Milk is a basic ingredient for children’s diet because it’s rich in nutrients (calcium, vitamin D, protein, fat) that are essential for healthy growth.
But what happens when a child refuses to drink milk because it causes digestive problems and makes them suffer? Perhaps they have lactose intolerance?
Lactose is a sugar which is exclusively contained in milk and helps with calcium absorption. Lactose intolerance is the decreased ability to digest lactose due to lack of lactase, an enzyme which breaks down lactose in the small intestine.
What are the symptoms?
Lactose which is not broken down passes into the large intestine and is fermented. This results in the production of gas which causes abdominal pain, cramps and bloating. Moreover, increased water flow into the bowel causes diarrhea.
How common is it?
Congenital alactasia is extremely rare and starts showing up in neonates.
In persons with genetic predisposition, gradual decrease in the production of lactase is observed after two years, with symptoms appearing typically after the 6 years of age. It is the most common type of lactose intolerance, with a frequency in the child population in Europe of 20%.
Secondary lack of lactase may appear after gastroenteritis or chronic intestinal disorders (such as celiac and idiopathic inflammatory bowel disease) that can damage the small intestine mucosa. The frequency of lactose intolerance in children after gastroenteritis from rotavirus is close to 13%. The production of lactase, after gastroenteritis, comes back to normal levels after a period of 2 to 8 weeks.
Which milk is ideal for children with lactose intolerance?
When children follow a low lactose diet, calcium and vitamin D intake must be monitored to ensure sufficiency. Calcium is necessary for growth as well as the metabolism of growing children. Vitamin D helps with intestinal calcium absorption and its deposition into the bones.
In conclusion, lactose-free milk which is fortified with calcium and vitamin D is the ideal formula for children with lactose intolerance.
* Heinz F Hammer MD, ChristophHӧgenauer MD, Lawrence S Friedman MD, Shilpa Grover MD, MPH, AGAF Lactose intolerance: Clinical manifestations, diagnosis, and management, Up To Date, last updated: Jan 15, 2018.
* Suchy FJ, Brannon PM, Carpenter TO, et al. National Institutes of Health Consensus Development Conference: lactose intolerance and health. Ann Intern Med 2010; 152:792.
* National Digestive Diseases Information Clearinghouse. Lactose intolerance. Available at:http: //digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance. Accessed August 18, 2005
* Abrams SA, Griffin IJ, Davila PM. Calcium and zinc absorption from lactose-containing and lactose-free infant formulas. Am J Clin Nutr.2002;76:442– 446
Pediatrician – Neonatologist
Formerly at the A’ University Clinic of “Agia Sofia” Hospital