The role of therapeutic nutrition in acute intestinal infections in children

E. N. Preobrazhenskaya, Ph.D., will talk about what methods exist for testing a patient for lactose intolerance, in what cases it is necessary to prescribe treatment and what kind of nutrition an adult patient needs, as well as about the nutritional features of an infant with lactase deficiency. nutritionist of the highest qualification category (North-Western State Medical University named after I.I. Mechnikov, St. Petersburg).

author: E. N. Preobrazhenskaya, Ph.D., nutritionist of the highest qualification category (North-Western State Medical University named after I. I. Mechnikov, St. Petersburg)

Diagnosis of lactose intolerance

Lactose tolerance test

You should not eat anything before the test. On the day of the test, the patient drinks a liquid containing lactose, which can cause gas and abdominal pain. After this, the blood is checked every 30 minutes for 2 hours. If your blood sugar does not rise, it may indicate lactose intolerance. This test is not applicable to diabetic patients and infants.

Lactose intolerance in a child is determined by exclusion. For 2 weeks, milk and dairy products are excluded from the child’s diet. After the symptoms of dyspepsia disappear, milk is gradually reintroduced into the child’s diet in small portions. If symptoms of lactose intolerance occur 4 hours after your child drinks milk or formula, this means that the child does not have enough lactase enzyme.

Breath hydrogen test

This is the most accurate test for lactose intolerance. Determining the hydrogen content in exhaled air makes it possible to identify the activity of microflora in digesting lactose. The concentration of gases is determined after a dosed load of regular or labeled lactose. The method is used to diagnose lactose intolerance in adults and older children.

Stool acidity analysis

Determination of the total carbohydrate content in feces, which reflects the body's ability to absorb carbohydrates.

How to stop diarrhea in a baby

And also study all the symptoms of diarrhea in infants in order to make the correct diagnosis and prescribe effective treatment.

Signs of diarrhea in a baby

Signs of diarrhea in infants include:

• Watery, greenish stools. If this is observed in a child in the first one and a half to two weeks after birth, then there is no reason to worry. Loose stools in a baby may also be due to the fact that during this period his body creates microflora and attempts to adapt to dairy foods. Immediately after birth, meconium is released from the baby's body - the original stool, which has a black-green color. A gradual lightening of the stool from black to green, from green to normal light (golden) will occur as the child grows and his digestive system develops.
• The appearance of blood, foam, mucus in the stool.
• If diarrhea in a breastfeeding baby is accompanied by the presence of foam, this may be the result of active fermentation. Foamy stool can either indicate the formation of the digestive system (and then there is no cause for concern), or indicate pathology.
• If a child behaves normally in the presence of foamy stool, eats well, reacts to the world around him and gains weight, then foamy stool is an indicator of the formation of the digestive system. And this particular child manifests itself in this way.
• If the baby is restless and has a fever, most likely foamy stool indicates the presence of an inflammatory process, an infectious disease, or malnutrition of the nursing mother. And also if the child is on IV or IV, perhaps the selected mixture is not suitable for him. Diarrhea in an infant with a fever may also be the body's reaction to teething. In this case, you should pay attention to the child’s gums and salivation (the gums will be pinkish and slightly swollen, and salivation will be profuse).

Symptoms of diarrhea in infants in some cases can be quite normal (for example, after teething or adaptation of the digestive system). But they can also be a signal of the presence of more serious diseases. In this case, you should not self-medicate and expect that everything will go away on its own - consult a doctor. Additional tests, such as a colonoscopy, may be necessary to make a diagnosis. The MEDICOM clinic has all the necessary equipment and comfortable conditions for this procedure. It is also possible to place the child in a children's hospital.

Treatment of lactase deficiency

Only those cases of lactose intolerance that are clinically manifest require treatment. The main principle of treatment is a differential approach to therapy depending on:

• on the age of the patient (full-term or premature newborn, infant, young, older, adult patient);
• degree of enzymatic deficiency (alactosia, hypolactosia);
• genesis of fermentopathy (primary or secondary).

