Is it possible to consume milk and dairy products while breastfeeding. Is milk highly allergenic?

Although in official medicine there is no such term - "milk intolerance" - it is often used in everyday life when they want to describe some digestive problems. It's usually called discomfort that occur after taking milk: abdominal pain, flatulence, loose stools, or just discomfort. These problems are common in infants and are often associated with lactose intolerance.

Lactose - This is milk sugar, which makes up about 99% of all carbohydrates of any milk, including women's. Lactose gives milk a sweet taste and is the main source of energy-supplying glucose, while galactose is necessary for the formation of the central nervous system and the retina of the eye. AT gastrointestinal tract enzyme lactase(produced enterocytes - mucosal cells small intestine) breaks down lactose into glucose and galactose, and then these monosaccharides are absorbed.

However, chest child receives so much lactose that even in healthy children under 3 months it is not completely broken down. In an unsplit (undigested) form, it enters the large intestine and there it becomes nutrient medium for beneficial lactic acid bacteria (bifidobacteria, lactobacilli, lactose-positive Escherichia coli). These bacteria break down lactose into gases, water, and short-chain fatty acids (hence the sour-smelling stool in infants). These acids are important for the regulation of intestinal peristalsis (contractions), the absorption of salts and water. In addition, the acidic environment prevents the growth of putrefactive bacteria.

Therefore, if you immediately deprive child lactose (for example, feed him only lactose-free mixtures), then beneficial bacteria will not receive nutrition, the acidity of the intestinal contents will decrease and the intestines will be populated by pathogenic microbes. However, if there is too much undigested lactose in the intestine (the activity of lactase-splitting is reduced), and there are not enough lactic acid bacteria, then undigested lactose provokes the flow of water from the body into the intestinal cavity, as a result child loose stools (diarrhea) develop. Such a state is called lactase deficiency. Lactase deficiency is primary and secondary.

Inherited from parents

Primary lactase deficiency called a condition in which the activity of the lactase enzyme is reduced, but the enterocytes that produce it are not damaged. Primary congenital lactase deficiency - a congenital disorder of the process of lactase production, which is quite rare.

In addition, there is lactase deficiency adult type - a situation where lactase activity falls at the end of the breastfeeding period (usually such a decrease occurs by 3-5 years). In both variants, the biochemical mechanism of disorders is the same, which indicates its hereditary nature. The baby can inherit the initially low enzyme activity from his parents.

Indeed, congenital disorders are most common in families where adults have milk intolerance, although sometimes parents are not even aware of their lactase deficiency . They say they just don't like milk, or that it's not customary in their families to drink it.

Also primary lactase deficiency occurs in premature babies, as well as in full-term, but immature babies. The fact is that high lactase activity is needed only at the time of birth, and in the fetus, enzyme activity begins to grow by about 34 weeks of gestation, reaching a maximum level by 37-40 weeks.

Therefore, a premature baby may have low lactase activity at birth. Such a state is called transient lactase deficiency. As the name implies, it passes over time, and the activity of the enzyme returns to normal.

Anxiety child when breastfeeding, increased gas formation and liquefied stool - these are typical symptoms primary lactase deficiency. The baby usually has a good appetite, greedily begins to suck, but after a few minutes she cries, throws her chest, presses her legs to her stomach. Stool frequent, thin, yellow, sour smelling, frothy (reminiscent of yeast dough). If you collect the chair in a glass container and let it stand, then the stratification of the fraction becomes clearly visible: liquid and denser. It must be borne in mind that when using disposable diapers, the liquid part is absorbed into them, and then stool disorders may not be noticed.

Usually symptoms of primary lactase deficiency increase with an increase in the amount of milk consumed. At first, in the first weeks of a newborn's life, there are no signs of disturbances at all, then increased gas formation appears, even later - abdominal pain, and only then - loose stools.

An example from practice. Mum month old girl complained of anxiety child during feeding and at night. On this occasion, she consulted first with a neurologist, but he did not reveal in the girl neurological disorders. Already during a conversation with the pediatrician, the mother remembered that before the baby always willingly took the breast, actively sucked, but in the last two weeks everything changed: 2-3 minutes after the start of feeding, the girl threw the breast, cried and turned away. Mom had enough breast milk and, judging by her feelings, its amount has been growing rapidly over the past month. The mother did not notice loose stools in her daughter, but upon examination it was noticeable that the girl's tummy was swollen and a lot of gases were leaving. The stool was yellow, and after it was collected on an oilcloth, and not in a disposable diaper, it turned out that it was quite liquid. Follow-up examination confirmed the diagnosis. lactase deficiency. But, since my mother went to the doctor in a timely manner, everything unpleasant symptoms I managed to remove it in 2-3 days.

Complicated inflammation

Any inflammation of the intestine - infectious or not - leads to damage to enterocytes. Therefore, it is much more common to encounter secondary lactase deficiency, in which there is a lot of mucus, greenery in the stool, and undigested lumps of food may be present. The secondary lactase deficiency, arising on the background allergic inflammation in the intestines, when the main disease is food allergy, and lactase deficiency turns out to be just a complication.

