Lactose Intolerance in Children: Parent FAQs

Anushka struggles every day to convince her five-year-old daughter, Ankita, to finish her glass of milk, often forcing her to gulp it down. The struggle reached a peak last Wednesday evening about an hour after the child finished her glass of milk. Ankita spent much of that night in pain. She had abdominal cramps and diarrhoea and told her mother that she felt sick to her stomach. That’s when the child’s mother realized that this could be a sign of a serious health condition and took her to see a doctor the very next day.

The doctor asked Ankita and her mother a number of questions and noted that the child’s discomfort seemed to be associated with milk and dairy products. The answers led to the suspicion that the child may be lactose intolerant and said that he would like to have a test performed to verify the suspicion. The test result confirmed his suspicion.

The doctor explained lactose intolerance – a set of symptoms caused by the body’s inability to digest lactose – to Anushka. He also discussed how she could best alter her daughter’s diet to prevent discomfort while still obtaining sufficient calcium. The doctor also mentioned various products that contain lactase, the enzyme responsible for lactose digestion, and assured the mother that using one of those products her daughter would still be able to consume dairy products, including a glass of milk occasionally.

How Lactose Intolerance Works

Lactose is a sugar present in food that most children love, including ice cream, milk, and cheese. It is also found in some salad dressings, baked goods, candies, sauces, and so on. Breast milk and infant formulas too contain lactose.

Lactose is made up of glucose and galactose – two simple sugar molecules. In order for it to be absorbed by the body, lactose has to be split into its two components by an enzyme called lactase, which is found in the lining of the small intestine. But for those who are lactose intolerant, the activity of lactase is ineffective. It’s unable to digest and absorb lactose in the small intestine, which then passes into the large intestine where it’s fermented by gut bacteria. This process produces carbon dioxide and hydrogen, and certain by-products which possess a laxative effect.

What Causes Lactose Intolerance?

Lactose intolerance may happen to both adults and children. Some common causes include the following:

  • Digestive disease or infection
  • Small intestine injury
  • Family history of lactose intolerance. In such cases, over time the body may make less of the lactase enzyme. Symptoms may show during the teens or adult years.
  • A baby born too early – a premature baby. This type of lactose intolerance can be a short-term problem that usually does not last.

In rare cases, some new-borns cannot make lactase from birth. This condition is known as congenital lactase deficiency.

Signs Your Child is Lactose Intolerant

If your child is intolerant, the symptoms will be directly proportional to the quantity consumed. The following are some of the common symptoms you should look out for, especially after your child consumes dairy products:

  • Loose stools and gas
  • Watery diarrhoea
  • Stomach bloating, gas
  • Stomach “growling” or making rumbling sounds
  • Upset stomach and nausea
  • Skin rashes and frequent colds
  • Abdominal pain and cramping

Parents often confuse lactose intolerance with a milk allergy. Although both have similar symptoms, these are different conditions. A milk allergy is an immune system reaction that generally appears in the first year of life. Lactose intolerance is a digestive issue that’s rarely seen in toddlers or infants.

Lactose intolerance symptoms can start in adolescence or late childhood, and may become more noticeable when stepping into adulthood. Apart from the discomfort generally associated with the above-mentioned symptoms, lactose intolerance is a non-threatening disorder with minimal or no long-term complications.

How is lactose intolerance diagnosed?

Your paediatrician will seek a medical, family, and diet history to help diagnose lactose intolerance in your child. During the discussion, he/she will review your child’s symptoms with you.

  • In some cases, a hydrogen breath test is performed to test for lactose intolerance
  • Paediatricians check acidity in the stools of infants and young children who are unable to take the hydrogen breath test. Acidic stool (low pH) indicate lactose malabsorption. Another stool test (reducing substances) checks glucose in the stool, which signifies undigested lactose.
  • If your child’s symptoms persist, he/she may be referred to a paediatric gastroenterologist (GI) for further evaluation.

How is Lactose Intolerance Treated?

Treatment depends on your child’s age, symptoms, general health, and how severe the condition is. But remember that no treatment will help produce more lactase. It is easy to manage your child’s symptoms by following a diet that limits lactose intake. He/she may not have to stop consuming all foods that contain lactose. Your child’s healthcare provider may also suggest some over-the-counter enzymes that can help.

