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Home , Lactose intolerance

50 Digestive Disorders FAMILY P RACTICE N EWS • October 15, 2006 -Intolerant Kids Should Get Some

BY MICHELE G. SULLIVAN The document is the first AAP lactose tive Americans, followed by blacks and “The avoidance of products to Mid-Atlantic Bureau guideline update since 1990 (Pediatrics Hispanics. The incidence is very low in control symptoms may be problematic 2006;118:1279-86). whites, whose northern European her- for optimal bone mineralization. Children t is usually not necessary to eliminate A statement from the American Dairy itage seems to be protective, according the who avoid milk have been documented to dairy foods from the diets of lactose-in- Council hailed the AAP guidelines as a guidelines. Among white children, symp- ingest less than the recommended Itolerant children and adolescents, and common sense approach to a problem toms typically don’t develop until after age amounts of calcium needed for normal doing so may compromise their long-term that sometimes prevents children from 4 or 5 years; they may manifest earlier in bone calcium accretion and bone miner- skeletal health. getting milk’s unique nutritional package other groups. alization.” Most of these patients still can consume of protein, vitamins, and minerals. Newborns who develop intractable di- Most lactose-intolerant children can enough dairy every day to meet their cal- “Although calci- arrhea after consum- tolerate varying amounts of dairy, de- cium and vitamin D needs, especially if um-fortified bever- Rice and soy are not ing any mammalian pending on their individual symptoms: they drink lactose-reduced milk and eat ages and other foods milk product, includ- One glass of milk may be fine, but two with live cultures and/or aged can provide an alter- good substitutes for dairy ing human milk, may may provoke . , like cheddar or Swiss, according native source of cal- products, because they are have congenital lac- Parents should be encouraged to feed to the American Academy of Pediatrics’ cium, the report re- tase deficiency, a life- children lactose-free or lactose-reduced new guidelines on lactose intolerance. inforces that they do lacking in nutrients that threatening inability milk, and to encourage them to enjoy If dairy products are eliminated from not provide an equiv- are needed for bone growth to digest lactose. A and yogurt with live bacterial cul- the diet of these children, the AAP strong- alent nutrient pack- biopsy of the small tures, according to the guidelines. Yogurt ly recommends regular calcium supple- age to dairy foods in children. intestine will show and cheese may be especially valuable for ments. However, the guidelines said, sup- like milk, cheese, and normal histology but very sensitive children, since the firmer plemental calcium is not as bioavailable as yogurt,” Ann Marie Krautheim, a regis- low or absent concentrations. Un- textures of these foods delay gastric emp- that contained in mammalian milk. tered dietitian and an official on the coun- less this disorder is recognized and treat- tying and intestinal transit time, which re- The report also noted that, although cil, said in a statement. ed immediately, fatal dehydration from sults in fewer symptoms. the gastrointestinal distress of true lac- “We hope this report will further edu- diarrhea is possible. Treatment is simple— The guidelines also pointed out that all tose intolerance is unpleasant, is not cate parents on how to continue to include feed the child a commercial lactose-free mammalian milks contain lactose, so there harmful. However, when such symptoms dairy in the diets of children sensitive to formula, the guidelines said. is no advantage in switching from cow occur in newborns or children who are lactose and also help improve their nutri- When lactose-intolerance symptoms milk to milk. younger than 3 years old, they should be ent intake.” appear, the most common reaction is to In addition, they said, rice and soy milks immediately investigated as they may sig- Symptoms of lactose intolerance usu- remove dairy foods from the diet com- are not good substitutes, because they are nal a serious, even life-threatening, di- ally emerge slowly over several years and pletely. However, that may be a mistake, lacking in nutrients that are needed for gestive disorder. are most common among Asians and Na- the guidelines noted. bone growth. ■ Charcoal May Subdue Excessive Flatus In Children With Cerebral

