Lactose-Intolerant Kids Need as Much Dairy as They Can Stomach

CHICAGO, Sept. 5 -- Lactose-intolerant children should not avoid dairy products but consume as much as they can tolerate, according to a report issued today by the American Academy of Pediatrics.

It is better for children to suffer the intestinal symptoms of lactose intolerance from time to time than to not get enough dietary calcium, said Melvin B. Heyman, M.D., M.P.H, of the University of California San Francisco, the report's principal author who wrote for the academy's committee on nutrition.

The report strengthened previous academy recommendations on lactose intolerance and dairy consumption, which had said that milk products should "not be discouraged." The new recommendations go much further by saying that milk products should be "pushed to the point of tolerance," Dr. Heyman said in an interview.

Although the academy has never recommended that lactose-intolerant kids should avoid milk products, there is a perception among pediatricians that this is a correct course of action, Dr. Heyman said. Doctors often suggest milk avoidance to control intestinal symptoms, he added.

"Treatment of lactose intolerance by elimination of milk and other dairy products is not usually necessary given newer approaches to lactose intolerance, including the use of partially digested products (such as yogurts, cheeses, products containing Lactobacillus acidophilus, and pretreated milks," Dr. Heyman and colleagues wrote in the September issue of Pediatrics.

"Evidence that avoidance of dairy products may lead to inadequate calcium intake and consequent suboptimal bone mineralization makes these important as alternatives to milk. Dairy products remain principal sources of protein and other nutrients that are essential for growth in children."

Children "with primary lactose intolerance have varying degrees of lactose deficiency and, correspondingly, often tolerate varying amounts of dietary lactose," they wrote.

"Lactose intolerant children (and their parents) should realize that ingestion of dairy products resulting in symptoms generally leads to transient symptoms without causing harm to the gastrointestinal tract," they added.

Recommended ways to incorporate more dairy products into the diets of lactose intolerant children included:

• Drink lactose-free and lactose reduced milk. It is more expensive than regular milk, but some stores sell less-expensive products under their own brand names.
• Consume small amounts of dairy products spaced throughout the day. "Some children are able to drink one to two glasses of milk each day without difficulty," Dr. Heyman said.
• Consume dairy products with other foods, as this often reduces symptoms.
• Try yogurt, which is often better tolerated because the bacteria partially digest the lactose into glucose.
• Try aged cheeses like cheddar and Swiss which have lower lactose content.
• Use oral lactase replacement capsules or dairy products supplemented with lactase.

More than 70% of the world's population has a lactase deficiency, the report noted. However, the condition is disproportionately found in Asians and Native Americans (nearly 100%), Hispanics (80%), blacks (60% to 80%) and Ashkenazi Jews (60% to 80%). Only 2% of European populations are lactose intolerant, the report said.

Children in high-risk ethnic groups may develop symptoms as early as ages two or three years. Caucasian children usually develop symptoms no earlier than ages four or five. Lactose intolerance is rarely found in children younger than two or three, and such symptoms before age two may indicate another condition, such as an acute infection or bowel injury, the report said.

Diagnosis of lactose intolerance can be made with dietary elimination of lactose and challenge, the report said. More-formal testing includes fecal pH and hydrogen breath testing. The lactose tolerance test should no longer be used because of its high rate of false positives and negatives, the report recommended.

If a child simply cannot tolerate any dairy products, then a lactose-free diet is necessary. However, this diet should include a good source of calcium or calcium supplementation to meet daily recommended levels, the report said.

Although it is logical to assume that a lactose free-diet places one at greater risk for low calcium intake and poor bone mineralization, "the effects of lactose-free diets in childhood on long-term bone mineral content and risk of fractures remains to be clarified," the report said

In the future, genetic testing may identify those with lactose intolerance. "Recent research has even suggested that gene-replacement therapies might someday be available for susceptible individuals," the report said.