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Understanding Lactose Intolerance in Children

Lactose, a primary component of milk, necessitates the action of an enzyme for proper digestion and absorption in the human gut. A research team from Australia has examined prevalent misconceptions about lactose intolerance in children, presenting their findings in a recent paper.

What is Lactose Intolerance?

Lactose intolerance is a common condition characterized by the inability to digest lactose, a sugar found in many everyday foods. Approximately 70% of the global population experiences this condition, which can lead to symptoms such as abdominal pain, flatulence, and diarrhea. While children under five typically tolerate lactose well, intolerance often develops after this age. It is important to differentiate lactose intolerance from cow’s milk allergy (CMA), as the latter requires complete avoidance of milk products, while lactose intolerance can often be managed with lactose-free formulas that still contain cow’s milk protein. Misunderstandings about lactose intolerance in children persist.

Types of Lactose Intolerance

Ralf Heine and colleagues from the Murdoch Children’s Research Institute have identified four distinct types of lactose intolerance:

  • Developmental Lactase Deficiency: Temporary condition seen in premature infants, improving as they grow.
  • Congenital Lactase Deficiency: A rare genetic disorder where lactase is completely absent from birth.
  • Lactase Non-Persistence (LNP): A common form affecting about 70% of the global population, where lactase activity declines after weaning. This typically does not affect children under five.
  • Secondary Lactose Intolerance: Results from other gastrointestinal conditions, such as gastroenteritis or Crohn’s disease.

Diagnosis of Lactose Intolerance in Children

Diagnosing lactose intolerance in children differs from infants. While infants often display diarrhea, older children typically experience symptoms like bloating and abdominal pain. Accurate laboratory diagnosis is essential, particularly to rule out secondary lactose intolerance, which can have different underlying causes. Stool samples are commonly used to assess lactose absorption based on sugar content.

Treatment of Lactose Intolerance in Children

Infants diagnosed with lactose intolerance should continue breastfeeding, or if formula-fed, be given a temporary lactose-free formula. For older children with persistent diarrhea, a short-term reduction in lactose intake may be necessary, although reintroduction is encouraged afterward. Infants with congenital lactose deficiency require lifelong lactose restriction, while older children may tolerate small amounts depending on the severity of their condition. Lactase supplementation has also been suggested as a way to alleviate symptoms.

Conclusion

The prevalence of misconceptions surrounding lactose intolerance in children can lead to inappropriate treatment options. It is uncommon for children under five to present with this condition, and those who do should be evaluated for potential underlying gastrointestinal issues. Education for parents and healthcare providers is crucial to ensure accurate diagnosis and effective treatment. Addressing these misconceptions should be a priority in the medical community.

Written by Ingrid Qemo, BSc

Reference: Heine, R.G., et al. 2017. Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited. World Allergy Organization Journal. DOI 10.1186/s40413-017-0173-0