Lactose intolerance in children, what should be considered?

Have you ever seen your little one experience diarrhea after drinking milk? If so, it is likely that the child has lactose intolerance, especially when accompanied by a variety of other characteristic symptoms. If left untreated, this condition will cause various nutritional problems in children. In order not to be mistreated, let's dive deeper into lactose intolerance in children and how to handle it properly.

What is lactose intolerance in children?

Lactose intolerance is the appearance of clinical symptoms because the body has difficulty digesting the intake of lactose, which is the sugar in milk. Normally, the body has the enzyme lactase, which acts as a sugar breaker to make it easier for the body to absorb.

The lactase enzyme will later be responsible for breaking down lactose into glucose and galactose, so that it can be directly absorbed by the intestine. However, in children who are lactose intolerant, their bodies only produce very little of the enzyme lactase from the intestine.

As a result, the child's body has difficulty breaking down the lactose that enters, causing various symptoms of intolerance to appear. Starting from flatulence, stomach pain, nausea, vomiting, sour smelling stools, to diarrhea.

Diarrhea is one of the typical symptoms experienced by children with lactose intolerance. In other words, lactose intolerance and diarrhea are two conditions that almost always occur together in children.

Rotavirus infection can also result in lactose intolerance

Lactose is a source of carbohydrates in the form of sugar which is usually found in breast milk and formula milk. After the child consumes food or drink sources that contain lactose, the small intestine is responsible for breaking it down into glucose and galactose.

The absorption process is assisted by the enzyme lactase which is present in the microvilli in the small intestinal tissue. Here, the microvilli are in charge of expanding the surface of the intestine in order to facilitate absorption of nutrients in the intestinal cells.

Furthermore, the results of the absorption process enter the bloodstream to be delivered throughout the body as nutrients. However, it is a different story if the child has a virus called rotavirus. This virus is considered dangerous because it is easily transmitted and can cause severe diarrhea in children.

Diarrhea caused by rotavirus is what then makes the microvilli in the intestine damaged. As a result, the production of the enzyme lactase, which is actually found in the intestine, will be disrupted so that the amount is not optimal for digesting lactose.

In short, lactose intolerance can not only cause diarrhea in children, but also vice versa. Severe diarrhea, particularly those caused by rotavirus, can lead to lactose intolerance in children.

What are the types of lactose intolerance in children?

Lactose intolerance in children is not only one type, here are several types:

1. Primary lactose intolerance

Primary lactose intolerance is one of the most common types of intolerance in children. This condition is caused by a decrease in the production of the enzyme lactase with age. This then makes milk intake difficult for children to digest.

2. Secondary lactose intolerance

In contrast to primary lactose intolerance, secondary lactose intolerance in children tends to occur less frequently. Secondary lactose intolerance occurs when the production of the enzyme lactase decreases due to disease, injury, or surgery involving the intestine.

Some diseases that can cause lactose intolerance in children include celiac disease and Crohn's disease.

3. Congenital lactose intolerance

Congenital lactose intolerance is less common than the other two types of intolerance. This condition is caused by the absence of lactase enzyme activity in the body, which can be inherited from a gene family called autosomal recessive.

In addition, congenital lactose intolerance in children can also be acquired by premature babies due to insufficient production of the enzyme lactase.

What are the food sources that contain lactose?

Most of the lactose is generally found in milk and dairy products. For example, milk, whey, powdered milk, and nonfat milk usually contain lactose in them. In addition, various processed food products are also often given additional milk and processed products.

Milk and processed products that contain lactose

Here are some milk and lactose-containing products to watch out for in children with intolerance:

• Cow's milk
• Goat milk
• Ice cream
• Yogurt
• Cheese
• Butter

Types of foods that sometimes contain lactose

Here are some types of food that sometimes contain lactose from milk, so it should be noted in children with intolerance:

• Biscuits
• Cake
• Chocolate
• Candy
• Cereals
• Fast food

Lactose intolerance in children cannot be underestimated. It's best to always check food ingredient labels as some foods may contain "hidden" lactose.

Here are some types of foods that can contain lactose:

• Bread
• Some processed meats such as sausages and ham
• Mayonnaise

How to treat lactose intolerance in children?

Until now, there is no treatment that can increase lactose production in children with intolerance. However, as a parent, you can help maintain the child's condition in ways such as:

• Avoid consuming large portions of milk or its processed products, and it's even better not to eat them even though the portions are small.
• Pay close attention to the ingredient composition labels listed on food or beverage products, especially for products that are susceptible to containing lactose.
• Change the type of milk for children with lactose-free milk.
• Quoted from medicalnewstoday, it is advisable to follow a lactose-free diet for 2 weeks, then reintroduce foods with lactose to assess tolerance levels. Consuming 12 grams of lactose at one time does not seem to have any effect.

Several conditions of lactose intolerance in children still allow them to consume milk and its processed products even though a little. It's just that, if it turns out that your child is not recommended at all to consume milk, its processed products, or various types of foods with lactose content, don't worry.

Children can still get a source of calcium, vitamin D, and other nutrients from the following food sources:

• Almonds
• Tofu
• Cabbage
• Salmon, tuna and mackerel
• Egg yolk
• Beef liver

After a positive diagnosis of lactose intolerance, the doctor will usually suggest several types of food and drinks that children can consume.

The Guidelines for Balanced Nutrition from the Indonesian Ministry of Health also recommend that children who experience diarrhea and lactose intolerance should not be given milk from animal sources. Instead, provide eggs, soy milk, and fish to help meet the nutritional needs of the child.

Meanwhile, if a child experiences diarrhea due to lactose intolerance, the Indonesian Pediatric Association (IDAI) recommends the following actions:

• Administration of hypotonic oral rehydration fluid (CRO)
• Quick rehydration for 3-4 hours
• Breast milk is still given
• You should not miss your daily food intake
• Dilute formula is not recommended
• Replace special formula milk according to the child's condition
• Antibiotics are only given based on certain indications

If diarrhea in a child with lactose intolerance does not go away within 3 days, consult a doctor immediately. Especially if the child has a fever, has very runny bowel movements mixed with blood, and vomits repeatedly.

When can special formula milk be given to children?

Breastfeeding should not be missed as long as the child has lactose intolerance and diarrhea. This is because breast milk contains immune substances which are important to help the healing process of diarrhea.

However, if the child is not getting breast milk, IDAI recommends considering changing formula milk during acute diarrhea (less than 7 days) as follows:

1. Diarrhea without dehydration and mild or moderate dehydration: normal formula feeding is continued.
2. Diarrhea without dehydration or mild and moderate dehydration with clinical symptoms of severe lactose intolerance (other than diarrhea), lactose-free formula can be given.
3. Diarrhea with severe dehydration can be given lactose-free formula.

Important to note. It is better to avoid giving formula milk for allergies to children who have acute diarrhea, even though the child does not show clear allergy symptoms. Because lactose intolerance and food allergy are two different conditions with different treatments.

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