Here are some tips for managing lactose in your child’s diet:

  • Start slowly. After a week of limiting foods with lactose, add small amounts of milk or milk products to the diet to see if there are any symptoms. Note the foods your child can handle and the ones he/she must avoid.
  • Milk and milk-based products should be consumed with other foods. For instance, let your child have milk with cereal or cheese with crackers. This is likely to reduce the symptoms.
  • Opt for dairy products that have lower levels of lactose such as yogurt and hard cheeses.
  • Choose lactose-reduced and lactose-free milk and milk-based products.
  • Ask your child’s healthcare provider if your child must take lactase pills or lactase drops when consuming milk products.

Consult a dietitian to know what products or dietary changes may help your child.

When should I call my healthcare provider?

Seek immediate medical health if you have trouble managing symptoms. Your paediatrician can work with you to help keep them in check.

Seasonal Allergies in Kids: A Guide to Keeping Symptoms in Check

Every spring, five-year-old Neha develops a runny nose, itchy, puffy eyes, and attacks of sneezing. Her mother shares the same problem, which she dismisses as mild hay fever. Lately, Neha has also suffered attacks of wheezing when she visited her grandmother and played with her cats. Neha’s paediatrician’s suspects allergic asthma. The doctor further explained that the child’s symptoms are by no means rare among children and in many cases, the condition starts in childhood and goes away later in life.

What are Seasonal Allergies?

Seasonal allergies, often called ‘hay fever’ or seasonal allergic rhinitis, are allergy symptoms occurring during certain times of the year, particularly when outdoor molds release their spores and grasses, weeds, and trees release tiny pollen particles into the air to fertilize other plants. The immune systems of those individuals who are allergic to mold spores or pollen, react to this invasion by releasing chemicals, including histamine, into the bloodstream as a defence mechanism. It’s the release of these chemicals that results in the allergy symptoms.

People can be allergic to one or more types of molds or pollens. Symptoms are an indication of the type of allergen. Such allergies can start at any age. Children who’ve never had seasonal allergies in the past can suddenly develop them. Usually, they develop by the time someone has turned 10 years old and reach their peak in the early 20s. The symptoms often disappear later in adulthood.

When to Suspect an Allergy

Some allergies can be identified easily by the pattern of symptoms that follows exposure to a particular substance. But others are usually more subtle and may masquerade as other conditions. Here are some of the common clues that could lead you to suspect that your child may be suffering from an allergy. Repeated or chronic cold-like symptoms that last over a week or two or that develop at about the same time annually. These may include the following:

  • Runny nose
  • Sneezing
  • Nasal stuffiness
  • Throat clearing
  • Sniffling
  • Sneezing
  • Nose rubbing
  • Snorting
  • Itchy, runny eyes

Itching and/or tingling sensations in the throat and mouth is a hallmark of an allergy. Coughing, difficulty breathing, wheezing, along with recurrent itchy, dry, scaly rashes in the creases of the skin may indicate an allergy.

Four Must-Dos for Kids with Seasonal Allergies

The good news is that there are some simple things that you can follow to make your child — and anyone else in the house who has hay fever — feel better.

Close the windows

After a long winter, it is tempting to open them, but don’t — the fresh air brings pollen with it. If you have an air conditioner, switch it on.

Wash up and change when you get home

People who are prone to allergies must change clothes and wash their hands and faces when they come in, but it is a good idea for everybody to follow the same routine, as all of us can be pollen-carriers. The idea is to keep the house as pollen-free as possible. It is a good idea to bathe your child before he/she goes to bed.

Be thoughtful about outside time

If your child frequently suffers from an allergy, think before sending your child outside. Dry and windy days are the worst. It is also advisable to avoid places with lots of plants. Many weather sites and apps have local pollen counts; check them when making outdoor plans.

Use medication the right way — and talk to your doctor if it’s not working

When it comes to taking medications for relieving symptoms like sneezing or itchy eyes, we often tend to follow the start and stop approach – stopping the medications as soon as the symptoms go away. But it turns out that allergy medications work best when you keep taking them consistently.

