Nutrition Challenges in Pediatric Gastroenterology

Editor(s): Frequently Asked Questions Vol.1 / 1,  2013

Summary

Nutritional challenges are routinely encountered and pose a formidable barrier to successful clinical outcomes in a paediatric care practice. Specific nutritional interventions, therefore, play an important role in the management of various gastroenterology diseases in children. The Nestlé Nutrition Institute is pleased to bring you the 1st issue of our scientific publication on “Nutritional Challenges in Paediatric Gastroenterology - Frequently Asked Questions”. This publication has been prepared with contributions from specialists in the field of Paediatric Gastroenterology and comprises relevant, practical reference information for nutritional care in children with gastrointestinal disorders.

Questions like what is the difference between lactose intolerance and milk allergy is answered in detail. Lactose intolerance refers to the inability to breakdown the lactose sugar due to the deficiency of the enzyme lactase (disaccharidase) in the intestinal brush border cells. Cow's milk protein intolerance involves the immune system and is intolerance to the protein moiety of the milk. Lactase deficiencies are of three types, primary, secondary and congenital. Congenital lactase deficiency is very rare and results in severe diarrhoea in the new born period. Primary lactase deficiency is the most common type noted. It can present above the age of 5 years but mostly seen in adults and is due to the lack of lactase persistence genes. This is found in almost 70% of adults. Secondary intolerance is the most common in children and is usually transient. It often follows acute gastroenteritis. Lactose intolerance presents with diarrhoea, abdominal pain, bloating, flatulence, borborygmi etc. Various tests can be used to diagnose lactose intolerance such as stool test for reducing substances, low fecal ph, Lactose tolerance test or Lactose breath hydrogen test. The treatment of lactose intolerance is by restriction of lactose in the diet and/or enzyme supplementation (bacterial or yeast beta galactosidases). Yoghurt is tolerated very well by these patients. Calcium and Vitamin D supplementation should be advised if milk and milk products are limited in the diet.

A question like how would you treat a baby with milk allergy was answered as such. The infant with cow milk protein allergy must be placed on a diet free of cow milk protein. This would include milk and milk products including yogurt (dahi), paneer, butter, ghee, biscuits, tea etc. If the baby is exclusively breast fed, eliminating milk (and milk products) from the mother's diet should be advised. For non-breastfed babies, hydrolyzed formulas, soy milk formulas (beyond 6 months of age) or amino acid based formulas may be used depending upon the clinical situation. Growth should be monitored regularly and nutritional counselling should be carried out. For an older infant or toddler semi-solids can be started and milk intake eliminated. Solids should be introduced preferably at the age of 6 months, according to the recommendations of IAP .However there are newer recommendations which suggest that to reduce the risk of other food allergies solid food should be introduced into the baby's diet between 4 and 6 months of age under the cover of breast feeding. It appears that it is the duration of breast feeding that is important rather than exclusive breast feeding. IAP guidelines recommend the continuation of breast feeding for as long as feasible and preferably well into the second year of life, along with the addition of semisolid feeds.