Lactose Intolerance in Children

Why is it some people can ingest foods containing lactose, while others are plagued by even a trace of it? The American Academy of Pediatrics says, "Lactose intolerance occurs in people who can't digest lactose. Lactose is the sugar found in milk and other dairy products."

Dr. Deb Winburn, pediatrician with Premier Pediatrics, says, "Lactose intolerance affects many children each year." Children who don't naturally produce the enzyme lactase, which is responsible for digesting lactose, may have symptoms ranging from nausea, bloating, diarrhea, and cramps, to actual vomiting, skin rash, nasal congestion (less specific) and/or bloody stools.

According to Winburn, no single, simple test exists to prove or disprove that a patient has lactose intolerance. "Most often, elimination is tried and results are subjectively monitored to see if there is improvement," she says. "The elimination technique should ideally be done for at least three weeks before a conclusion is drawn."

For those who are still uncertain, Winburn says a trip to the GI specialist may be warranted. "To date, the most 'objective' test for lactose intolerance is via a breath test," she says. "The child's cooperation is needed, and the equipment is costly."

Melissa Mereghetti, a Kansas City pediatric registered dietitian says, "The most common sources (of lactose) include milk, cream, ice cream, cheese, butter, pudding and yogurt. Lactose can also be found in processed foods that have milk products added to them such as bread, waffles, pancakes, baked goods, instant potatoes, soups, breakfast drinks, salad dressing, margarine, luncheon meats (hot dogs, sausages) and candy."

Other hidden names for lactose-containing foods are whey, curds, milk by-products, dry milk solids or not-fat dry milk powder, according to Mereghetti. Lactose free milk (such as Lactaid) and fortified soy milk both contain calcium. "Lactaid milk is made from cow's milk but contains an enzyme that breaks down the lactose to make it easier to digest," Mereghetti says. "Calcium fortified orange juice, broccoli, spinach, beans and tofu are also rich in calcium."

Winburn cautions that rice milk is lactose free but is nutrient poor in both zinc and protein, making it the least desirable substitute commercially available. "In either case, children should consume 1200-1500 mg of calcium and 400-800 IU of vitamin D daily for adequate bone ossification," she says.

Dietitian Mereghetti agrees, "Make sure your (lactose intolerant) child has adequate intake of vitamin D (because) most of our vitamin D comes from dairy products."