From the Guidelines
Lactose intolerance is a common condition in children that can be effectively managed through dietary modifications and lactase enzyme supplements, prioritizing nutritional adequacy and symptom reduction over complete dairy elimination. The management of lactose intolerance in children is crucial to prevent exacerbation of symptoms such as diarrhea, gas, and bloating, while ensuring adequate nutrition, particularly calcium intake 1.
Key Considerations in Management
- Dietary modification is the primary approach, focusing on reducing lactose intake to tolerable levels rather than complete elimination of dairy products.
- Small amounts of dairy can be consumed with meals, and lactose-free or reduced-lactose products can be used as alternatives.
- Aged cheeses, which contain minimal lactose, can also be part of the diet.
- Lactase enzyme supplements, such as Lactaid, can be taken before consuming dairy to help digest lactose and reduce symptoms.
Nutritional Adequacy
- Maintaining adequate calcium intake is crucial, with recommended daily intake ranging from 700-1300mg depending on age.
- Lactose-free dairy products or non-dairy calcium sources like fortified plant milks, leafy greens, and calcium-fortified foods can help meet calcium needs.
- Most children with lactose intolerance can tolerate small amounts of lactose (about 4-8g, equivalent to 1/3-2/3 cup of milk) without symptoms, especially when consumed with other foods.
Approach to Lactose Intolerance
- The condition results from reduced lactase enzyme production rather than an allergy, and symptoms are dose-dependent and not harmful, just uncomfortable.
- Therefore, a balanced approach that allows for some lactose intake while managing symptoms is preferable to complete dairy elimination, as evidenced by guidelines for the management of acute diarrhea in children, which suggest the use of full-strength, lactose-free, or lactose-reduced formulas under certain conditions 1.
From the Research
Prevalence of Lactose Intolerance in Children
- Lactose intolerance is a common condition that affects a significant portion of the world's population, with approximately 75% of the world's population losing the ability to digest lactose at some point 2.
- The prevalence of lactose intolerance varies widely among different regions and countries, with around 70% of the adult population having limited expression of lactase enzyme 3.
- In children, lactose intolerance can be primary, secondary, congenital, or developmental, with differences in lactase deficiency leading to varying degrees of intolerance 4.
Symptoms and Diagnosis of Lactose Intolerance
- Symptoms of lactose intolerance include abdominal pain, bloating, flatulence, and diarrhea, with considerable variability in severity 2.
- Diagnosis of lactose intolerance can be performed through non-invasive methods such as the hydrogen breath test, or invasive methods like intestinal biopsy determination of lactase concentrations 4.
- The hydrogen breath test is a commonly used method for diagnosing lactose intolerance due to its non-invasive nature, low cost, and high sensitivity and specificity 5.
Recommended Management of Lactose Intolerance
- Treatment of lactose intolerance consists of reducing or eliminating lactose from the diet, supplementing lactase, and inducing colon microbiome adaptation by probiotics 3.
- The use of lactase-treated dairy products or oral lactase supplementation can help manage lactose intolerance, as well as limiting lactose-containing foods or dairy elimination 4.
- It is essential to preserve breastfeeding in infants with lactose intolerance, and lactose reduction or elimination should be transient, with replaced foods having similar calorie, protein, mineral, and vitamin content 6.
- A dietetic approach has a crucial role in managing lactose intolerance, and the use of specific labeling can help guide patients to choose safer products on the market 3.