Need to Know about Lactose Intolerance in Children

Three days ago I was invited to provide a health orientation at an Elementary school about the kind of foods which should be given to children and knowing the food they can tolerate but surprisingly people aren't aware of Food intolerance especially in this part of the world. which is getting quite common in today’s children and it can be difficult to know whether your infant or child is having symptoms of lactose intolerance or whether he or she may have a milk allergy.

For many Kids, an ice cream Sunday or cool glass of milk at lunch means an afternoon of cramps, gas and diarrhea.

What is Lactose?

Lactose is a sugar found in foods that many children love-milk and dairy products, such as frozen yoghurt, some breads, cereals and frozen canned foods. Lactose is broken down by the lactase enzyme located in small intestine. When we eat lactose, lactase breaks lactose down into two simple sugars: glucose and Galactose. The body absorbs these simple sugars into our intestine. When there is a decrease or loss of the lactase enzyme, we cannot break down or absorb lactose. The unabsorbed lactose can lead to symptoms which is called intolerance.

What is Lactose Intolerance?

Lactose intolerance is a condition caused by lack of an enzyme called lactase. Inadequate amounts of lactase cause the body to be unable to digest lactose, a sugar found in milk and milk products. The disorder affects some populations more than others: African-American, Jewish, Mexican Americans e.t.c. it is least common among people with a northern European Heritage.

What Causes Lactose Intolerance?

Injuries or Diseases at the small intestine which can reduce the amount of enzymes produced which is the usual cause of intolerance in children. But, most causes of Lactose intolerance develop over a period of many years in adolescents and adults.

Symptoms of Lactose Intolerance in Children?

Symptoms that are observed depend on the amount of Lactose that’s consumed, the time (30 minutes and 2 hours) of consumption of a diary product. Here are symptoms you should look out for:

• ·         Cramps
• ·         Painful gas
• ·         Bloating
• ·         Gas
• ·         Diarrhoea
• ·         Malnourishment
• ·         Gradual growth
• ·         Watery eyes
• ·         Coughing
• ·         Vomiting
• ·         Stools

How is Lactose Intolerance Diagnosed?

The most common diagnostic tests are used to measure the absorption in the Digestive system include:

Lactose Tolerance Test- 

This test measures the absorption of Lactose in digestive system. After Fasting, the patient drinks a Liquid that contains lactose. The diarrhoea stools are then tested for the next 24 hours.

Undigested lactose fermented by bacteria in the colon creates lactic acid and other fatty acids, which can be detected in a stool sample, along with glucose as a result of unabsorbed lactose.

Hydrogen breath Test- 

The patient drinks a lactose- heavy beverage. The breath is then analysed at regular intervals to measure the amount of hydrogen. Undigested Lactose in the colon is fermented by bacteria, resulting in the production of various gases, including hydrogen. When high levels of hydrogen are present in the breath improper digestion of lactose is diagnosed.

Stool Acidity test- 

This test used in infants and young children measures the amount of acid in the stool. Lactic acid and glucose, produced by undigested lactose,  and other fatty acids can be detected in a stool sample.

How is Lactose intolerance treated?

Treatment of Lactose intolerance depends on the extent of your child’s symptoms. Some children with lactose intolerance may be able to small amounts of dairy products without having symptoms.

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        Your paediatrician may recommend an over-the-counter Lactase enzyme supplement to alleviate the symptoms.

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        If the symptoms are severe, your paediatrician may refer your child to registered dietitian. Since dairy is a good source of calcium and vitamin D..  which all kids need while a dietitian can suggest other foods to provide those nutrients.

Finding levels of Lactose intolerance

The committee of Nutrition for the American Academy of Paediatrics recommends slowly introducing the dairy products to Judge the Child’s level of tolerance.

• ·         Some children are able to tolerate one glass of milk, but get symptoms with a second one
• ·         Some can’t tolerate milk but can tolerate yoghurt while some can tolerate hard cheese.
• ·         Keep a record of your child’s tolerance by first eliminating and slowly reintroducing specific dairy products and observing the change in symptoms.
• ·         Based on this record, you can monitor his diary intake and make sure he does not miss out on his nutrients.

Understanding Malnutrition

Malnutrition

What is Malnutrition?

Malnutrition or Malnourishment is a condition that results from eating a diet in which nutrients are either not enough or are too much such that the diet causes health problems.  It may involve calories, protein, carbohydrates, vitamins or minerals. Not enough nutrients is called Under nutrition or Undernourishment while too much is called overnutrition.  Several different nutrition disorders may develop, depending on which nutrients are lacking or consumed in excess.

According to the WorldHealth Organization (WHO), malnutrition is the gravest single threat to global public health.

Obese people, who consume more calories than they need, may suffer from the subnutrition aspect of malnutrition if their diet lacks the nutrients their body needs for good health.

Poor diet may lead to a vitamin or mineral deficiency, among other essential substances, sometimes resulting in scurvy - a condition where an individual has a vitamin C (ascorbic acid) deficiency.