With artificial feeding, intolerance may occur when child too soon begins to receive a foreign protein - most often the protein of cow's milk or soy contained in mixtures for artificial feeding. In the intestine, it begins to interact with the cells of the intestinal mucosa. immune cells they recognize the "stranger", and the reaction of the immune system develops - allergic inflammation. As a result, lactase-producing enterocytes are damaged.

In addition, in such children, the permeability of the intestinal mucosa is disturbed, many substances cease to be absorbed and diarrhea develops (accelerated loose stools). Allergic inflammation in the intestines usually precedes changes in the skin, so in the beginning, allergies may not have any external signs. With natural feeding, allergic inflammation of the intestines can also develop if the nursing mother consumes allergenic foods. The most dangerous in this regard are citrus fruits and red berries, nuts, honey, smoked meats. Less dangerous are cottage cheese and chicken, but if you use them often and in large quantities, they can also cause allergic reaction at the baby.

Dangerous doubles

Symptoms similar to lactase deficiency occur in children with insufficiency of other enzymes - sucrase, isomaltase. The first symptoms appear when regular sugar is included in the diet of children (many mothers try to sweeten complementary foods). A rare and severe pathology is malabsorption of monosaccharides - glucose and fructose. It is manifested by severe diarrhea immediately after the start of feeding (when honey, juices, etc. are included in the diet).

Another disease that can occur under the "mask" of milk intolerance is galactosemia. This is rare disease from the group of metabolic disorders. It is based on a violation of the metabolism of galactose in the body. In such children, the use of any product containing lactose (and therefore galactose) causes severe, life-threatening symptoms (vomiting, jaundice, low blood glucose, excretion of sugar in the urine). The disease manifests itself early - in the first days of life. It is important for parents to know that for lactase deficiency vomiting is not typical (there may be only regurgitation). Vomiting child- this is always a reason for an urgent consultation with a doctor and examination.

Survey

So if u child frequent, sour-smelling, watery, frothy stools, suggestive of lactose intolerance. Before visiting the doctor, try to remember whether immediately with the start of feeding, child diarrhea or after the introduction of some new products. A nursing mother will have to remember what changes have occurred in her own diet. The simplest and most accessible study to determine lactose intolerance is to determine the amount of carbohydrates in feces. This analysis does not say anything about the cause of intolerance, and does not even indicate which carbohydrate is not tolerated. But it is done quickly, cheaply and allows you to understand whether there is a general violation of the digestion and absorption of carbohydrates. Since babies who receive only breast milk consume mainly lactose, this test is enough to talk about lactase deficiency. In other cases, it is desirable to conduct more specific tests.

The "gold standard" of diagnostics lactase deficiency is to determine the activity of the enzyme in a small fragment of the mucous membrane of the small intestine, but this examination is carried out only in cases where it is necessary to distinguish the insufficiency of this enzyme from other diseases. The examination also necessarily includes a study of feces for dysbacteriosis, and if allergies are suspected, a blood test for specific antibodies to potential allergens.

Therapeutic diet

At the time of the examination, and upon confirmation of the diagnosis - and in the future, it is necessary to reduce the content of lactose in the diet. natural feeding save! If a child received breast milk, then you do not need to deprive him of this wonderful product. But at the same time, the lactase enzyme is prescribed (drug " LACTASE ENZYME"). The drug is available in capsules - this is convenient for older children and adults, because. the capsule protects the enzyme itself from being digested in the stomach. And for infants, the capsule is opened and the enzyme is added directly to the milk. It is only necessary to express part of the volume of one feeding, add an enzyme to the expressed milk, and then supplement the baby with the remaining milk at his request.

Lactase is prescribed for each feeding, the dosage of the enzyme and the proportion of milk that needs to be expressed is selected by the doctor individually: the more carbohydrates are not digested, the greater the proportion of milk must be pre-treated with the enzyme. If there is an allergy to foods consumed by a nursing mother, it is enough to adjust her diet. Sometimes lactase is temporarily prescribed.

With mixed or artificial feeding, the adapted milk formula is replaced with a low-lactose or lactose-free one. .

It is better to consult a doctor about the selection of a therapeutic mixture, since an excessive reduction in lactose in the diet is also undesirable - it can lead to constipation. At primary lactase deficiency mixtures are prescribed that differ from the standard ones only in the composition of carbohydrates (lactose is replaced by maltose, glucose polymers and other sugars), and the protein remains cow. With food allergies, a low-lactose diet makes sense, but only until the allergic inflammation is eliminated, then the activity of the enzyme is quickly restored.

If the deficiency has developed against the background of an allergy, specialized mixtures are prescribed for cow's milk proteins for the treatment of allergies, containing either other proteins (for example, soy) or the protein of the same cow's milk, but specially processed (split into short fragments and amino acids).

It is important to know that both soy protein and goat milk protein are foreign. And even a split protein can contain elements that can cause an allergy in a patient. child. For children older than a year, the use of milk is no longer so significant, but still milk and dairy products are important for them. Fermented milk products contain about half as much lactose as whole milk.

