How to tell if your child is lactose intolerant? Does your child experiences diarrhea, stomach pain or bloated stomach after drinking milk? Are you hit with questions as to what to feed the child other than milk? Hold on! Firstly, let’s understand the problem. What is the lactose intolerance, its causes, symptoms and treatment?

WHAT IS THE LACTOSE INTOLERANCE?

Lactose intolerance is a condition occurring when the digestive system has trouble digesting lactose, found in milk and milk products. This is different from that of milk allergies. So, let’s understand, what exactly happens if a child is lactose intolerant. Lactose is composed of two simple sugars namely, glucose and galactose. Normally, when we consume lactose rich foods, an intestinal enzyme called lactase digests lactose into its simple counterparts (glucose and galactose). This helps in its easier absorption in the small intestine as well as the bloodstream.

However, in the case of lactose intolerant people, the ineffective lactase enzyme doesn’t break down the lactose. So this undigested lactose reaches the large intestine where colonic bacteria converts them into short-chain fatty acids and gas including hydrogen, carbon dioxide and methane, causing bloating, child stomach pain/ cramps and diarrhea. (What are other causes of stomach pain?)

What are the causes/types of lactose intolerance?

Depending on different factors, the causes/types of lactose intolerance are as follows:

• Primary lactase deficiency: It is most commonly observed and it is also called as lactase non-persistence. Here, the production of the enzyme lactase declines with time (usually around age 2 or 5). Children start experiencing the unpleasant symptoms of lactose intolerance in their adulthood. In some cases, offsprings inherit from their parents.
• Secondary lactase deficiency: This usually occurs due to an infection, injury or disease involving the small intestine. Secondary lactase deficiency is temporary and can be improved on treating the disease or infection. A well-known example of this is a digestive disorder called celiac disease which impairs the small intestine and causes temporary lactose intolerance. Once the intestinal damage heals, people with celiac disease can tolerate milk and milk products. (What are the foods good for digestion?)
• Developmental lactase deficiency: Premature babies or babies born before 34 weeks with poorly developed gastrointestinal tract lacking enzymes are more likely to have developmental lactase deficiency. This condition lasts only for a short period after birth since developmental changes happen as the child grows. However, the majority of premature infants will be able to tolerate breast milk and lactose-containing formula. (What is developmental delay in a child?)
• Congenital lactase deficiency: In this type of deficiency, the small intestine doesn’t produce the enzyme lactase from birth. Affected parents pass on this disorder to their offspring which results in severe diarrhea and weight loss when lactose-containing foods are fed. 

What are lactose intolerance symptoms?

If your child is lactose intolerant, he/she might show the below mentioned symptoms/signs. These symptoms can depend on the amount of milk and milk products consumed and lactase that their body produces. Generally lactose intolerant child will show symptoms 30 minutes or 2 hours after food consumption.

Symptoms include:

• Stomach pain/ cramps
• Nausea
• Bloating
• Gas formation
• Diarrhea
• Vomiting

How to diagnose lactose intolerance?

Firstly, the paediatrician looks into the medical, family and diet history of your child. Secondly, the doctor might prescribe the following tests:

• Hydrogen breath test: The child takes a lactose drink and breathes in the hydrogen breath tester tube. The level of hydrogen in the breath will be measured before and after consuming a high lactose drink. If the breath shows high levels of hydrogen, then it means that the child is lactose intolerant.
• Lactose tolerance test: This test determines how well the lactose is absorbed by the child’s digestive system. After fasting, the child drinks lactose liquid and the stool test is carried out for the next 24hours. 
• Biopsy test: This test involves lactase analysis and is done based on the severity of the child’s symptoms. A small tissue sample is drawn from the small intestine to measure the levels of lactase present.

Treatment of Lactose Intolerance:

The treatment of lactose intolerance depends upon the child’s symptoms, age and health. It also depends on the severity of the condition. Mostly the treatment of lactose intolerance will not help the child’s body to produce more lactase but the child’s symptoms can be managed by limiting the lactose intake. The pediatrician may also suggest lactase enzymes for your child.

Other tips to manage lactose intake in a child’s diet:

• Introduce small amounts of milk and milk products to the child’s diet and observe if the child has any symptoms. Moreover, note down the foods causing symptoms and avoid them.  
• Try milk and milk products with a combination like milk with cereal or cheese with crackers. The symptoms may be fewer when consumed in this way.
• Consume products that naturally contain low lactose like hard cheeses and yoghurt.
• Pick lactose-free or lactose-reduced milk and milk products at the supermarket. Unlike regular milk and milk products, they have lactase enzymes added to them. It is also a better option to get calcium in the diet. 
• Check the ingredients of any packaged foods before giving them to your child.

Foods that can help:

The child with lactose intolerance consumes little or no milk in their diet, which is a great source of calcium. Calcium aids in bone growth, repair and prevents certain diseases. The required amount of calcium has to be provided to the child through calcium rich non diary foods. For the body to absorb calcium, Vitamin D is needed. (Why calcium & vitamin D are important?) 

Below is the Recommended Dietary Allowances (RDA) for calcium and vitamin D to be present in child’s diet based on their age:

Age	Amount of Calcium/day	Amount of vitamin D/day
0-6 months	200 mg	400 IU
7-12 months	260 mg	400 IU
1-3 years	700 mg	600 IU
4-8 years	1000 mg	600 IU
9-18 years	1300 mg	600 IU

The calcium rich non dairy foods that can be included in a child’s diet:

• Green veggies like turnip greens, broccoli, kale and collard greens.
• Soft and edible bone containing fishes like salmon and sardines
• Ragi
• Moringa
• Tofu
• Calcium-fortified juices and cereals
• Almond and soy milk with added calcium
• Dried figs
• Papaya

You can also talk to a pediatrician and provide calcium supplements to the child if he/she doesn’t get sufficient calcium from the diet. 

Vitamin D: Since Vitamin D is required for calcium absorption in the body, it is necessary that the recommended dietary allowances (RDA) for vitamin D is also met in the child’s diet. Vitamin D food sources include eggs and liver.

How to live with lactose intolerance?

Unpleasant symptoms can be caused by lactose intolerance. However, it is not necessary that you avoid all the foods containing lactose. You can figure out which food your child can handle and not. If you remove any food, then make sure the required nutrients are met with other foods. You can also talk to your child’s pediatrician about the diet plans and changes that may help your child. 

Lactose intolerance vs Milk allergies: 

Many parents get confused between the terms – lactose intolerance and milk allergies. Although, both the terms sound similar- they describe two distinct digestive disorders, one being severe than the other. (What are common food allergies faced by kids?)

Main differences between Lactose intolerance and milk allergies are:

	Lactose Intolerance	Milk Allergies
Mechanism	Enzyme deficiency	Immune mediated reaction
Onset of symptoms	Usually in adulthood	During first year of life
Caused due to	Lactose, the carbohydrate present in milk	Cow’s milk proteins
Symptoms	Stomach pain, gas, bloating, diarrhea, vomiting, nausea	Stomach pain, vomiting, diarrhea, abdominal pain, itching, wheezing, shortness of breath, anaphylaxis
Dietary treatment	Low or no lactose diet	Cow’s milk protein-free diet

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