Kids complaining of cramps, loose motions and abdominal pain after having a glass of milk, ice cream or any dairy products might have lactose intolerance. It means baby has difficulty in digesting lactose that is main component in milk or milk derived products. Usually symptoms of lactose intolerance clear in 30 minutes to two hours after ingesting milk products.
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One day, a 28 days old baby presented with loose stools since 15 days, at my clinic, along with not gaining weight after 1 month of life. Baby went for stool routine and stool for reducing substance and showed transient intolerance to mother’s milk which got relieved on its own (happened due to viral diarrhea) and baby started gaining weight on mother’s milk only. No change in milk was done but continued on breast milk only.
It is also called as lactase deficiency or hypolactasia which is the inability to digest and metabolize lactose which is present in milk as a sugar. It is not an allergy but it is caused because of lactase deficieny.
Lactose- it is a mixture of galactose and glucose. Human milk contains 200mmol/l of it which is being digested by enzyme lactase to form glucose and galactose.
Lactose containing food:
• Condensed milk
• Curd
• Cheese
• Processed food
• Stuffings
Types of lactase deficiency:
• Primary lactase deficiency- it is due to genetics
• Secondary lactase deficiency- it is transient due to small intestinal mucosal disease, abnormalities of brush border cells and transport processes.
• Congenital lactase deficiency- is very rare, autosomal recessive genetic disorder that prevents lactase expression from the first feed. It is a serious disorder in which the infants may fail to thrive unless switched to lactose free formula feeds.
Patient presents with:
• Abdominal cramps and bloating
• Diarrhoea
• Blood in stools
• Nausea
• Flatulence
• Vomiting
• Failure to thrive
Diagnosis:
• History of patient
• Familial history of patient
• Stool acidity test, hydrogen breath test
Sometimes misdiagnosed as:
• Irritable bowel syndrome
• Gastroenteritis
• Celiac disease etc.
Management:
• Avoiding lactose containing food items like milk which depends upon which type of lactase deficiency is there.
• Change to soy milk, rice milk, almond milk, oat milk etc.
Do not say no to milk, first assess for lactase deficiency
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