FOOD PROBLEMS IN CHILDREN: LACTOSE
If a child or adult lacks the ability to deal with lactose, the sugar passes through into the intestine, where it provides a bonanza for waiting bacteria. They consume the sugar, giving off gas and toxic products as they grow and multiply. These toxins then cause unpleasant symptoms such as pain and diarrhoea. They may be at the root of colic, which is why lactose intolerance is important here.
Following a bout of diarrhoea – due to an infection or whatever other cause – the digestive processes in our intestines take a little while to get back to normal. During this recovery period, there is often far less lactase produced by the gut lining than there is normally. This is something that happens in both children and adults, and it may cause a continuation of the diarrhoea if milk is consumed after an infection. Formula feeds without lactose are available, and your doctor may be able to prescribe one for you for a time, if your baby has had gastroenteritis and continues to have colic or diarrhoea afterwards. In the case of breast-fed babies, it is probably better, on balance, to continue breastfeeding, even though breast milk contains lactose. In general, children and adults should not be given too much milk to drink if they are recovering from a stomach upset. Yoghurt and cheese (but not cottage cheese) are usually tolerated because they contain far less lactose. Soya milk is lactose-free.
It is also possible that some small babies have insufficient lactase to cope with very large feeds – they can digest small feeds, but if their morning feed is larger than usual, the extra lactose overwhelms their capacity to cope with it. This could explain why some babies only have colic in the evening, when the morning feed reaches the intestines and the bacteria that live there begin to feed on the undigested lactose. This theory has recently been investigated scientifically, and the results suggest that it could well be correct.
In the past, it was often assumed that all babies who could not tolerate milk were lactase-deficient, and this idea is still current in some quarters. It is now known that most children who are sensitive to cow’s milk are actually reacting to the proteins it contains. But the diarrhoea produced by this reaction may, in turn, cause lactase deficiency. Doctors refer to this as secondary lactase deficiency. There are readily available tests for lactase deficiency, but these do not distinguish between true lactase deficiency (or primary lactase deficiency) and secondary lactase deficiency. More complicated tests can distinguish the two, and these show that primary lactase deficiency is actually very rare. So if you are told that your baby is lactase deficient after some routine tests, you should be prepared to question the diagnosis and ask your doctor to help you investigate the possibility of food sensitivity, as described in the following section.
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