Many patients with adult lactase deficiency tolerate dairy products, but they still need to limit the use of lactose-rich foods - condensed milk, ice cream, etc. Limit cheese intake butter usually not necessary. Lactase deficiency with timely diagnosis is easily treated, but it is important to remember that treatment is selected individually. Its duration depends on the type of disease. With transient lactase deficiency premature it takes 1-3 months, with congenital - as long as milk is consumed. If identified lactase deficiency adult type, lactase preparation is recommended to be used whenever foods rich in lactose are in the diet.

Lactase deficiency, or hypolactasia, is a very common phenomenon among both infants and adults. This is pathological condition forces nursing mothers to stop breastfeeding ahead of schedule, transferring the child to artificial nutrition, which cannot but affect his health in the future. However, as practice shows, the “fashionable” diagnosis of “lactase deficiency” today often has nothing to do with true milk intolerance, but is a common food allergy of a newborn to the mother’s diet or complementary foods. Knowing the causes, symptoms, tests, and treatment of true hypolactasia is important to avoid treating the underlying disease.

Lactose and lactase: why they should not be confused

Often on the Internet you can find the fundamentally wrong term "lactose deficiency". What is lactose and lactase?

Lactose, or milk sugar, is a carbohydrate from the group of disaccharides present in the milk of any animal.

Lactase is an enzyme produced by the cells of the mucous membrane of the small intestine and is involved in the breakdown of lactose.

Hypolactasia: its types and causes

A decrease in lactase activity (and sometimes a complete absence of this enzyme) is called hypolactasia or lactase deficiency (LN). This condition entails the inability to properly digest milk sugar, which serves as a breeding ground for the reproduction of various microorganisms. Bacteria provoke strong gas formation, stool disorders, colic and many other problems.

Lactase deficiency is divided into two types.

Primary lactase deficiency

It implies low activity of lactase or its complete absence without damage to enterocytes - intestinal epithelial cells. Such hypolactasia happens:

• congenital (genetic anomaly);
• transient (temporary intolerance breast milk characteristic of premature infants);
• hypolactasia of the adult type (about 18% of adult Russians suffer from LN).

Secondary lactase deficiency

In this case, lactase deficiency is caused by damage to enterocytes. It occurs much more often than primary hypolactasia and is provoked by diseases such as:

• allergy to cow's milk protein;
• intestinal infection;
• intestinal inflammation;
• atrophic changes after prolonged tube feeding or with celiac disease (intolerance to the cereal protein gluten).

Lactose overload

In addition to these two types, there is a condition similar to the signs of hypolactasia - lactose overload. At the same time, the necessary enzyme is produced in the intestines of the baby in sufficient quantities, but due to the large volume of the “front reservoir” in the breast between feedings, too much “front” milk with a high content of lactose and other carbohydrates accumulates (more than 130).

Also, as noted by the famous pediatrician E.O. Komarovsky, lactose overload can occur due to the banal overfeeding of a child (details in the video below): this condition does not require treatment, but proper organization GV.

Symptoms of the disease

Indicate the disease in question can the following symptoms lactase deficiency:

1. Bloating.
2. Liquid stools (may be frothy and sour-smelling).
3. Restless behavior of the baby during or after feeding.
4. Poor weight gain or even weight loss (in severe cases of LN).

Sometimes profuse regurgitation is added to the symptoms.

In primary hypolactasia, the first few weeks of a baby's life, LN does not appear at all, then flatulence appears, followed by abdominal pain and liquid feces.

A distinctive feature of secondary hypolactasia is the appearance in the stool of a large amount of mucus, greenery and undigested pieces food.

In the case of an overload with lactose, the child gains weight well, but at the same time he is worried about pain, and the feces can be green and sour.

Hypolactasia or common allergy?

It is not uncommon for an allergy to breast milk or complementary foods to be taken by an inexperienced pediatrician for lactase deficiency, which leads to the appointment of improper treatment. food allergy on breast milk is provoked by the diet of a nursing mother, and her specific pathogens are:

1. Gluten. Even in the absence of celiac disease (gluten protein intolerance) in a child, a nursing mother should limit the intake of gluten-containing products in the first months of lactation.
2. synthetic additives. The diet of a nursing mother should exclude any canned food. Sweets are better to eat white - without dyes.
3. Spices and herbs.
4. Milk products. Cow or goat milk is markedly different in terms of chemical composition from human. Proteins of cow's and goat's milk often act as a strong allergen for a newborn.

Instead of treating LN and switching to artificial formulas, it is better for a nursing mother to start by adjusting her diet by excluding milk protein and other food allergens from it.

The first food should be vegetable puree (zucchini, potatoes, cauliflower). This is the only way to determine the presence or absence of hypolactasia for sure.

Against ordinary infantile colic, dill water will suffice.

Diagnosis of lactase deficiency

There are several different tests that can be used to confirm LN:

1. Biopsy of the small intestine. The most reliable, but also the least used method. The reasons are obvious: anesthesia and penetration of biopsy forceps into the intestines of the newborn.
2. Hydrogen test. Measurement of the amount of hydrogen in the air exhaled by the patient.
3. Lactose curve (blood test).
4. Analysis of feces for carbohydrates. The most popular, but the least reliable method, since there are still no exact instructions with the norms of carbohydrates in feces.
5. Coprogram analysis.

