Lactose intolerance

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Lactose intolerance
• Symptoms after dairy, growth, stool pattern, and diet reviewed
• No weight loss or poor growth, blood in the stool, symptoms that wake the child at night, persistent vomiting, or family history of celiac or inflammatory bowel disease
• History consistent with primary lactose intolerance
• Recommended limiting lactose to the amount tolerated rather than avoiding all dairy
• Discussed lactose-free milk, lactase tablets, yogurt, aged cheeses, and dairy in small portions with meals
• Reviewed calcium and vitamin D intake
• Follow up as needed

Lactose intolerance is common, causes gas, bloating, belly pain, or loose stools after dairy, and does not harm the gut; most children can still enjoy some dairy, especially yogurt, hard cheeses, and lactose-free milk. Recommended supportive care with an emphasis on smaller dairy portions with meals and enough calcium and vitamin D. Return precautions given including weight loss, blood in the stool, symptoms that wake the child at night, persistent vomiting, severe belly pain, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Symptoms and relation to dairy, growth, stools
Alarm features present or absent
Primary, secondary, uncertain, under 2-3 years, alarm
Limit rather than eliminate; diagnostic trial; temporary reduction
Lactose-free products and lactase; yogurt, aged cheese, portions
Calcium, vitamin D; supplement
Celiac screen, stool for parasites, breath test
Dietitian or GI

Return precautions in the template

weight lossblood in the stoolsymptoms that wake the child at nightpersistent vomitingsevere belly pain

Sources

AAP Clinical Report: Lactose Intolerance in Infants, Children, and Adolescents. Heyman MB; Committee on Nutrition. Pediatrics 2006;118(3):1279-1286. (free; reaffirmed…