Trip Answers

Question answered:24/10/07 Warning! this question is over two years old.

Unfortunately, we cannot answer this question.

 

We searched the NLH Gastroenterology and Liver Diseases Library and TRIP and Medline databases but found no guidelines on the management of secondary lactose intolerance in infants that answers your question. However, we did locate some information of partial relevance and this we will reproduce, below.

 

A 2006 guideline issued by the American Academy of Pediatrics on lactose intolerance notes:

 

“Secondary lactase deficiency

 

 

Several recent studies and a meta-analysis found that children with rotaviral (and other infectious) diarrheal illnesses who have no or only mild dehydration can safely continue human milk or standard (lactose-containing) formula without any significant effect on outcome, including hydration status, nutritional status, duration of illness, or success of therapy. However, in the at-risk infant (eg, younger than 3 months or malnourished) who develops infectious diarrhea, lactose intolerance may be a significant factor that will influence the evolution of the illness. Giardiasis, cryptosporidiosis, and other parasites that infect the proximal small intestine often lead to lactose malabsorption from direct injury to the epithelial cells by the parasite. Secondary lactase deficiency with clinical signs of lactose intolerance can be seen in celiac disease, Crohn disease, and immune-related and other enteropathies and should be considered in these children.
Diagnostic evaluation should be directed toward these entities when secondary lactase deficiency is suspected and an infectious etiology is not found.

 

Young infants with severe malnutrition develop small intestinal atrophy that also leads to secondary lactase deficiency. Although uncommon in the United States, malnutrition is associated with lactose malabsorption and carbohydrate intolerance in developing countries. Lactose malabsorption has also been associated with poor growth in these countries. Most infants and children with malabsorption attributable to malnutrition are able to continue to tolerate dietary carbohydrates, including lactose. However, the World Health Organization recommends avoidance of lactose-containing milks in children with persistent postinfectious diarrhea (diarrhea lasting more than 14 days) when they fail a dietary trial of milk or yogurt.

 

Treatment of secondary lactase deficiency and lactose malabsorption attributable to an underlying condition generally does not require elimination of lactose from the diet but, rather, treatment of the underlying condition. Once the primary problem is resolved, lactose containing products can often be consumed normally, and these excellent sources of calcium and other nutrients need not be unnecessarily excluded from the diet.” [1]

 

A second guideline from 2006, one on acute gastroenteritits (AGE) in children aged between 2 months and five years of age, notes:

 

“The vast majority of patients with AGE do not develop clinically important lactose intolerance. In selected patients with documented, persistent lactose intolerance, lactose-free formulas are recommended (Brown, Peerson, & Fontaine, 1994 [M]).” [2]

 

Given the lack of guidance on this issue, the NLH Primary Care Q & A Service can only recommend seeking advise from a local specialist.

 

References
1. Heyman M. Lactose intolerance in infants, children and adolescents. 2006. (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/3/1279)
2. Cincinnati Children's Hospital Medical Center. Evidence-based clinical care guideline for acute gastroenteritis (AGE) in children aged 2 months through 5 years. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2006 May. (http://www.guideline.gov/summary/summary.aspx?doc_id=9529&nbr=5079&ss=6&xl=999)

---

DISCLAIMER: TRIPanswers is a collection of clinical questions and answers.  Each provider will have their own methodology in answering questions and these are likely not to be as rigorous as systematic review.  If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. TRIPanswers and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document.  Also, ensure you have read the terms and conditions for using the site.