So, while it’s understandable that you’d want to avoid taking medications until things get bad, and skip them when things look fine, your child is more likely to do better if you get them started at the first sniffle — and continue until the allergy season is over. Consult your doctor as to when you should stop.

These days, most common allergy medications are available without a prescription, so it may not occur to parents to consult a doctor when the allergy season hits; they simply head to the pharmacy. If the medicine you have bought is working, great. But if not, give your doctor a call —sometimes altering the dose or changing the medication can make all the difference.

If your child is suffering from seasonal allergies, the right paediatrician can help you find the perfect solution. And when children feel better, as parents you will too. With the right precautions, you can enjoy the spring too!

Childhood Obesity

Kavita, like almost every mother, expressed her love for Kavya, her 8 year old daughter in the form of food. Slowly, the junk food that started as occasional treats, became a part of her daily diet. Fast food is rich in energy because of the tremendous amount of fat and sugar content, however lack important nutrients like protein, fibre, vitamins and minerals. Kavya was already two to three times bigger than other girls of her age. One day when Kavya came back home crying after getting teased at school, Kavita knew she had to consult a doctor.

Childhood Obesity – An Overview

Children who are above the normal weight for their age and height are considered as obese. Childhood obesity is a serious medical condition as it can lead to numerous health problems like diabetes, high blood pressure and cholesterol, which were earlier considered adult diseases. Obese children often become obese adults, especially if one or both parents are obese. Preventing and treating obesity is absolutely necessary to protect your child’s health now and in the future. Childhood obesity not only affects health but can also lead to poor self-esteem and even depression.

How to figure out if your child is overweight

If your child is heavier than others, it does not necessarily mean he/she is overweight, the reason being that some children naturally have larger body frames than others and also carry different amounts of body fat at various stages of development. Doctors use growth charts, BMI and other tests to figure out if your child is overweight and if it can pose health problems. If you are worried that your child is gaining too much weight, consult a doctor to determine if your child’s weight is in an unhealthy range.

What causes childhood obesity

Many of these factors usually work in combination to cause obesity:

  • Unhealthy eating habits – Regularly eating high calorie foods like fast foods, sugary drinks, baked goods, etc. can cause your child to gain excessive weight leading to obesity
  • Lack of physical activity – Children who don’t exercise much do not burn as many calories as required. Too much time spent in sedentary activities leads to weight gain
  • Family factors – Children coming from a family of overweight people tend to put on more weight than others, especially where physical activity is not encouraged
  • Psychological factors – Some children tend to overeat to cope with problems, or to deal with emotions such as stress, or just to fight boredom. In most cases, their parents have similar tendencies.

How obesity affects your child’s heath

Obesity can affect your child’s physical, social and emotional well-being and lead to complications like:

  • Type 2 diabetes
  • Asthma
  • Heart disease
  • High blood sugar
  • High blood pressure
  • Cholesterol
  • Excess abdominal fat
  • Sleep disorders
  • Liver damage
  • Bone fractures
  • Low self-esteem
  • Behavioural problems
  • Depression

Measures to control childhood obesity

  • Limit your child’s sugar intake
  • Adjust portion sizes according to age
  • Ensure your child gets enough sleep
  • Take your child for timely check-ups
  • Encourage physical activity

With proper lifestyle changes, childhood obesity can be prevented. Your child’s Paediatrician can guide you on how to prevent and reverse obesity.

Could That Joint Pain Be Arthritis?


Mrs Rita Sen, ‘Rita Miss’ to hundreds of her students who still remember her as their ramrod straight, elegant teacher of English who was much respected and loved. Now touching 84, the elderly lady has to walk with support, as her movement has become painful owing to arthritis.

Mrs Sen lost her husband to a cardiac arrest last year, and with her daughter settled in London, she lives alone. She manages with household help, and the spirited old lady has not let the pitfalls of life affect her. Lately, chronic pain has restricted her movements and she has been finding it difficult to perform daily activities like cooking and gardening which keeps her happy.

A Mrs Sen exists in almost every household in our country. With age comes grey hair, wisdom and joint pain! Arthritis, however, is not restricted only to the elderly. Increasingly younger people are also becoming victims of the condition that was earlier equated with hold age.

