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Lactose is a sugar found in dairy products like milk and cheese. In order to digest it, our small intestines produce an enzyme called lactase. Lactase transforms lactose into glucose, which is used for energy by the body. However, in lactose intolerance in children and adults, this digestive process does not occur properly. Lactose intolerance occurs when your intestine lacks lactase. If you don't produce lactase, you won't be able to break down lactose properly. Which can lead to various gastrointestinal problems and symptoms. Symptoms of lactose intolerance in children When a child cannot properly digest lactose, it can cause many symptoms. Signs that your child may be lactose intolerant include: • Swelling • Diarrhea • Gases • Sickness • Stomach pain and cramps Babies with lactose intolerance can be very fussy and not gain weight or grow well. Symptoms of lactose intolerance can range from mild to severe, depending on the amount of lactose a child consumes and the amount of lactase the child's body produces. Is there a difference between lactose intolerance and a milk allergy? Lactose intolerance is not the same as an allergy to milk proteins, the most common food allergy in babies. Babies with a milk allergy are allergic to the protein in cow's milk. Children who are lactose intolerant cannot properly digest lactose, which is a sugar. While both groups can experience similar symptoms, the two conditions are very different. Causes of lactose intolerance in children Lactose intolerance in children can occur for different reasons depending on their age. Reasons may include prematurity, congenital lactase deficiency, primary lactase deficiency, and secondary lactase deficiency. Prematurity and lactase deficiency Although lactose intolerance is not common in babies, some babies born before 34 weeks do not have a fully functional gastrointestinal tract. They may lack lactase and other enzymes they need to digest food, although they can develop later as the child grows. Interestingly, these premature babies can still tolerate milk protein-based formulas. Congenital lactase deficiency In rare cases, babies can be born lactose intolerant, which is known as congenital lactase deficiency. Babies with congenital lactase deficiency are born without any lactase enzyme. These babies are diagnosed very early in life because they have severe diarrhea and do not gain weight. You will be able to know immediately if your child has it. Primary lactase deficiency The most common cause of lactose intolerance in children is primary lactase deficiency. These children do not have enough lactase enzyme and the amount of lactase they have may decrease as they get older. While it may seem like lactose intolerance starts suddenly, it gradually worsens over time and symptoms become more obvious. Approximately 65-70% of the world's population is affected by primary lactase deficiency, which is a genetic condition. It is extremely common among people of Asian and African descent, as well as Native Americans. Although primary lactase deficiency can begin as early as 2 years, symptoms may not be noticed until adolescence and young adulthood. Secondary lactase deficiency Other children may develop a secondary lactase deficiency, which can occur suddenly after illness. Any disease that injures the small intestine, such as gastroenteritis, can result in a temporary or long-term lactase deficiency. Babies younger than 3 months are at higher risk of being adversely affected by this. They may experience severe diarrhea and poor growth. Chronic conditions like Crohn's disease or celiac disease can also lead to lactase deficiency. How can lactose intolerance be diagnosed in children? An easy way to determine if your child is lactose intolerant is to stop giving dairy products (such as milk, cheese, ice cream, pizza) and see if their symptoms go away. To ensure that your child continues to eat a balanced diet, you can offer milk substitutes such as vitamin D and calcium supplements. Your child's pediatrician can also offer additional recommendations and provide a referral to a specialist for further help. A pediatric gastroenterologist can diagnose lactose intolerance in children by performing a hydrogen breath test. Increasing the amount of hydrogen during testing after drinking a lactose-containing product indicates lactose intolerance. Your child may also be diagnosed with endoscopy, a minimally invasive procedure to take samples of tissues from the esophagus, stomach, and small intestine. The tissue sample from the small intestine can be tested for lactase and other sugar enzymes. What to do if your child is lactose intolerant If your child is lactose intolerant, there are many solutions that will allow him to have a healthy and balanced diet. With the right foods and treatments, you can help stop your child's symptoms. For truly lactose intolerant babies, it is recommended that parents seek the help of a pediatric gastroenterologist to manage this condition. Because these babies often "do not grow well" and have diarrhea, they may need special formula and must be closely monitored for adequate weight gain. Older children have multiple options, such as consuming dairy-free milk and non-dairy cheese products or ingesting Lactaid tablets, which contain lactase enzymes. Lactaid tablets come in a chewable form for children 4 years and older. If your child has a temporary secondary lactase deficiency, you can help him avoid dairy for about two weeks and then reintroduce them. Transient lactose intolerance can sometimes occur after viral or bacterial gastroenteritis. 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