Lactose Intolerance Handling the Dairy Dilemma

Handling the Dairy Dilemma

Your child's frequent diarrhea, bloating and gassiness have been a trial to both of you. But finally you've found out the cause: It's lactose intolerance, explains your doctor.

This may sound like a disease, but it isn't. It just means that your child has problems digesting lactose, the sugar in milk and dairy products. Normally this milk sugar is broken down by an enzyme called lactase that's produced in the small intestine, but some people don't produce enough lactase to do the job. So when your lactase-deficient child drinks milk or eats milk products, there isn't enough lactase to digest the lactose--and the intestines seem like a battle zone.

''Just about everyone is born with the ability to digest milk,'' explains Jay A. Perman, M.D., professor of pediatrics and director of pediatric gastroenterology and nutrition at Johns Hopkins University School of Medicine in Baltimore. ''But for some, the ability to produce lactase declines once they're out of babyhood.'' Sometimes the decline is so gradual that symptoms don't pop up until adulthood, but others have problems as youngsters.

The good news is that, once diagnosed, lactose intolerance can be managed quite easily and successfully at home, says Dr. Perman. Managed so well, in fact, that children don't always have to say no to milk and cookies or birthday cake and ice cream. Here's how to handle your child's lactose intolerance to ensure smooth intestinal sailing.

Read labels. If your child has severe lactose intolerance, make scrutinizing food labels a habit. Foods other than milk, cheese, ice cream and the like can also contain lactose. ''There are some kids who are so sensitive that even a bit of lactose found in processed meat can set them off,'' says Dr. Perman.

Study labels and look for lactose-containing ingredients such as casein, whey, lactose, milk solids or milk. In restaurants, check with the chef about the ingredients of the dish your child wants.

Keep a food journal. Use a daily diary of food and symptoms to keep track of what bothers your child and what doesn't, says Ana Abad Sinden, R.D., a pediatric nutrition support specialist in the Department of Nutrition Services at the University of Virginia Health Sciences Center in Charlottesville. ''This lets parents get a better handle on what specific foods cause particular symptoms,'' she says.

In the diary, write down the quantity of lactose-containing food, the time when it was eaten and any symptoms that followed. That way you can tell at a glance if a bowl of ice cream caused gassiness, for instance, or a cup of milk produced diarrhea.

Experiment cautiously. ''Everyone's tolerance level is different, and before you can manage a lactose malabsorption problem you need to identify its severity,'' says Dr. Perman. Start with small amounts of lactose-containing foods and gradually build up, suggests Sinden. Once you've established through the daily diary that your child can eat a half-slice of cheese without symptoms, for example, try a whole slice. And when you've found how much of one lactose-containing food your child can handle without problems, try another.

Check medications. Lactose can lurk where you least expect it. About one-fourth of both prescription and over-the-counter medications are made with lactose. '' You should read the labels of medications your child needs to take, or ask your pharmacist whether there's any lactose in a particular drug,'' says Dr. Perman.

Don't go it alone. Encourage your child to eat lactose-containing foods along with other foods, says Dennis Savaiano, Ph.D., professor of food science and nutrition at the University of Minnesota in Saint Paul. ''Milk with cereal or cookies, for example, is tolerated better than milk alone,'' he says. ''In fact anything with milk is better than milk alone.'' The other foods keep the lactase from arriving at the intestines all at once and overwhelming the few lactase enzymes your child does have.

Choose low-lactose foods. A glass of milk, with 12 grams of lactose, will be too much for many lactase-deficient kids, says Dr. Perman. ''But hard cheeses have only a trace of lactose, while ice cream and cottage cheese have a moderate amount,'' he says. Yogurt with live cultures (check the container) is usually tolerated by lactose intolerant youngsters, because the bacteria in the yogurt has predigested much of the lactose.

Try lactase enzymes. Most drugstores carry a lactase supplement that makes up for the enzyme deficiency in your child's intestines. This product is sold as liquid, pills or capsules. Mix the liquid with regular milk 24 hours before use to break down 70 percent of the lactose, says Sinden. ''That's usually all that's needed for milk to be tolerated,'' she says.

You can give your child a lactase pill before he or she eats the offending ice cream or cheese, says Dr. Savaiano. He also suggests opening up a capsule of the enzyme and sprinkling the contents on cereal and milk. ''The amount your child will need depends upon the severity of her intolerance, and that's determined by experimentation,'' he says.

Consider calcium intake. If your child is severely lactose intolerant, there's a chance he or she may not be getting enough calcium--which is crucial for young, growing bones. Your child can get plenty of this essential nutrient by eating lots of yogurt, cheese and green vegetables, says Dr. Perman.

''But if your child is a finicky eater and eats no dairy products, then you may want to consider other sources of calcium,'' adds Dr. Perman. He suggests calcium-enhanced wafers you can find at health food stores or Tums, which also contain calcium. Check with your doctor about the dosage. Another option is calcium-fortified juice.