forms. If lactase is not produced at all, then this is complete lactase deficiency - alactasia. If it is synthesized only in a certain amount, then a partial deficiency of the enzyme occurs - hypolactasia.

Dr. Komarovsky, a popular pediatrician with 30 years of experience, has a slightly different point of view on this issue. He believes that the problem with lactase deficiency is largely fictitious and only a very small percentage of babies actually have real difficulties with digesting lactose. His practice shows that the basis for milk aversion is the usual overfeeding of the child. Lactase in a newborn or infant is produced in sufficient quantity, but he is given so much milk that the baby cannot digest it. To establish the truth, the doctor suggests visiting pediatric gastroenterologist and carrying out special analyses.

How to spot lactose intolerance in your baby

Signs of lactose deficiency are easy to notice immediately after the baby is born. If left unattended, the child's health can be seriously affected. Symptoms of insufficient lactase production are:

The child refuses the breast soon after the start of feeding - the child begins to actively suckle the breast, has a good appetite, but after a while he becomes restless, whiny, stops eating
Abdominal pain, colic - the symptom appears during or after feeding, the baby cries and kicks his legs
Regurgitation to the point of vomiting
Rumbling and bloating
Changes in the color, smell and shape of feces - most infants experience diarrhea, some children experience constipation
Increased gas formation
If diarrhea occurs, the stool foams, has a greenish color, the smell becomes sour, and there are lumps in the stool. The frequency of bowel movements reaches 12 times per day. This condition is called fermentative dyspepsia
Atopic dermatitis
The weight of a newborn or infant does not increase, and in the worst cases, malnutrition develops - insufficient body weight, that is, the baby loses weight

It is important to remember and know that the signs of lactase deficiency partially coincide with the symptoms of dysbiosis, intestinal infections, and rotavirus. Put accurate diagnosis Only a gastroenterologist can do it based on examination and laboratory tests.

Diagnosis of lactose intolerance

If there is a suspicion of lactase deficiency, the doctor takes the following measures:

Examines and learns all the nuances of feeding and behavior of the baby
Conducts dietary diagnostics - the mother is asked to reduce or remove dairy products from the child’s diet. The results are recorded in a special diary
Tests for lactase deficiency - for laboratory research The baby's stool is collected. The presence of carbohydrates is determined - the norm is 0.25%, pH - with lactose intolerance it becomes less than 5.5
In rare cases, due to the complexity of the procedure, lactase activity is studied directly in the small intestine
If there is a suspicion of the hereditary nature of the disease, then how to determine lactose deficiency in this case, there is also a way - to conduct a genetic test

How to help a child with lactase deficiency

When the diagnosis of lactose intolerance is confirmed and the nature of the disease is determined, a treatment method is selected. When identifying hereditary form drug therapy carried out throughout life. Treatment of the secondary form begins with eliminating the root cause.

For all types of lactose intolerance, the following measures are taken:

Completely avoiding products containing lactose or reducing its amount
Taking lactase enzyme before breastfeeding
When breastfeeding, switch to combined feeding - alternating with artificial nutrition for up to 6 months
Expressing foremilk, which contains maximum lactose
The right choice of mixture - soy-based, lactose-free, low-lactose, with the addition of lactase enzyme

The choice of treatment regimen is determined by the doctor. Parents should not experiment with the baby’s health, because the consequences may be irreversible.

Prevention and prognosis

Prevention of lactase deficiency begins with a responsible attitude towards pregnancy - the child should be born full-term and at a normal weight. For a newborn, prevention consists of excluding infectious diseases of the gastrointestinal tract. Unfortunately, it will not be possible to prevent the development of a hereditary form. The main thing is to find out about such cases in the family history in time.

The prognosis for lactose intolerance is as follows:

Primary - cannot be treated
Secondary - lactase synthesis is restored partially or completely. Depends on the severity of the underlying disease and treatment
Transient - goes away with appropriate treatment as the gastrointestinal tract develops by 6 months or earlier