What is Arthritis?

Arthritis is the inflammation in one or more joints. The inflammation causes stiffness, pain and swelling in the joints and surrounding tissues, which worsens with age. The two most common types are osteoarthritis and rheumatoid arthritis.

What is Osteoarthritis?

Osteoarthritis is caused by joint damage. Joints are covered by a protective tissue called cartilage. Cartilage helps in keeping the movement of the joint fluid. When this cartilage breaks down, it causes the bones that form the joint to rub against each other, which in turn results in stiffness and pain. Osteoarthritis is also referred to as degenerative disease as it usually occurs in older people as a natural process of wear and tear. It is a condition that can occur in any joint in the body. The areas most commonly affected, however, are hands, fingertips, knees, hips and spine.

What is Rheumatoid Arthritis?

Rheumatoid arthritis is an auto-immune disorder. When immune systems mistake the soft lining around joints to be a threat and attack them, it causes fluid build-up in the joints leading to stiffness and pain. It is a chronic inflammatory condition that can affect more than just your joints. It can affect the skin, eyes, lungs, heart and blood vessels.

Types of Arthritis

Other types of inflammatory arthritis include:

  • Psoriatic arthritisincludes scaly spots on the skin along with swelling in some or all the joints. The condition may also be identified with back stiffness, and at times, swelling of fingers or toe, resulting in a sausage-like appearance.
  • Gout and pseudogout, in which needle-like crystals of uric acid or rhomboid-shaped crystals of calcium pyrophosphate, respectively, form in cartilage and are released into the joint fluid, producing painful effects. Gout is most common in the metatarsophalangeal joint or the first toe, where it meets the foot but may also be common in other joints, such as the midfoot, ankles, knees, and bursa of the elbow. Pseudogout is more common in the elders and generally involves the ankles, wrists, knees, and shoulders.
  • Ankylosing spondylitis (AS)and related conditions affect the spine and peripheral joints. These conditions can be identified with severe morning stiffness in the spine.
  • Parvovirus arthritisis a contagious, viral form of arthritis that may cause flu-like symptoms and rashes. Children suffering from the fifth disease (Erythema infectiosum) due to parvovirus will have a classic slapped-cheek appearance of rashes. Although parvovirus arthritis resolves within a few weeks, some patients may keep experiencing ongoing symptoms.
  • Lyme disease is caused by a spirochete (bacteria) contracted via the bite of an infected deer tick. The condition typically reveals IA symptoms in later stages but in some cases may include early symptoms such as rashes, chills, fever, fatigue, headache, and an aching neck. Although blood testing is useful once arthritis develops, it may be falsely negative if tested fairly early in Lyme disease.
  • Systemic lupus erythematosus (SLE) or lupus is an inflammatory condition that usually involves all systems of the human body. Arthritis is one of the single most common ways for lupus to present, and lupus arthritis appears similar to the early stages of rheumatoid arthritis. Some of the common signs of lupus include sun-sensitive skin rashes, mouth sores, rapid hair loss, chest pain with a deep breath, and a positive ANA blood test.

Living with Arthritis

Irrespective of the type of arthritis you have, it will be easier to stay ahead of your pain if you:

  • Learn all you can about your condition, including what type of arthritis you have and whether.
  • Keep your joints moving. Do daily, gentle stretches that move your joints.
  • Maintain good posture. A physical therapist can show you how to sit, stand and move correctly.
  • Balance your activities and don’t overdo them. Lifestyle changes are important for easing pain.
  • Manage weight. Being overweight can increase complications and contribute to increased arthritis pain. Making lifestyle changes is often the most effective method of weight management.
  • Quit smoking. Smoking leads to stress on connective tissues, which tends to increase arthritis pain.

Treatment

Arthritis can be treated with occupational or physical therapy, exercise. Over-the-counter pain-relieving medications are also prescribed.

Surgical options for the treatment of arthritis include synovectomy, arthroscopy, osteotomy, and total joint replacement. While the first three offer relief from pain, they cannot completely cure the condition. In most cases, the only cure for arthritis is joint replacement surgery.

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