Treatment

It must be remembered that the presence of one or two signs of hypolactasia does not at all mean that the child is sick. Only the combination of all of the above symptoms with a poor analysis can indicate a true LN. Lactase deficiency in children is treated by the following methods.

Proper organization of the GW

The instruction includes the following items:

• do not express milk after feeding;
• you can change the breast only after the baby has emptied it completely;
• try to breastfeed with one breast, but more often;
• it is advisable not to skip night feedings;
• it is not recommended to take the baby from the breast if he has not yet had enough;
• correct attachment to the chest.

Refusal of food allergens

Especially dangerous are cow and goat milk proteins, because of which children are allergic to mother's breast milk.

Use of lactose-free foods as complementary foods

Expressing a small portion of milk before feeding

This is the last of the "home" treatments.

Doctor prescribing lactase enzyme

A typical example is the drugs "Lactase Baby" and "Lactazar" in capsules or "Baby Doc" in the form of drops. Usually, the course of using the enzyme is canceled at 3-4 months of the life of the baby, when the production of its own lactase begins in its intestines. Enzymes from drugs are very effective and relatively safe, which is confirmed by many reviews. Care must be taken when purchasing such enzyme supplements, as there have been cases of counterfeiting of the Lactase baby drug.

Treatment of "dysbacteriosis"

It implies the restoration of both the microflora and the very condition of the intestinal walls (i.e., the treatment of the underlying disease in secondary hypolactasia - for example, gastroenteritis). Often accompanied by the use of "Lactase baby", "Baby Doc" or other drugs with lactase.
Attention moms! In the treatment of dysbacteriosis, the baby may be prescribed drugs such as bifidumbacterin, plantex or analogues. It is important to know that they contain lactose and should not be taken with LN.

Feeding lactase-fermented breast milk, low-lactose or lactose-free formula

It is practiced only in the most extreme and rare cases, when milk intolerance is congenital, and the enzyme deficiency manifests itself extremely strongly (this is observed in one child out of 20 thousand). Such supplementary feeding is usually a temporary measure. Long-term use of lactose-free formulas can cause the baby to completely refuse breast milk. In addition, the long-term consequences of artificial feeding in infancy have not yet been studied. From the nearest side effects the child is at risk of allergy to soy protein, and soy includes most of these mixtures. Even more common is allergy to cow's or goat's milk protein, the second major component of lactose-free formulas.

As noted by the same E.O. Komarovsky, there is a clear commercial connection between the appearance in the country of low-lactose and lactose-free mixtures and the widespread appeals of doctors to treat “lactase deficiency”. So, Komarovsky has already collected more than 50 reviews from nursing mothers, whose doctors strongly (and unreasonably) recommend that they abandon breastfeeding in favor of artificial nutrition.

Conclusion

Lactase deficiency is a fairly common phenomenon among children, characterized by the fact that milk is not absorbed by the body of the newborn. At the same time, the appointment of lactose-free or low-lactose mixtures is justified only in congenital pronounced LN, which must be confirmed and clinical picture, and "bad" analyses. In other cases, it is enough to wait until the baby’s own lactase “ripens” in the intestines, helping him ferment milk with the help of dietary supplements (“Lactase Baby”, “Baby Doc”, “Lactazar”, “Tylactase”, “Lactraza”, etc.), changing the diet of a nursing mother (during the breastfeeding period, there are no products containing milk protein and other allergens), taking dill water against colic, proper organization of breastfeeding and proper complementary foods.

lactase deficiency(lactose intolerance) is a condition that is characterized by the inability of the body of a child or adult to digest milk sugar (lactose) due to insufficient production of the enzyme lactase in the intestine.

Causes of lactase deficiency in children

Physiological (normal) lactase deficiency

In most children over 6-7 years old, adolescents and adults, lactase deficiency is a consequence of the body growing up and is considered a completely normal, physiological phenomenon.

A natural and gradual decrease in the production of lactase in the intestines of a child begins by the end of the first year of life. By the age of 6, lactase levels may drop so much that the child can no longer digest normally. a large number of milk.

This is a genetically programmed process.

However, in some cases it is sufficient high level lactase production in the intestine persists even in adults. Scientists explain this fact by the fact that in ancient times, due to the development of animal husbandry, people gained access to animal milk, which became part of the diet of adults. This fact influenced the evolution of human ability to digest milk and made some people able to produce lactase even as adults.

Congenital and acquired lactase deficiency

Much big problem than the physiological decrease in lactase activity in adults is early lactase deficiency in newborns and children of the first months of life, for whom milk is the main food.

Lactose intolerance in children early age may be due to the following reasons.

