Mead Johnson Asia - Malaysia

Lactose intolerance is a term used to describe a special medical condition wherein an infant or child is unable to tolerate any foods containing lactose (a sugar found in the milk of mammals), due to an absence of lactase, the specific enzyme required within the body's small intestine to digest lactose before its constituents can be absorbed through the intestinal wall.

There are two types of lactose intolerance:

1. Congenital lactose intolerance – when an infant is born without the enzymes required to digest lactose. This is a serious condition requiring expert medical attention. It is very rare.
2. Acquired lactose intolerance – when an infant or a child has sufficient damage to the lining of the small intestine to reduce lactase enzyme activity near to zero. Acquired lactose intolerance most frequently occurs as a result of a severe, chronic or protracted episode of diarrhoea. This is also a serious, but more easily treatable, condition. If not treated early, it can result in health and developmental consequences.

When the intestines do not provide enough lactase enzymes, all of the lactose in the diet does not get broken down. Any lactose that is not digested within the small intestine moves on into the colon, where it undergoes fermentation by the bacteria residing in the colon. This fermentation process results in the production of several gases that distend the colon, causing pain to the infant or child. This often leads to a range of mild to severe symptoms of lactose maldigestion, referred to clinically as "colicky behaviour".

You may notice the following symptoms in your child as early as 30 minutes to 2 hours after feeding him regular milk or foods containing lactose:

• • Bloating, flatulence (frequent passage of gas)
• • Colic, or "colicky behaviour"
• • Abdominal pain and cramps
• • Irritability
• • Watery diarrhoea
• • Rumbling stomach

While these symptoms are not usually dangerous, it may be very distressing and cause the child to persistently cry. The severity of symptoms varies depending on the amount of lactose your child can tolerate.

It is important to note that lactose intolerance/maldigestion is different from CMPA. Lactose maldigestion is non-immunological, and results from insufficient lactase enzyme to break down all of the lactose that is ingested. It is more common during early infancy, though may persist, in some cases, into late childhood or adulthood. It is generally a benign condition. Symptoms that may occur in more serious cases of maldigestion are mainly limited to the gastrointestinal tract, such as abdominal pain, colic, flatulence and watery diarrhoea.

Lactose intolerance is also non-immunological and is the inability of the body to digest lactose— a consequence of an absence of lactase enzyme. The body cannot produce lactase, the enzyme that aids lactose digestion, to break down lactose ingested (from milk).

In contrast, CMPA is an overreaction of the body's immune system towards cow's milk proteins and has the highest prevalence in infants and lowest in adults. Apart from the common food allergy symptoms (e.g. abdominal pain, diarrhoea, vomiting), CMPA may also produce mild to severe reactions in the respiratory system (e.g., wheezing, difficulty in breathing) and skin (e.g., rashes). In severe cases, anaphylaxis can occur.

Table: Lactose intolerance/ maldigestion versus CMPA.

*Lactose intolerance/ maldigestion usually does not cause much morbidity, unless it occurs in infants after an episode of infection, such as gastroenteritis, and if serious or prolonged can cause malnutrition and significant morbidity

To rule out other problems that may be causing your child's symptoms, some tests can be used to confirm lactose intolerance/maldigestion. Tests may include a hydrogen breath test, lactose tolerance test or stool test. However, hydrogen breath testing requires research or medical specialists using special equipment. Lactose tolerance tests may not be suitable for infants and very young children who are suspected of having lactose intolerance. Ask your healthcare provider to determine which test is suitable and safe for your child.

• Hydrogen breath test
This test measures the amount of hydrogen in a person's breath. Normally, very little hydrogen is detectable in the breath. However, when undigested lactose enters the colon, bacteria in the colon attacks it and produces various gases, including hydrogen. The hydrogen is carried through the bloodstream to the lungs and comes out in the breath - the level of hydrogen in the breath indicates the degree of improper digestion of lactose.

• Lactose tolerance test
Blood glucose levels are measured prior to the administration of a specific amount of lactose, then measured again 1 to 2 hours after the dose of lactose. If lactose is incompletely broken down, the blood glucose level does not rise above certain levels, it confirms the condition of lactose intolerance/ maldigestion.

• Stool test
Fermentation of undigested lactose in the colon produces lactic acid that can be detected in a stool sample. A stool test measures the amount of acid (the pH level) in the stool to determine if lactose is properly digested. A high acidity level (low pH) indicates the presence of lactose intolerance/ maldigestion. This test may be given to infants and young children. In addition, a stool test (called Clinitest) may also be performed to determine the presence of reducing sugars in the stool — a result of unabsorbed lactose in the colon.

There is no way to improve your child's body's ability to produce lactase, but there are ways to overcome the problem. The easiest way to prevent the symptoms is to avoid feeding your child with cow's milk or foods containing lactose.

For a baby or young child who is experiencing symptoms of lactose intolerance/ maldigestion, your healthcare provider may simply recommend changing from cow's milk to a lactose-free milk formula while waiting for symptoms to abate.

