If you have problems with a chair that occurs in infants or iskusstvennomu from the very first days, as it increases the volume of injected power in the milk can make thinking about the presence of lactase deficiency. This abnormality of the enzyme metabolism, deficiency of substances that actively breaks down in the intestine and the milk sugar – lactose. If the enzyme lactase is lacking, then the milk sugar is fermented in the gut by bacteria, produced an excess of water and carbon dioxide that forms diarrhea and disrupts digestion. But Lactasoy failure is often confused with many other digestive problems (disruption of the microbial flora, infections, functional dyspepsia). Therefore, an important sighting and accurate diagnosis, which is especially difficult for infants
How does lactase deficiency in infants?
There are a number of manifestations, the permanent formation which can be suspicious regarding the presence of lactase deficiency, the baby who is fed breast milk or regular formula. It is important that parents noticed that shortly after eating as soon as food enters the small intestine, where should be the digestion of milk sugar and the digestion of food components, the formation of such symptoms as bloating of the belly, which is much growling, the kid in the background that starts to cry. The formation of gas in the intestines leads to stretching of the bowel loops, which forms of colic, from which the child is in pain. He starts screaming and crying inconsolably, which suffers from sleep, and any improvised and folk methods do not help.
The symptoms are formed because of violations related to the breakdown of milk sugar that occurs inside the small intestine, as well as problems with absorption of excess fluid in the region of the colon is formed diarrhea.
It is important
Typical changes of stool – frequent and liquid feces with foam, acquiring sour milky smell, formed as a result of active fermentation processes in the intestine. Appetite in children is good, no fever and malaise, but there are frequent diarrhea and poor weight gain.
Usually a lot of lactase in the mix, breast milk contains less of this substance, so diarrhea may not be expressed very strongly. The symptoms will be more pronounced if the child gets a front rich in lactose milk when its put to the breast often and not for long.
As a diagnosed “lactase deficiency”?
Usually the doctor makes a diagnosis based on typical symptoms, of which he is complaining about parents, and also supplements the data in clinical studies – fecal analysis (coprogram), which will change the digestion of certain components, with additional methods.
It is important to understand that some children lactase deficiency is relative, it is associated with immaturity of the gut and its enzymes, the degree of its severity is small and the treatment itself does not require at all, only certain dietary adjustments.
There are also a number of tests that can confirm the presence of lactase deficiency in combination with the clinical picture. But there is among them a perfect studies that is always in 100% of cases confirmed or denied the diagnosis, is a condition that is difficult to identify in connection with influences of various other intestinal problems. Select the analysis by age, so he was maximally informative and minimally uncomfortable for the baby.
Tests and studies with lactase deficiency
Among all the studies that can confirm the presence of lactase deficiency, there are more and less reliable, and also different degrees of complexity and trauma for infants. So, most accurately confirm the diagnosis can biopsy the small intestine. The removal of a piece of cloth by means of the instruments introduced into the digestive tract of the crumbs in infants is possible only under anesthesia. In these cases, the fence several samples from different parts of the intestine can help in the determination of enzyme activity according to the state of the mucosa and the degree of health of most of the lactase. This method is rarely used even in adults, in infants it is generally used only rarely in connection with risks of anesthesia, the actual procedures of the fence, etc.
Construction of lactose curve is another method of determining the presence of the enzymatic defect. Its essence is the fasting a couple of servings of milk sugar and then testing the blood for hours. According to the results obtained in the study carried out a comparison with averages and fluctuations of glucose. The results data may indicate the presence of lactase deficiency, if the curve reaches a peak for glucose, which indirectly speaks about the lack of the enzyme that breaks down milk sugar.
This test is difficult to apply to infants, as it should be done on an empty stomach, without giving the child and taking it from him several times over the hours blood. In addition, the load of lactose leads to pronounced symptoms of abdominal discomfort, which makes this examination in infants is extremely limited. I will add here more and high percentages of false results – both negative and positive. The informative value of this test is higher than the study of feces on carbohydrates, it is usually used to clarify doubtful situations.
The hydrogen breath test is the determination of hydrogen content in the air which the child breathes after load of lactose. For kids difficulties in measuring results are related to the fact that are not clearly defined performance standards. In addition, as with previous studies, there are also difficulties with the unpleasant symptoms that causes a load of milk sugar.
The main method of diagnosis of lactose intolerance
Leading method on the basis of which diagnose lactase deficiency is the fecal level of carbohydrates. Even though he is one of the most simple methods, but the accuracy is not as great as the level of lactose in the diet of children varies greatly depending on how tightly ate the baby.
Difficulties related to the fact that the exact standards for allowable levels of carbohydrates stool is defined conditionally averaged. Scientists today say that rules should be differentiated according to age, from month to month in the first year of life. So, standards not more than 0.25% is considered fair only for children under the age of six months, and for toddlers at an earlier age are due to the immaturity of enzymes can be higher. Today, the Institute gabrichevskogo suggests standards in the following interval:
- The child can have the carbs in the Kale no more than 1%,
- Child to two months – not more than 0.8%
- In the period from 2 to 4 months that the standards are not above 0.6%, up to six months – not more than 0.45%.
In addition, it defines carbohydrates in the feces in their total value, that may be in addition to lactose and other options (galactose, glucose), therefore it is not always the data can be in favor of lactase deficiency. The interpretation of this analysis is conducted only with those complaints and the clinical picture, and after decoding the coprogram of child.
Holding coprogram gives specific data about the presence of digestive problems in the child. Particularly closely need to examine such parameters as the pH of faeces, normally it leaves about 5.5 or more, in the presence of lactase deficiency is lowered to 4.0 or less. Also examine the levels of fatty acids, the more you have, the more likely the diagnosis.
Can also be the basis for the diagnosis and trial feeding with the introduction of the Lactase enzyme in the drug. If the background of all positive tests and subsidies enzymes all digestive processes are aligned, this speaks in favor of lactase deficiency.
Parezca Allen, pediatrician, medical columnist