The main treatment for patients with absolute lactase deficiency (alactasia) is a complete abstinence from consuming milk and dairy products. In parallel, therapy is carried out aimed at correcting intestinal dysbiosis, replacement therapy (use of lactase drugs: lactrase, thylactase, lactaid) and symptomatic treatment.

In secondary lactase deficiency, the focus is on treating the underlying disease. Reducing the amount of lactose in the diet is temporary until the small intestinal mucosa is restored.

In patients with primary or secondary lactase deficiency, the degree of restriction in the consumption of milk and dairy products is strictly individual, since some patients cannot tolerate only milk, but are able to eat fermented milk products with a low lactose content. And patients with a slight degree of hypolactasia can consume even small amounts of fresh milk (up to 100–150 ml per day) without harm to health. In such cases, it is allowed to take milk not on an empty stomach, slowly, in small portions no more than 1-2 times a week. Restrictions are lifted when the patient's tolerance to dairy products increases.

Keep a food diary!

The patient needs to keep a food diary. Thanks to the recordings, you can get answers to two important questions:

• What particular product caused flatulence and diarrhea?
• How much lactase should be added to foods containing lactose?

In order to identify the patient's reaction to milk, it is recommended to carry out test loads of milk or lactose. Training of the corresponding enzyme systems is also indicated by administering small amounts of fermented milk products when the sick child or adult patient is in satisfactory condition. An indicator of an increase in the threshold of tolerance to milk is the absence of intestinal disorders.

Carefully!

In the food industry, lactose is used in the production of many food products. In addition to milk and dairy products, lactose is present in packaged sausages, packaged soups, ready-made sauces, chocolate, and cocoa powder. It is used to increase the viscous properties of the product and ease of use. Lactose is 30–35% less sweet than sucrose; it is added in large quantities. When baked, milk sugar turns brown, so it is an invariable ingredient in French fries, croquettes, confectionery and baked goods.

Lactose is also widely used in the manufacture of pharmaceuticals and is one of the main components of flavors, flavor enhancers, sweeteners, etc.

Read food and drug labels.

Infant formula for diarrhea

Diet therapy for gastrointestinal dysfunctions in young children

G. A. Samsygina

Doctor of Medical Sciences, Professor

Dysfunctions of the gastrointestinal tract (GIT), or, more correctly, functional disorders of the GIT, are so common in the first months of life that they are observed in almost every child to one degree or another. It is difficult to imagine a baby who has not at least once experienced regurgitation or vomiting, loose stools or constipation, flatulence or intestinal colic.

All of the above manifestations can be observed once and not have any effect on the child’s health and well-being, i.e., be random. At the same time, all these manifestations can be the first symptoms of a disease, not only of the gastrointestinal tract, but also of other organs and systems of the body. Finally, these manifestations may reflect functional disorders of the gastrointestinal tract, caused by a discrepancy between the capabilities of the growing organism and the requirements placed on it. Therefore, before treating the above conditions, the doctor needs to understand them.

Let us note that all gastrointestinal dysfunctions, unlike diseases, always begin gradually, almost imperceptibly, and in the first weeks of life. Moreover, the onset of clinical manifestations of dysfunction is never accompanied by a rise in temperature, a change in the condition and behavior of the child (changes in the color of the skin and visible mucous membranes, the appearance of shortness of breath, anxiety or, conversely, lethargy and drowsiness, etc.), much less toxicosis. Impaired body weight gain is observed no earlier than 3-4 weeks from the manifestation of dysfunction, and a slowdown in growth and development is observed either after several months or is not observed at all. However, long-term persistence of functional disorders creates favorable conditions for the formation of gastrointestinal diseases, such as persistent reflux (cardioesophageal, duodenogastric, etc.), chronic inflammation of the intestinal mucous membranes, secondary enzymatic deficiency, etc., as well as diseases of other organs and systems (hypotrophy , deficiency conditions, neuroses, etc.). Therefore, the treatment of functional gastrointestinal disorders is as important and justified as the treatment of other diseases. But the principles and methods of this therapy are somewhat different.