Congenital (primary) lactase deficiency- characterized by a complete inability of the intestines of a newborn child to produce lactase. According to special literature, carbohydrate metabolism diseases associated with changes in the activity of enzymes that break down sugars, including lactose, are extremely rare in the population. The frequency of such diseases varies from 1 in 20,000 to 1 in 200,000 children. As a rule, congenital lactase deficiency develops due to a mutation in the genes responsible for the production of lactase. In this regard, in children under 2 - 3 years of age, any symptoms that are usually "attributed" to lactase deficiency, with a high degree of probability, may be symptoms of some other disease.

transient lactase deficiency- this is a temporary inability to produce lactase in sufficient quantity / with a sufficient degree of activity, characteristic of preterm or immature newborns and associated with the unpreparedness of their intestines for the process of digesting food. Typically, within a few months after birth, the intestines of a premature baby develop the ability to produce enough lactase, and the baby begins to absorb breast milk or formula milk well.

Acquired (secondary, temporary) lactase deficiency- occurs quite often and, as a rule, is a consequence various diseases intestines (intestinal infection, allergic processes in the intestines, celiac disease, etc.), which disrupt the ability of the small intestine to produce lactase and digest food efficiently.

Acquired lactase deficiency is a temporary phenomenon. After eliminating the diseases that caused lactase deficiency, the ability of the intestine to produce lactase is restored and lactase deficiency completely disappears.

"Overload" with lactose. This is a condition similar to transient lactase deficiency, which can be corrected by changing the organization of breastfeeding. The amount of lactose in breast milk is about the same throughout the feeding, but the amount of fat that the baby receives at the beginning and at the end of feeding is different. The fat content gradually increases from the beginning to the end of each feeding, the greater the difference, the more time has passed since the previous feeding, the greater the mother’s breast capacity, the less baby sucked in the previous feeding. Thus, in the beginning, the child sucks out a more watery white or slightly yellowish color. The lighter foremilk moves rapidly through the gastrointestinal tract and most of the lactose can enter the colon before being broken down by the enzyme lactase. There, lactose causes fermentation, gas formation, and frequent sour stools. In small quantities, unsplit lactose in any case enters the large intestine and this is the norm for a child on breastfeeding, but when the child systematically receives only forward, quickly passing through the gastrointestinal tract, milk (for example, due to limited feeding time, too frequent breast changes, too long breaks in feeding) and does not get back, there are signs of lactase deficiency.

Thus, in the vast majority of cases, lactase deficiency in children of the first years of life is not independent disease, but only a consequence of other diseases or errors in the organization of nutrition. In this regard, the diagnosis of lactase deficiency established in a child under 2-3 years of age can almost never be considered a complete explanation of his condition. In all cases when a child is diagnosed with lactase deficiency, it is necessary to establish the cause that has disrupted the ability of the intestine to digest milk sugar, since only the elimination of this cause will help to effectively solve the problem.

Today in Russia, the diagnosis of "lactase deficiency" is made to a lot of babies. Naturally, if all these children really suffered from such a serious illness, accompanied by weight loss, the person would simply die out as a species. Very often, lactase deficiency is confused with an allergy to cow's milk protein (CMP). The symptoms are similar, and CMP is a very strong and common allergen.

Symptoms and signs of lactase deficiency in newborns and children of the first years of life

The problem of correctly assessing the symptoms and signs of lactase deficiency in young children is of great importance, since in most cases the diagnosis and initiation of treatment are entirely based precisely on determining the likely signs of impaired milk absorption in the intestine.

The main signs of lactase deficiency include:

Developmental delay of the child (slow and insufficient increase in weight and height).

Very frequent watery stools in a child, possibly with greenery, frothy, combined with a developmental delay.

False constipation: prolonged absence of stools, frequent ineffectual urge to defecate - and loose stools, or alternating constipation and diarrhea.

Severe persistent gas formation, bloating a few minutes after the start of feeding or later.

IMPORTANT! Not episodic moments of anxiety (“I feed calmly in the morning and at night, and in the evening it starts to cry, tighten my legs, writhe”), but a reaction to every full meal (milk or mixture) containing lactose.

In children with lactase deficiency, other pathological processes may occur. Often lactase deficiency is accompanied by anemia or allergic rashes on the skin. This is due to the fact that lactase deficiency can provoke a deterioration in food absorption, an increase in the permeability of the intestinal wall, etc.

Symptoms that are NOT in themselves signs of lactase deficiency

Colic and bloating can occur in many healthy babies and are considered completely normal until 6 months of age. Therefore, only because of the presence of colic in a child during the first months of life, it cannot be said that he suffers from lactase deficiency.

Regurgitation (rare and not very abundant) - like colic, are considered a completely normal phenomenon (up to the age of 8-10 months) that does not require any treatment. Only very frequent and profuse regurgitation should cause concern, especially if they lead to malnutrition and development of the child.

Regurgitation cannot be considered a direct symptom of lactase deficiency, since the main cause of their occurrence is a malfunction of the valve that blocks the transition from the esophagus to the stomach, and with lactase deficiency, as mentioned above, there is a violation of the digestion of milk sugar in the small intestine.

Frequent loose stools in children of the first months of life, provided that the child looks happy and healthy, in no case can be considered a sign of lactase deficiency.

During the first year of life, stools MUST BE:

frequent (in the first month up to 10 times a day or more),
liquid,
with a little mucus
with white lumps of undigested milk,
greenish color stool should also be considered perfectly normal.

Such a chair baby is not diarrhea!