Some infants and older children may be able to tolerate moderate amounts of lactose and do not need to avoid lactose completely.

Careful control of your child's diet not only helps relieve or prevent the symptoms of lactose intolerance, but also ensures that your child gets all the nutrients required for growth and development.

• Keep track of the food that your child eats to check how much lactose-containing food can be handled. If moderate amounts of lactose-containing food can be tolerated, then he can continue eating them in small feedings.

• If your child develops typical symptoms even with small amounts of lactose, then you may have to make sure all foods that contain lactose are avoided.

• Ask your child's healthcare provider about switching to a lactose-free milk formula. It helps supply necessary nutrients, such as calcium, without producing symptoms of lactose intolerance/ maldigestion.

• If your child can handle some lactose, you may feed him food that contains active cultures (lactobacillus), such as yoghurt. Active cultures produce some lactase enzymes that help to digest lactose.

• Read food labels carefully to know which products contain lactose. Watch out for hidden lactose. Lactose is often added to prepared foods, even though in small amounts. Some non-dairy products may also include ingredients that are derived from milk and therefore contain lactose.

If any of these ingredients are listed on a label, the product contains lactose.

Although there is no straightforward treatment for the underlying cause of lactose intolerance/ maldigestion, you can help your child grow and stay healthy by carefully monitoring his diet and working hand in hand with your healthcare provider.

Please consult your healthcare provider for more information on childhood lactose intolerance/ maldigestion and ways to manage it.

Breast-feeding is universally accepted as the best method of feeding babies. Over the last decade there has been a plethora of scientific evidence and data supporting the supremacy of breastmilk and the health benefit derived from it.

Breast-feeding bonds mother and child
During breast-feeding, a mother's smell, feel and visual image are imprinted on an infant while the baby's are imprinted on the mother – a process called BONDING that will have a lifelong positive effect on the relationship between mother and child.

Breastmilk is the perfect food for infants
Mother's milk is the best food for infants and it contains all the nutrients required for the growing and developing baby in the right proportions. Mothers should be instructed on how to prepare for and maintain lactation and about the importance of good maternal nutrition. Breast-feeding should be initiated immediately after birth or within one hour after delivery.

Breast-feeding is a baby's first immunisation
Breastmilk and especially colostrum is rich with antibodies and live cells that protect infants from bacteria and viral pathogens.

Breast-feeding saves lives
Overall it is estimated that if more mothers were to breastfeed optimally, an additional 2 million infants' lives can be saved each year.

Breast-feeding saves money
It is one of the most cost-effective child health survival measures. Breast-feeding is an economic plus for families, hospitals, communities and nations. Working mothers should also be encouraged to continue breast-feeding even after they resume their full-time jobs.

Important Notice: Pregnant women and new mothers should be informed on the benefits and superiority of breast-feeding. Mothers should receive guidance for proper maternal nutrition and that the decision to avoid or discontinue breast-feeding may be hard to reverse. The introduction of partial bottle-feeding may have a negative effect on breast-feeding. Inappropriate infant feeding practices should be avoided so breast-feeding is not discouraged. Mothers should be advised of the social and financial implications of the decision to formula feed and the importance to the health of the infant to use infant formula properly. It is recommended to seek professional advice when mothers are unable to breast-feed.

Content developed by: CMPMedica Medical Education

With editorial advice from: Associate Professor Christopher Boey Chiong Meng, Department of Paediatrics, University Malaya Medical Centre

A health educational service sponsored and brought to you by:

Mead Johnson Nutrition (M) Sdn Bhd
16th Floor, Menara Lien Hoe,
8 Persiaran Tropicana,
47410 Petaling Jaya,
Selangor, Malaysia.
Tel: 603-7804 7995
Fax: 603-7803 5886

This article is compiled by CMPMedica Medical Education for your general knowledge and benefit and is not intended as a substitute for professional medical care and advice. Only your doctor can diagnose and treat a medical problem. Please consult your doctor on your/your child's specific medical condition. The views and opinion expressed by the author of the article above do not represent the views and opinion of Mead Johnson Nutrition (M) Sdn Bhd or CMPMedica and should not be relied on as such. Mead Johnson Nutrition(M) Sdn Bhd and CMPMedica Medical Education shall not be liable for any loss or damage howsoever arising, including from reliance on any information provided in this article. Editorial development by CMPMedica Medical Education. ©2004 CMPMedica. All rights reserved. No parts of this article may be reproduced by any process in any language without the written permission of the publisher.

CMPMedica Pacific Limited, Unit 901-903, 9th Floor, AXA Centre, 151 Gloucester Road, Wan Chai, Hong Kong.

Enquiries: c/o 5/F, Tower 2, Wisma MCIS Zurich, Jln Barat, 46200 Petaling Jaya, Selangor, Malaysia.
Tel: (603) 7954 2910
Fax: (603) 7958 7853
E-mail: enquiry.my@asia.cmpmedica.com
Web site: www.asia.cmpmedica.com