Amount of lactose in products

Using a special list of products, you can determine the amount of lactose present in the diet. Below are data from various authors.

Lactose content in some products in grams per 100 g of product (T. Schleip, 2004):

• Dessert cream - 2.8–6.3.
• Coffee whitener - 10.0.
• Yogurt made from powdered milk - 4.7.
• Whole milk yogurt (3.5%) - 4.0.
• Milk yogurt (1.5%) - 4.1.
• Milk yogurt (3.5%) - 4.0.
• Natural yogurt - 3.2.
• Creamy yogurt - 3.7.
• Low-fat fruit yogurt - 3.1.
• Low-fat fruit yogurt - 3.0.
• Yogurt ice cream - 6.9.
• Creamy fruit yogurt - 3.2.
• Cocoa - 4.6.
• Mashed potatoes - 4.0.
• Semolina porridge - 6.3.
• Rice porridge with milk - 18.0.
• Kefir - 6.0.
• Low-fat kefir - 4.1.
• Sausages - 1.0–4.0.
• Margarine - 0.1.
• Butter - 0.6.
• Sour milk - 5.3.
• Low-fat milk - 4.9.
• Pasteurized milk (3.5%) - 4.8.
• Condensed milk (7.5%) - 9.2.
• Condensed milk (10%) - 12.5.
• Condensed milk with sugar - 10.2.
• Powdered milk - 51.5.
• Skimmed milk powder - 52.0.
• Whole milk (3.5%) - 4.8.
• Whole milk powder - 38.0.
• Milkshakes - 5.4.
• Milk chocolate - 9.5.
• Ice cream - 6.7.
• Dairy ice cream – 1.9–7.0.
• Ice cream sundae - 1.9.
• Creamy ice cream - 5.1–6.9.
• Fruit ice cream - 5.1–6.9.
• Nougat - 25.0.
• Buttermilk - 3.5.
• Dry buttermilk – 3.5.
• Donuts - 4.5.
• Pudding - 2.8–6.3.
• Whipped cream (10%) - 4.8.
• Whipped cream (30%) - 3.3.
• Coffee creamer (10%) - 3.8.
• Pasteurized cream - 3.3.
• Pasteurized whole cream - 3.1.
• Sour cream (10%) - 2.5.
• Dry whey – 70.0.
• Gouda cheese (45%) - 2.0.
• Camembert cheese (45%) - 0.1–3.1.
• Mozzarella cheese - 0.1–3.1.
• Parmesan cheese - 0.05–3.2.
• Roquefort cheese - 2.0.
• Steppe cheese - 0.1.
• Cottage cheese (20%) - 2.7.
• Cottage cheese (40%) - 2.6.
• Low-fat cottage cheese - 3.2.

Lactose content in some products in grams per 100 g of product (I.M. Skurikhin, M.I. Volgarev, 1987):

• Buckwheat groats - 0.03.
• Oatmeal - 0.05.
• Oatmeal - 0.02.
• Winter wheat - 0.05.
• Soft spring wheat - 0.02.
• Women's milk - 6.6–7.0 (cow's milk - 4.8, sterilized cow's milk - 4.7, mare's milk - 5.8, sheep's - 4.8, goat's - 4.5, camel's - 4.9, dry whole - 37.5, dry low-fat - 49.3).
• Full-fat kefir - 3.6.
• Yogurt - 4.1.
• Acidophilus - 3.8.
• Yogurt - 3.5.
• Kumis - 5.0.
• Pasteurized buttermilk - 4.7.
• Dry cream - 26.3.
• Sterilized cream (25%) - 3.3.
• Condensed milk with sugar - 12.5.
• Condensed milk without sugar - 9.5.
• Low-fat cottage cheese - 1.8.
• Fat cottage cheese - 2.8.
• Cream (10%) - 4.0.
• Cream (20%) - 3.7.
• Sour cream (30%) - 3.1.
• Cocoa with condensed milk and sugar - 11.4.
• Coffee with condensed milk and sugar - 9.0.
• Coffee with condensed cream and sugar - 9.0.
• Hard cheeses (the indicator depends on the fat content of the product) - 2.0–2.8.
• Cheese cheese - 2.9.
• Oil of traditional composition - 0.81 (“Peasant” - 1.35, “Buterbrodnoe” - 1.89).
• Creamy ice cream - 5.8.
• Dry milk mixture low-lactose, with rice flour - 0.36, with buckwheat flour - 0.36, with oatmeal - 0.36.

