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Lactose intolerance in babies is a subject that often causes many doubts. Check out some answers

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The Scientific Department (DC) of Pediatric Nutrology of the Brazilian Society of Pediatrics (SBP) has developed a short questionnaire to help physicians and patients understand the issues related to lactose intolerance in infants and children, that is, the body's inability to absorb properly one of the carbohydrates present in milk (lactose).

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The correct way to treat the problem often causes many doubts among parents. To help society gain a better understanding of the topic, Dr. Jocemara Gurmini prepared ten frequently asked questions and answers on the topic. Below, the reader will find general guidelines about the disorder, which can be very helpful.

In the case of babies, are milk allergy and lactose intolerance the same thing?

Cow's milk allergy and lactose intolerance are different illnesses. In lactose intolerance, we are talking about a carbohydrate (lactose) that does not cause allergic reactions, but because it is not properly absorbed, it is processed by intestinal bacteria, forming gases and causing symptoms of abdominal discomfort, cramps, distension, flatulence, loose bowel movements, sometimes explosive, and perineal dermatitis. Milk allergy involves the protein, which, in this case, crosses the mucous barrier of the small intestine and enters the bloodstream. Various allergic phenomena can occur, such as digestive symptoms (soft bowel movements, blood in the stool, vomiting, poor weight gain) or reactions in other devices and systems (hives, eczema or, in more severe cases, anaphylactic shock).

At what age do symptoms of intolerance usually appear?

Lactose intolerance can be primary, such as a premature infant's deficiency; the congenital (rare); and that of the adult or ontogenetic type. Secondary lactose intolerance occurs due to some diseases that lead to changes in the intestinal mucosa, changing the size of the villi, an area where lactase (an enzyme that digests lactose) is produced. This fact can occur in celiac disease, infectious enteritis, malnutrition, among others.

Another important fact refers to the fact that lactose intolerance is dose-dependent, that is, perhaps small volumes of milk or dairy products are well tolerated. Some children tolerate 1 to 2 glasses of milk a day without symptoms. Concomitant intake of solids increases gastric emptying time and intestinal transit, allowing for a longer time of action of endogenous lactose. So, take care to have an adequate calcium intake or, if necessary, drug supplementation. In allergy, a small volume is enough for symptoms to appear.

What are the symptoms in adults and children? Are the same?

The amount of lactose needed to trigger symptoms varies from individual to individual, depending on the amount of lactose ingested, the degree of lactase deficiency, and the type of food with which the lactose was ingested. The main symptoms are: abdominal pain, borborygmus, abdominal distension, flatulence, explosive watery diarrhea, perianal dermatitis, dehydration and metabolic acidosis may occur in more severe cases.

How to find out if the child has developed intolerance? When should we take her to the doctor?

Seek medical evaluation in cases of symptoms mentioned above before starting a diet without milk and dairy products. Remember that individuals with a diet low in milk and dairy products and without adequate replacement or supplementation are more likely to develop inadequate bone mineralization.

If the child is allergic or has an intolerance, what should the diet be like? What can replace milk? What precautions should be taken?

In cow's milk allergy, a diet without milk and dairy products is necessary, with special attention to the labels, as the milk may come with another name, such as: powdered milk, skimmed milk, fluid milk, dairy compound, casein, caseinate, lactalbumin, lactoglobulin , lactulose, lactose, whey proteins, whey, whey protein. Also pay attention to medicines and cosmetics. In case of milk allergy, do not consume foods that contain cheese, yogurt, butter, cream, whole milk, skimmed milk, powdered milk, condensed milk, products prepared with milk and dairy products. Also avoid products with cheese flavor, artificial butter flavor, caramel flavor, coconut cream flavor, burnt sugar flavor. The child who is being breastfed must be maintained with breast milk and the mother will follow the diet, in case of using infant formula, this will be replaced by a special formulation with hydrolyzed protein or amino acids

Is it genetic?

The first description of lactose intolerance was made by Hippocrates 400 BC and the reduction in lactase activity occurs more frequently in some ethnic groups (eg, Eskimos, Jews, Orientals, Indians, Blacks) that progressively lose enzyme activity. Its prevalence can range from 10% to 90%, depending on the ethnicity considered. It is postulated that this variation in prevalence is due to natural selection that occurred in people raising domesticated dairy cattle, consumers of milk and dairy products in the diet, with the acquisition of a dominant genetic trait that perpetuates lactase activity after weaning, by selecting individuals genetically able to digest lactose. In these cases, there is the persistence of a “regulatory gene”, recently sequenced and located on chromosome 2 (2q21), which does not allow the suppression of lactase synthesis in the programmed time. Despite this discovery, genetic tests have no diagnostic function for lactose intolerance and do not influence treatment.

Is there any way to prevent lactose allergy or intolerance?

In lactose intolerance, there are no prevention guidelines. In food allergy, however, there is a lack of evidence that sensitization starts in the intrauterine period. To date, there is little evidence that maternal diet during pregnancy and lactation prevents allergy. It is important to encourage exclusive breastfeeding up to six months of age, and supplemented up to two years or more; and not delay the introduction of solid foods or the so-called “more” allergens (fish, peanuts, nuts, eggs, etc.) in order to prevent allergies. There is no justification for delaying the introduction of solid foods after the sixth month of life, under the risk of increased sensitization to food antigens and possible manifestations of allergies, especially atopic dermatitis.

Are there levels of intolerance?

The amount of lactose needed to trigger symptoms varies from individual to individual, depending on the amount of lactose ingested, the degree of lactase deficiency, and the type of food with which the lactose was ingested.

Is there treatment? Or is it for life?

Intolerance to secondary lactose and that of premature infants are transitory, the individual returns to tolerating it after a period of diet without carbohydrate. The others are for life.

Are there any number of how many people in Brazil have lactose intolerance?

There are no data on the exact number of individuals with lactose intolerance.