The infrequent appearance of a stool (once every few days) is considered by many parents as a clear sign of constipation and leads them to take measures to "stimulate the appearance of a stool." These actions are in most cases unreasonable and can even harm the child.

Even if the stool in a child older than 6 weeks is exclusively breastfeeding appears once a week, this should not be considered constipation if the feces remain soft and the child feels well and develops normally. Such a delay in stool cannot be considered a sign of lactase deficiency.

Anxiety of the child from the first minutes of feeding - in no case can be a sign of lactase deficiency. With lactase deficiency, the digestion of milk in the intestines is impaired. Milk enters the intestines at least 15-30 minutes after the start of feeding, and the stomach and esophagus of the child (which may be associated with crying and anxiety during feeding) with lactase deficiency work completely normally.

Methods for addressing the causes of temporary lactase deficiency or lactose overload

1) You can not express after feeding (especially if this is combined with limiting the time the baby stays at the breast), because. in this case, the mother pours out or freezes the hind milk, and the breastfeeding child receives low-fat milk, which can provoke the development of signs of LN.

2) (usually it takes at least 15-20 minutes for a child of the first months of life), otherwise the child will receive a lot of foremilk and, not having time to suck out the hindmilk, will again switch to foremilk from the second breast.

3) If there is a lot of milk, the baby sucked the breast for a very short time and the mother feels that it is still quite full, and the baby no longer wants to eat, then it is better to offer the same breast at the next feeding. General rule in case of excess milk: change the breast no more than once every 2-3 hours. Most likely, after a few days of such a regimen, the amount of milk will decrease, while the child will no longer show any signs of LN.

If the baby has symptoms similar to LN, it is possible that reducing the breast rotation (once every 3 hours or even less often) in order to reduce the total volume of milk will lead to a decrease in the manifestation of symptoms.

4) Do not try to maintain certain intervals between feedings. It is better to feed more often, since the longer the break, the stronger the stratification of milk.

5) It is also necessary to monitor (best of all, a consultant on breastfeeding will tell you about this at an in-person consultation), and also make sure that the child does not just suck, but also swallows. In which case is it possible to suspect improper application? In case you have nipple abrasions and/or breastfeeding is painful, or you hear smacking, clicking and similar extraneous sounds while suckling. Also, feeding through pads often leads to improper grip and inefficient sucking.

6) Night feedings are very desirable: in a sleepy state, the child is relaxed, not distracted, sucks the breast longer and more “qualityally”, therefore, it empties it better.

7) It is undesirable to take the baby from the breast before he is full, let him suckle for as long as he wants (especially in the first 3-4 months).

If all this does not help, it may really be lactose intolerance, and not a similar condition that can be corrected with proper feeding, or other problems with similar symptoms.

What else can be done?

II. . Most often we are talking about cow's milk protein. If CMP is an allergen for a child (and this happens quite often), allergic inflammation can occur in the intestines, which, in turn, can lead to insufficient breakdown of lactose and lactase deficiency. The way out is to exclude whole milk from the mother's diet. You may also need to eliminate all dairy products, including butter, cottage cheese, cheese, sour-milk products, as well as beef and anything cooked with butter (including pastries). Another protein (not necessarily cow's milk) may also be an allergen.

To the most frequently allergic products include: cow's milk, chicken eggs and meat, soy, wheat, seafood, nuts. When it is possible to identify and eliminate allergens, the activity of the child's intestines improves and the symptoms of LN stop. The effect of a restrictive diet should be expected no earlier than in 2-3 weeks. With an allergy to cow's milk protein, the effect of eliminating the product may occur only after 3 weeks.

III. Pumping before feeding. If changing breasts less frequently and eliminating allergens is not enough, you can try some foremilk BEFORE feeding. This milk is not given to the child, and the child is applied to the breast when more fatty milk comes. However this way must be used with caution so as not to trigger hyperlactation. The best way to use this method is to enlist the support of a breastfeeding consultant.

If all this does not help, and signs of lactase deficiency persist, you should consult a doctor!

Melnikova R., consultant on GW

Edited by Wolfson S., pediatrician

Sources

1. M., W. Sears. "Breast-feeding"

2. Website about lactase deficiency http://lactase.ru/

3. Science-Based Explanation medical problems and questions http://www.sitemedical.ru/content/%D0%9F%D0%BE%D0%B4%D1%80%D0%BE%D0%B1%D0%BD%D0%BE%D0%B5 -%D0%BE%D0%B1%D1%8A%D1%8F%D1%81%D0%BD%D0%B5%D0%BD%D0%B8%D0%B5-%D0%BB%D0%B0 %D0%BA%D1%82%D0%B0%D0%B7%D0%BD%D0%BE%D0%B9-%D0%BD%D0%B5%D0%B4%D0%BE%D1%81% D1%82%D0%B0%D1%82%D0%BE%D1%87%D0%BD%D0%BE%D1%81%D1%82%D0%B8-%D1%83-%D0%B4% D0%B5%D1%82%D0%B5%D0%B9-%D0%B8-%D0%B2%D0%B7%D1%80%D0%BE%D1%81%D0%BB%D1%8B% D1%85-%D0%BF%D1%80%D0%B8%D1%87%D0%B8%D0%BD%D1%8B-%D0%B2%D0%BE%D0%B7%D0%BD% D0%B8%D0%BA%D0%BD%D0%BE%D0%B2%D0%B5%D0%BD%D0%B8%D1%8F-%D1%81%D0%B8%D0%BC%D0 %BF