Products that almost always contain milk sugar:

• Milk and dairy products.
• Packaged sausages, including cooked ham.
• Soups in bags.
• Ready-made sauces.
• Bakery products.
• Nut butter.
• Ice cream.
• Breadcrumbs.
• Cakes and pies.
• Dumplings.
• Croquettes with cheese.
• Hamburgers.
• Cheeseburgers.
• Ham.
• Ketchup.
• Mustard.
• Mayonnaise.
• Flavor enhancers.
• Astringent component for making sauces.
• Sweeteners in prepared packaged foods.
• Condensed milk.
• Bulk spices.
• Chocolate bars, sweets such as candies, chocolate (with the exception of some varieties of dark chocolate).
• Cocoa powder.
• Nutritional supplements.
• Light sauces.
• Puddings, puree soups.
• Donuts and omelettes.
• Mashed potatoes.
• Saccharin tablets.

Products approved for use in lactase deficiency:

• Soy milk and soy drinks.
• Low lactose milk formulas.
• Raw meat, poultry, fish.
• Eggs.
• Lard.
• Vegetable oil.
• All fruits and vegetables.
• Potato.
• Cereals (rice, etc.).
• Legumes.
• Nuts.
• Jam, honey, syrups.
• Any type of sugar except milk (sorbitol, fructose).
• Liquid saccharin.
• Fruit and vegetable juices.
• Tea coffee.
• Pasta made from wheat flour without additives.
• Natural flour.
• Rye and wheat bread without whey and food additives.

What to feed a child with diarrhea

Table of contents

Causes of diarrhea in children Symptoms Viral infection What to feed a child with diarrhea? Functional diarrhea Diarrhea caused by food allergies Diarrhea from antibiotics Nutrition for diarrhea in children Drinking regime Diet after diarrhea Prevention

Photo source: shutterstock.com

All mothers sooner or later encounter the phenomenon of childhood diarrhea, or simply diarrhea. The cause may be either banal poisoning, which passes quickly and does not have serious consequences, or various infections. They can lead to exhaustion, dehydration and vitamin deficiency in the child’s body.

Therefore, parents should be vigilant and closely monitor the child’s condition.

Causes of diarrhea in children

First of all, let's figure out what condition of the stool is considered a deviation from the norm. With diarrhea, the discharge is liquid and may contain remnants of undigested food and mucus. The number of bowel movements increases and sometimes reaches 10-12 times a day.

The most common causes of diarrhea in children:

1. Too fast passage of food through the intestines as a result of impaired peristalsis.
2. Inflammatory processes in the intestines.
3. Excessive secretion of inflammatory secretion.
4. Impaired absorption of water by the intestinal walls.

Symptoms

The main symptoms of diarrhea are loose stools and a sharp increase in the frequency of bowel movements. In addition, you may notice bloating and rumbling in your baby. If a baby complains of pain and pain in the intestinal area, his temperature rises sharply - this may be a sign that an infection has appeared in the body.

Viral infection

Its most common pathogens are:

• rotavirus;
• enterovirus;
• astrovirus.

They enter the child's body through dirty fruits and vegetables, unwashed hands, and foods that have not undergone the necessary heat treatment.

The incubation period is 7-10 days, in some cases it can last up to 2-3 weeks.

Photo source: shutterstock.com

The main symptoms of a viral infection:

• diarrhea;
• stomach ache;
• elevated temperature;
• vomit.

