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Pediatric Lactose Intolerance Treatment & Management

  • Author: Stefano Guandalini, MD; Chief Editor: Carmen Cuffari, MD  more...
 
Updated: Jul 17, 2015
 

Medical Care

Treatment of lactose intolerance may include the following:

  • Lactase deficiency: The Lactase enzyme expression can be induced by lactose, but only during the newborn period. Studies demonstrate the use of inducing lactase activity by tube feedings with milk-containing lactose in premature infants. Early initiation of half-strength lactose-containing formula or breast milk results in rapid induction of lactase activity in the brush border and less feeding intolerance. One study suggested that full-strength lactose formula resulted in more feeding intolerance than low-lactose formula in premature infants;[12] thus, the precise lactose concentration of lactose for inducing lactase activity is still undetermined.
  • Lactose intolerance: This can be improved by dietary manipulation. If the quantity of lactose is increased slowly over time, lactobacilli are stimulated to grow in the colon. A greater number of lactobacilli allow the lactose to break down into monosaccharides. Although this allows much of the sugar to be absorbed, some of the resulting monosaccharides are still fermented by colonic bacteria; however, the relative amount of colonic fermentation is decreased.
  • Dietary aids
    • Lactase derived from yeast can be added to milk products as drops or ingested as chewable tablets prior to ingestion of lactose-containing substances. Studies demonstrate varying success. Digestive supplementations are apparently limited in their ability to digest large quantities of lactose.
    • Yogurt with live cultures is generally well tolerated by individuals with lactose intolerance. Dairy products with reduced or no lactose are widely available.
    • In addition, research is ongoing that is evaluating the clinical effects of feeding a highly purified, short-chain galactooligosaccharide (GOS/RP-G28) on lactose intolerance and changes in the composition of the colonic microbiota.[13] Intolerant adults fed this sugar showed major changes in their intestinal microbiota, and this was associated with improvement in lactose digestion and overall symptoms of lactose intolerance.
    • The risks of drastically limiting or excluding all dairy products in populations such as blacks, who may be at risk for nutritional deficiencies, have been illustrated.[14] The importance of maintaining a good intake of dairy products in the face of lactose intolerance has been stressed.[14]
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Consultations

Consultation with a pediatric gastroenterologist is suggested if the patient has symptoms that do not resolve after dietary elimination of lactose or if the patient has severe symptoms.

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Diet

Lactose is believed to enhance the absorption of several minerals, including calcium, magnesium, and zinc. In addition, milk products that contain a large amount of lactose also contain a high amount of calcium. Because calcium is extremely important in bone growth, children can quickly become deficient if adequate calcium intake is not maintained; thus, calcium supplementation is required in anyone restricted from dairy products. In fact, primary adult hypolactasia has been associated with decreased serum calcium level and lower bone mineral density in postmenopausal women.[15]

In children and teenagers, however, there is less evidence that those who are lactose intolerant are at risk of low calcium intake or bone mineralization. In fact, a study on 76 children and adolescents found no statistically significant difference between the groups (lactose malabsorbers and lactose absorbers) with respect to the intake of total calcium, milk calcium, milk, cheese, yogurt, ice cream, and calcium density of the diet. Additionally, there was no difference with respect to the bone mineral content and the bone mineral density of the lumbar spine.[16]

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Contributor Information and Disclosures
Author

Stefano Guandalini, MD Founder and Medical Director, Celiac Disease Center, Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medical Center; Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, North American Society for the Study of Celiac Disease

Disclosure: Received consulting fee from AbbVie for consulting.

Coauthor(s)

Delia M Rivera, MD Assistant Professor, Department of Pediatrics, Division of Infectious Disease and Immunology, University of Miami Leonard M Miller School of Medicine

Delia M Rivera, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Richard E Frye, MD, PhD Associate Professor, Department of Pediatrics, University of Arkansas for Medical Sciences

Richard E Frye, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, International Neuropsychological Society, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Stephen M Borowitz, MD Professor of Pediatrics and Public Health Sciences, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Virginia School of Medicine

Stephen M Borowitz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

Eric S Maller, MD 

Eric S Maller, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Society of Transplant Surgeons, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

References
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  10. Hovde O, Farup PG. A comparison of diagnostic tests for lactose malabsorption--which one is the best?. BMC Gastroenterol. 2009 Oct 31. 9:82. [Medline]. [Full Text].

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  17. Setty-Shah N, Maranda L, Candela N, Fong J, Dahod I, Rogol AD. Lactose intolerance: lack of evidence for short stature or vitamin d deficiency in prepubertal children. PLoS One. 2013. 8(10):e78653. [Medline].

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The small intestine is a major site of absorption.
 
 
 
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