4. M. Sorokina, GW consultant, member of AKEV. "Lactase deficiency" http://www.akev.ru/content/view/475/31/

5. N. Gerbeda-Wilson, Leader of the La Leche League. "Lactase deficiency? Do not treat tests!"
http://www.llli.org/Russian/lactoseintolerance.html

6. L. Kazakova, pediatrician, consultant on breastfeeding "Favorite diseases of a healthy newborn" http://akev.ru/content/view/47/52/

7. D. Newman "Colic in infants" http://breastfeeding.narod.ru/newman/colic.html

8. Technique for proper breastfeeding http://breastfeeding.narod.ru/latch.html

Young parents are often interested in whether breastfeeding mothers can have milk. After all, it is generally accepted that if a mother eats it, then milk protein can cause an allergy attack in a child. Let's try to figure out whether it is worth being afraid of milk, and also find out what can replace ordinary cow's milk for a woman who is breastfeeding.

How healthy is cow's milk?

For the health of the baby, it is important that he receives mother's milk from the first days. It has a complex composition, rich in trace elements, vitamins and contains everything that a child needs. At the same time, what the mother eats affects its properties. There are many dietary recommendations for women during breastfeeding. Often they are quite contradictory:

• some experts recommend limiting milk intake,
• others believe that it should be present in the diet,
• folk rumor advises drinking it more - this will increase lactation.

Where is the truth?

It has already been proven that if a mother drinks cow's milk, then a foreign protein will inevitably end up in the baby's body after feeding. To answer the question of whether milk is possible during breastfeeding, you need to find out how bad cow protein is for the baby. Is it true that his presence always causes Negative consequences– allergies or colic?

Indeed, cow protein is more often than others the cause of an allergic reaction. In this case, advises Canadian pediatrician Jack Newman, you need to understand what triggered the rash or irritability of the baby. Perhaps it's just a quick flow of milk from the nipple, the baby's well-being - there are many reasons!

According to Natalya Razakhatskaya (international breastfeeding consultant, mother of many children), the special composition of breast milk protects the baby’s intestines well, and if he is not allergic to cow protein, then the milk from the store drunk by his mother will not harm him. An allergic reaction to cow protein in a child can be identified as follows:

• with a blood test,
• consistently excluding various products (including dairy) from the mother's diet.

If it became noticeable that the skin of the child has cleared, while the woman does not drink milk, then it is an allergen. Then she should temporarily limit the intake of dairy products or replace them with sour-milk ones, since there the protein is present in a different form.

If mom is lactose intolerant

There are cases when adults cannot tolerate the milk sugar (lactose) contained in milk (in Russia, in different regions of such people, from 36 to 56 percent). Their intestines do not produce enough of the enzyme lactase, which is responsible for the digestion of milk sugar. The reason for the deficiency is bad heredity, ecology, malnutrition, stress.

In order not to give up dairy products, these people can:

• take pills containing this enzyme,
• Eat special dairy products that are low in lactose, such as low-lactose or lactose-free dairy products.

The use of such dairy products is an opportunity to enjoy the natural taste of milk without thinking about the unpleasant consequences.

Can breastfeeding mothers drink lactose-free milk? How will this affect the quality of breast milk? lactose free milk product less fat, it saves everything beneficial features regular milk. It is well absorbed by the body and does not cause discomfort associated with the body's low ability to break down milk sugar. Jack Newman believes that a woman with lactose intolerance should continue to breastfeed her baby. However, she does not need to refuse to drink milk. This should be done only if the child has colic, then you can remove dairy products from your menu.

Does condensed milk promote lactation?

Can breastfeeding mothers eat condensed milk? And in what quantity? Often during the feeding period, women feel the need for sweets. It seems to them that condensed milk is the “lesser evil”, because sometimes you can hear the opinion that its use increases lactation. Doctors advise not to get involved in condensed milk! You need to remember simple rules:

• carefully read the composition on the jar (only what does not contain vegetable fats, preservatives and flavor enhancers is suitable),
• choose a fresh, high-quality and less fatty product,
• don't get carried away! Nutritionists warn: one can of condensed milk will "give" you 1200 kcal. Therefore, taking care of the health of the baby and your own, allow yourself 2 teaspoons a day, no more!

No, sweet condensed milk will not increase lactation (for this it is better to choose other food), but it can cause an allergic reaction in the baby.

Sterilization saves calcium!

To understand whether it is possible for nursing mothers to sterilize milk, it is better to listen to the opinion of experts. They believe that sterilization produces a tasty and healthy product, and due to heat treatment, it retains much more calcium than boiled or pasteurized milk. Another argument is heat treatment. During sterilization, almost all spore microorganisms die, so this milk is the safest. It is stored for a long time. Select raw materials only good quality– heat-resistant, dense, without smacks and smells. Therefore, it is recommended for women to consume while breastfeeding.

