Think your little one might be lactose intolerant? Look out for these signs and learn about how you can help your little one.
WORDS REBECCA WONG
Symptoms of lactose intolerance typically depend on the volume of lactose consumed, with children experiencing more symptoms as lactose consumption increases, explains Dr Anthony Porto of the American Academy of Pediatrics. These symptoms are commonly observed within 30 minutes to several hours of lactose consumption and include pain, abdominal distention, bloating, bad breath, flatulence and diarrhoea.
“The unabsorbed lactose exerts an osmotic effect in the gastrointestinal tract where fluid is excreted from the lumen, causing diarrhoea,” notes Derrick Ong, founder and principal dietitian at Eat Right Nutrition Consultancy. “In addition, unabsorbed lactose is a substrate for intestinal bacteria, especially in the colon,” writes Melvin. B Heyman in a 2006 study for the journal Pediatrics. “Bacteria metabolizes lactose, producing volatile fatty acids and gases that lead to flatulence. In some cases, complaints of recurring abdominal pain may be the only present symptoms, observe Vicky R. Bowden and Cindy Smith Greenberg in Children and Their Families: The Continuum of Care. Abdominal pain occurs when sufficient intestinal gas is produced by the bacterial metabolic processes to cause stimulation of the intestinal nervous system, explains Heyman.
It’s also important to note the difference between lactose intolerance
and a dairy allergy, both of which may share similar symptoms.
Whilst lactose intolerance occurs due to maldigestion of lactose, a dairy allergy is an immune response to dairy proteins, explains Joseph E. Pizzorno in Textbook of Natural Medicine. Additionally, a dairy allergy typically causes hives, vomiting, diarrhoea, rashes, swelling of the lips and face, and may even trigger a severe allergic reaction known as anaphylaxis. In contrast, the more common symptoms of lactose intolerance are stomach cramps and diarrhoea, says Lindsay Boyers in The Everything Guide to Gut Health.
Diagnosing Lactose Intolerance
If you suspect that your little one is suffering from lactose intolerance, it’s best to schedule a consultant with your paediatrician. When it comes to diagnosing the condition, your child may be asked to take a breath hydrogen test. “An increase in breath hydrogen levels after ingestion of a load of lactose indicates lactose malabsorption,” explain Bowden and Greenberg. In the case of lactose-deficient children, breath samples typically yield a higher percentage of hydrogen (more than 20 parts per million above baseline), mention Hockenberry and Wilson. For infants and young children who are unable to do a breath hydrogen test, a stool acidity test may be conducted, says Dr Porto.
Acidic stools (i.e. stools with a low pH value) are a possible indicator of lactose malabsorption.
Another stool test looks out for the presence of glucose in the stool, another sign of undigested lactose.
Dealing with Lactose Intolerance
The best way to deal with lactose intolerance is to eliminate lactose from your child’s diet, advises Charlotte Lin, senior dietitian at the National University Hospital. “Lactose is most commonly found in dairy foods like milk, cheese, yoghurt and ice cream,” she observes. “Certain foods may also contain hidden sources of lactose — these include sausages, margarine, instant mashed potatoes and foods in batter or breadcrumbs.” In the instance of secondary lactose intolerance, lactose needs to be removed from the diet for two to four weeks.
“If your child experiences mild lactose intolerance, moderate consumption of dairy, consuming dairy products with meals and substituting dairy products with lactose-free foods could alleviate the symptoms,” recommends Ong. “According to the British Nutrition Foundation, consumption of two to three grams of lactose per 100 grams of food would not trigger lactose intolerance symptoms. Hard cheeses (cheddar, Emmental, edam and parmesan cheeses) surprisingly contain a negligible amount of lactose, making them safe for consumption.” Lactase enzymes may also be prescribed in tablets or drops – these may be ingested with lactose-containing foods to improve tolerance, says Bowden and Greenberg. With regards to giving lactose-sensitive children ready-made meals, Ong advises using caution. “Whey powder and dried skimmed milk may be present in these foods, so be sure to read nutrition labels carefully,” he says.
Naturally, you may also be concerned about your child’s calcium intake, given how dairy products often provide a good source of calcium.
If symptoms are severe and require a complete removal of lactose
from your child’s diet, your paediatrician may refer him or her to a dietician,
who can help with recommending alternative sources of nutrients.
Consider providing your child with other calcium-fortified foods such as sardines (bones), tofu and green leafy vegetables like watercress, says Ong. Calcium-enriched soy milk is another good alternative. Given how children require around 500-700mg of calcium every day, a suggested diet may consist of one and a half glasses of soymilk (675mg Ca), 2 sardine fish (540mg Ca), or 4 tablespoons of ikan bilis (540mg Ca), Ong recommends.