According to theNational Health Service (NHS), UK, it is estimated that around three million people in the UK are affected by malnutrition (sub nutrition).

According to the Foodand Agriculture Organization (FAO), the number of people globally who were malnourished stood at 923 million in 2007, an increase of over 80 million since the 1990-92 base period. Malnutrition at an early age leads to reduced physical and mental development during childhood. Stunting, for example, affects more than 147 million preschoolers in developing countries, according to SCN's World Nutrition Situation 5th report.

Globally, as well as in developed, industrialized countries, the following groups of people are at highest risk of malnutrition (sub nutrition):

⦁        Elderly people, especially those who are hospitalized or in long-term institutional care

⦁        Individuals who are socially isolated

⦁        People on low incomes (poor people)

⦁        People with chronic eating disorders, such as bulimia or anorexia nervous

⦁        People convalescing after a serious illness or condition.

What are the consequences of malnutrition?

According to World Health Organization, Malnutrition affects people in every country. Around 1.9 billion adults worldwide are overweight, while 462 million are underweight. An estimated 41 million children under the age of 5 years are overweight or obese, while some 159 million are stunted and 50 million are wasted. Adding to this burden are the 528 million or 29% of women of reproductive age around the world affected by anaemia, for which approximately half would be amenable to iron supplementation.

       Many families cannot afford or access enough nutritious foods like fresh fruit and vegetables, legumes, meat and milk, while foods and drinks high in fat, sugar and salt are cheaper and more readily available, leading to a rapid rise in the number of children and adults who are overweight and obese, in poor as well as rich countries. It is quite common to find undernutrition and overweight within the same community, household or even individual – it is possible to be both overweight and micronutrient deficient.

In Children

Malnutrition in children is common globally and results in both short and long term irreversible negative health outcomes. Which includes?

1.       Stunting referring to a child who is too short for his or her age. Stunting is the failure to grow both physically and cognitively and is the result of chronic or recurrent malnutrition. The devastating effects of stunting can last a lifetime.

2.        Overweight referring to a child who is too heavy for his or her height. This form of malnutrition results from expending too few calories for the amount of food consumed and increases the risk of no communicable diseases later in life.

3.       Wasting referring to a child who is too thin for his or her height. Wasting, or acute malnutrition, is the result of recent rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted has an increased risk of death, but treatment is possible.

4.       Some Children suffer from more than one malnutrition - Overweight and stunted or Stunted and wasted

  Forms of Malnutrition

Each form of malnutrition depends on what nutrients are missing in the diet, for how long and at what age.

The most basic kind is called protein energy malnutrition . It results from a diet lacking in energy and protein because of a deficit in all major macro nutrients, such as carbohydrates, fats and proteins.

Marasmus is caused by a lack of protein and energy with sufferers appearing skeletally thin. In extreme cases, it can lead to kwashiorkor, in which malnutrition causes swelling including a so-called 'moon face'.

Other forms of malnutrition are less visible - but no less deadly. They are usually the result of vitamin and mineral deficiencies (micro nutrients), which can lead to anaemia, scurvy, pellagra, beriberi and xeropthalmia and, ultimately, death.

Deficiencies of iron, vitamin A and zinc are ranked among the World Health Organization's (WHO) top 10 leading causes of death through disease in developing countries

Treatment for Malnutrition

 NICE (NationalInstitute for Health and Clinical Excellence), UK, has guidelines for malnutrition treatment

NICE guidelines say that individuals who are receiving nutritional support, as well as their caregivers (UK: carers):

⦁        Should be fully informed about their treatment

⦁        Should be given tailored information

⦁        Should be given the opportunity to discuss diagnosis, treatment options and relevant physical, psychological and social issues.

⦁        Should be given contact details of relevant support groups, charities and voluntary organizations.

When a diagnosis of either malnutrition or malnutrition risk has been made, the healthcare professional (either a doctor or dietician) who is responsible for the patient will devise a targeted care plan.

The care plan

Aims for treatment will be set out, which should include the treatment for any underlying conditions/illnesses which are contributory factors to the malnutrition.

Typically, treatment will include a feeding program with a specially planned diet, and possibly some additional nutritional supplements.

Severely malnourished patients, or individuals who cannot get sufficient nutrition by eating or drinking may need and should receive artificial nutritional support.

Diet

A good healthcare professional will discuss eating and drinking with the patient and provide advice regarding healthy food choices. The aim is to make sure the patient is receiving a healthy, nutritious diet.

Preventing malnutrition

Malnutrition is caused mainly by not consuming what the National Health Service (NHS), UK, calls "the right balance of nutrients from major food groups". These include:

⦁        Carbohydrates

⦁        Fruit and vegetables

⦁        Protein

⦁        Dairy - vegans are able to find abundant nutrients from non-animal sources

⦁        Fats

The average human should drink at least 1.2 liters of fluid per day.