At all times, it was generally accepted that milk is one of the most useful and nutritious foods, but is it really so? Can it have a negative impact on the body of the mother and child during breastfeeding? At what age can it be introduced into the diet? So, let's talk about everything in order.

Is it possible to drink cow's milk while breastfeeding

Every mother knows that when breastfeeding, it is necessary to follow a certain diet, especially strict in the first months. Since Soviet times, pediatricians recommend drinking more tea with milk to stimulate lactation. Now breastfeeding experts have a different point of view on this matter. Let's try and figure it out.

Milk: benefit or harm

Milk contains more than 100 essential components: balanced and fatty amino acids, sugar, lactose, minerals, proteins fats carbohydrates. Very rich set the most useful substances, which are also perfectly combined with each other for absorption by the body. So, for example, calcium is well absorbed in the presence of magnesium, with the help of vitamin D, which happens when cow's milk is consumed. Undoubtedly, milk is the most useful product, but his nursing mother should be used with caution.

The benefits of cow's milk have been known since ancient times.

The fact is that cow protein is a very strong allergen. It is highly likely that the baby's body will react to it with redness. skin or severe colic. After all, he is not yet ready for such a load. In general, in the first month of breastfeeding, experts do not recommend its use. But this does not mean that a nursing mother needs to completely abandon it.

Rules for choosing and using the product

After the first month of breastfeeding, you can try introducing cow's milk into the mother's diet. For the first time, a couple of spoons are enough. It should be consumed in the morning, preferably in the morning. After that, we observe the reaction of the baby. If no redness and rashes appear on the child’s skin, the baby’s behavior has not changed and he has not become more capricious, the stool has not changed color and structure, then after two or three days you can drink a little more milk. Despite all its benefits, you should not get carried away too much. For good nutrition breastfeeding mothers need only one glass of milk a day.

Fresh whole milk wins over pasteurized store milk in terms of the amount of useful trace elements, so it is preferable to drink it. But don't drink new milk, because it contains a large amount of the hormone that suppresses lactation - estrogen. To avoid negative reactions child's body, fresh milk can be replaced with fermented milk products such as cottage cheese and cheese. They are less allergenic, but may cause other adverse reactions such as increased colic and excessive gas.

Replacing fresh milk with baked milk is also not the best way out, because. it contains all the same allergens and it is more fatty, and therefore more difficult to digest. Although earlier it was believed that tea with baked milk stimulates lactation and increases its fat content, but modern experts have dispelled this myth. It has been proven that the intake of certain products does not affect lactation, and even more so the fat content of milk.

Goat milk: benefit or harm

Undoubtedly, goat's milk wins over cow's on almost all counts. It has unique properties, among them:

• prevention of rickets;
• strengthening immunity;
• improvement of tooth enamel and hair;
• stimulation of the digestive tract;
• stabilization of the nervous system;
• strengthening the heart muscle and vascular walls.

The main plus for a nursing mother is that it does not contain allergenic cow protein. This means that there is practically no negative reaction of the child's body. Although goat's milk has a fat content of 4–9%, due to the greater uniformity of fats, it is absorbed many times faster and completely. But this does not mean that it can be used in unlimited quantities one glass a day is enough. You need to enter it, like a cow, starting with a couple of sips. Then observe the reaction within 48 hours. If no negative reactions are observed in the baby, then gradually it can be completely introduced into the diet of the newly-made mother.

Goat milk richer than cow's, but absorbed faster

lactose-free milk for breastfeeding mothers

It should be noted right away that lactose-free milk is akin to medicine, it should not be consumed without the appointment of a specialist. And it is prescribed only to those mothers whose children have lactase deficiency. Lactase deficiency is the absence or deficiency in the baby's intestines of lactose, one of the sugars found in milk. This is not a disease, but a feature of the child's body, which eventually normalizes. To reveal it, hand over necessary tests, which the doctor prescribes in the presence of certain symptoms: the baby's stool becomes more frequent and changes color, colic intensifies, there are frequent regurgitation and general anxiety of the crumbs. Lactose-free milk comes from different companies - each mother, if necessary, can choose the right one for the price and quality.

Soy milk as a substitute for cow's milk: benefits and harms

Soy milk contains no animal protein and is made from soybeans. A product made from high-quality raw materials is of great benefit to the human body, but not to a nursing mother. Firstly, the likelihood of an allergic reaction is high, secondly, soy protein is rich in phytoestrogens, which can adversely affect lactation, and thirdly, the phytic acid present in the composition inhibits the normal absorption of iron, zinc and calcium.

Powdered milk: an alternative to a fresh product

Powdered milk, like regular milk, can cause an allergic reaction in the child's body. Therefore, before introducing it into the diet of a nursing mother, you should check how it can affect the health of the crumbs. To do this, you need to use a small amount of powdered milk and look at the reaction. If after a couple of days everything is in order, then you can safely use it, but, of course, within reason.

The benefits of milk are priceless, but, like all other products, it should be introduced into the diet of a nursing mother and consumed carefully. After all, the most important thing is the health of children, and it is in our hands.