Lactose Intolerance in Asian Children

Lactose intolerance is defined as the body’s inability to digest and absorb the milk sugar called lactose. This occurs secondary to a deficiency in a necessary enzyme essential in the digestion process of milk products. This enzyme is named lactase.

In many children who are internationally adopted this medical entity is incorrectly blamed for many intestinal symptoms these children experience.

Lactose intolerance is more prevalent among adult Asian, African, Native American and Mediterranean populations. Although many internationally adopted children come from the above-mentioned ethnic groups, this condition is relatively rare in infants and very young children. It does occur however under pathological conditions such as when a child has some sort of intestinal infection. In infants and very young children, the enzyme lactase remains active during the first few years in order to enable these children to absorb and digest breast milk or formula.

Clinical signs and symptoms

Abdominal pain and cramps
Abdominal distention
Nausea and vomiting
Diarrhea and flatulence
Lactose intolerance sometimes may occur as a temporary condition if it is secondary to an intestinal infection. Secondary lactose intolerance usually occurs because there is some damage to the mucus lining of the intestinal tract. Reasons for this could be secondary to an intestinal infection with parasites, viruses or bacteria.

Internationally adopted children, especially those of Asian descent, should have lactose intolerance high on the differential diagnosis radar, but other medical conditions need to be ruled out.

Such medical causes are as follows:

Parasitic intestinal infections with Giardia or cryptosporidium
Viral gastroenteritis, with the routine stomach virus caused by Rotavirus
Bacterial enteritis: salmonella and shigellosis
Severe protein malnutrition
Celiac disease
Cystic fibrosis
Toddler’s diarrhea secondary to excessive juice intake
A very good dietary history needs to be obtained and appropriate medical examination and laboratory tests need to be ordered before a diagnosis is made or excluded. General clinical suspicion of lactose intolerance can be confirmed by a favorable response to withdrawal of lactose from the diet. There is also more sophisticated laboratory testing such as hydrogen breath test that can help in confirming the diagnosis. Intestinal biopsies and lactose tolerance tests are rarely indicated in the Pediatric population.

Overall management of lactose intolerance is very simple: avoid milk products. Exclusion of milk from the diet should also be done even if the condition is a temporary one such a secondary to intestinal infections with Giardia. If the child is an infant, than Lacto-free formula should be prescribed. Older children may self-treat themselves by selectively eating foods that they can tolerate.

All newly arrived children who complain of intestinal symptoms should have a work-up for intestinal, viral, and bacterial organisms before the diagnosis of lactose intolerance can be used to explain their symptoms. This is especially important if the child comes from an ethnic background where lactose intolerance in more prevalent in the adult population.

By George Rogu M.D. of &

 For Domestic & International Adoption Medical record Reviews