BY SHERRY BOSCHERT such as dates and mangoes, in favor Airtight undergarments contain- Palsy, GERD Prevalence San Francisco Bureau of such low- fruits as can- ing a charcoal-lined cushion also taloupe. have been marketed. A recent study Is High, but Often Missed L AKE TAHOE, CALIF. — In- Artificial sweeteners used in found that the cushion made no dif- gesting six capsules of activated some chewing gum and soft drinks ference, but the airtight construction B OSTON — Gastroesophageal reflux disease is com- charcoal twice a day is the best treat- generate more gas, including sor- contained the smell, if not the mon, but often goes undiagnosed in children with severe ment option for patients with ex- bitol, mannitol, and xylitol. Advise sound, of flatus. generalized cerebral palsy, Dr. Rob Rieken reported at the cessive flatus not caused by an un- diabetic patients, who are more “These may not be comfortable annual meeting of the American Academy for Cerebral derlying treatable condition, Dr. likely to use these products, to look [for] sleeping, but if you’re trying to Palsy and Developmental . Nirmal S. Mann said at a meeting at product labels if they’re com- avoid a divorce, I think it is a small In a cross-sectional study of 29 children with intellec- on and hepatol- plaining of flatus, he suggested. price to pay,” Dr. Mann said. tual and severe motor disability (IQ less than 55 and Gross ogy sponsored by the University of deficiency, a congenital Another purported treatment, Motor Function Classification System levels I-IV), the California, Davis. disease, may be the cause of exces- simethicone, is an organopolysilox- prevalence of Gastroesophageal reflux disease (GERD)— People normally pass flatus a sive flatus. Consider this diagnosis, ane that produced contradictory based on 24-hour pH monitoring—was 59%, Dr. Rieken mean of 15 times per day. Those especially in children, and treat it results in trials and probably is in- reported in a poster. whose bowels release gas more of- with sacrosidase, Dr. Mann added. effective. The mean duration of reflux periods was 10% of the ten or in larger quantities than nor- Another underlying cause of ex- “I think it just breaks up the bub- total recording time, compared with a normal percent- mal can become socially embar- cessive flatus—small bowel bacteri- bles and has no value at all” for re- age of less than 4%. rassed by the sound and smell, start al overgrowth—occurs in about 35% ducing flatus, he said. There was no significant difference in the percentage shunning social gatherings, or may of patients with inflammatory bow- In the long term, ingesting pro- reflux times between upright and supine periods (per- even develop marital problems, said el disease. breath tests biotics may be the most promising haps because of the high use of anti-Trendelenburg’s po- Dr. Mann of the university. can detect this problem, which can strategy for the average patient sitioning of the bed in children with cerebral palsy), but Dietary modifications may help, be treated with antibiotics. with excessive flatus. Probiotics compared with upright periods, the percentage reflux such as avoiding excessive ingestion For patients who do not fit into any may replace bacteria in the gut time postprandially was significantly greater. This is like- of beans, cabbage, starch, or com- of the categories above, oral activat- with bacteria that produce less- ly explained by a higher frequency of transient relax- plex carbohydrates, which are more ed charcoal is the best short-term odiferous gases. ation of the lower esophageal sphincter, decreased low- likely to cause gas. The over-the- treatment option, Dr. Mann said. He In patients with lactose malab- er esophageal sphincter tone, and/or delayed gastric counter product Beano, containing and his associates gave activated char- sorption, prolonged use of lactu- emptying in the study population, explained Dr. Rieken, α-galactosidase derived from As- coal to six patients with excessive fla- lose changes the growth of bacteria of Erasmus University Medical Center, Rotterdam, the pergillus niger, claims to reduce flatus tus and six control patients and mea- and reduces malodorous flatus. Netherlands. but does not help, he said. sured the number of times they Bismuth compounds have been In more than half of the children with GERD, the di- Lactase-deficient patients should passed flatus in 8 hours, the amount used to control odor from flatus but agnosis following the recording was new, and only half avoid ingesting lactose. One lac- of gas with each release, and lead to black-colored stool. “This of those with a prior GERD diagnosis were receiving tose-intolerant patient who passed scores. All parameters decreased in causes confusion, so I don’t recom- treatment. But 40% of those who were shown in this flatus 134 times in 24 hours solved both groups with treatment. mend that,” he said. study not to have GERD were being treated for the dis- the problem by restricting lactose in “Five out of six patients came Studies in dogs suggest that zinc ease, he noted. the diet. back thanking me profusely” for re- acetate might be helpful, but there The findings suggest that the diagnosis of GERD is fre- The has a limited ducing flatus, he said. The sixth pa- are no data in humans. quently missed in children with cerebral palsy, and they capacity to absorb fructose, so pa- tient had only a marginal response, Yucca schidigera also has been stud- show that pH measurement is a feasible method for as- tients with excessive gas should so activated charcoal doesn’t work ied in dogs but may cause bleeding sessing this population, Dr. Rieken concluded. avoid high-fructose tropical fruits, every time. problems. ■ —Sharon Worcester