If you suspect your child has such an infection, you should not self-medicate. Be sure to consult with your pediatrician, who will make an accurate diagnosis and then prescribe treatment.

What to feed a child with diarrhea?

Diet for viral infection includes:

Drink plenty of fluids.

You can use either regular warm water or still mineral water. They will save the baby from dehydration and help the body get rid of toxins.

Moderate nutrition for diarrhea in children.

Let's talk about what a child can eat with diarrhea.

It’s good if the baby abstains from food altogether on the first day of illness. If this is difficult to do, then carefully ensure that the diet for diarrhea in a child is followed.

Avoid fried and fatty foods, as well as fruits and dairy products. Experts recommend feeding your baby small portions. These can be dietary meat broths, porridges, kefir and other fermented milk products.

Functional diarrhea

May appear if:

• you introduced new foods to your child’s diet;
• he ate something stale or not meant to be eaten (grass on the street, chalk, etc.).

At the same time, the child’s bowel movements become more frequent, bloating and mild abdominal pain may appear. But the process is not accompanied by high fever or vomiting.

Treatment includes taking adsorbent drugs and supplements that restore intestinal microflora.

We talked a little higher about what a child can eat with diarrhea.

Diarrhea caused by food allergies

This is a common occurrence when transitioning from breastfeeding/artificial feeding to complementary feeding.

The most common pathogen is cow's milk. Other foods that can cause diarrhea include eggs, nuts, chicken and fish.

When a child has a food allergy, he or she develops diarrhea, bloating, and severe pain in the intestinal area. In some cases, vomiting, swelling and urticaria may occur.

If you observe such symptoms, contact your pediatrician. He will conduct an examination and also schedule additional consultations with an allergist and gastroenterologist, if he deems it necessary.

Diarrhea from antibiotics

If a child takes antibiotics and has diarrhea, his intestinal microflora most likely suffers.

In this case, you should not stop taking the medication yourself. It is best to change your diet to include fermented milk products, dietary broths and jelly. And also consult with your doctor.

Photo source: shutterstock.com

Nutrition for diarrhea in children

During diarrhea, you should exclude fried, spicy and salty foods from the children's menu.

Remove sausages and other smoked meats, mushrooms, heavy meat and fish from your diet. Give preference to turkey and rabbit.

Avoid giving your baby fresh fruits and vegetables as they can cause bloating.

Temporarily exclude fresh bread and other baked goods, milk and dairy products, and eggs.

Canned food, sweets, fast food, soda, and freshly squeezed juices are also prohibited.

Do not give your child sour fruit teas, rosehip infusions, herbal mixtures, strong tea or coffee. They can increase intestinal motility and cause unnecessary complications.

Drinking regime

Regardless of the type of diarrhea, a child loses a lot of water during bowel movements, the balance of which must be replenished.

You can drink lightly salted or mineral water. You can use "Regidron".

If a child has diarrhea, it is worth excluding sweet drinks, soda, strong tea, juices, and cow's milk from the menu.

If the child is small, he is given 50-70 ml of liquid after each trip to the toilet “in a big way”. Children over 1 year of age usually already know how to drink on their own. Let them drink as much liquid as they want.

Diet after diarrhea

After the signs of diarrhea have passed, it is worth returning the child to their usual diet, but gradually. It is important to help the body fully recover.

Let meals be frequent and portions small. Do not introduce fried or salty foods into your diet yet. The best option would be steamed and boiled dishes.

Food should be light and healthy.

Temporarily eliminate soda, mushrooms, artificial sweets, smoked foods, fast food and heavy meals.

• The menu can include light soups, lean meats and fish. They are rich in fiber and nutrients, but do not overload the intestines.
• Rice and oatmeal have an excellent restorative effect: they coat the intestinal walls and restore digestion.
• Do not give your baby fresh bread and rolls; stock up on crackers or yesterday’s pastries.
• Skip the scrambled eggs and instead prepare a diet steamed omelet for your child.
• Boiled/stewed potatoes, pumpkin, carrots and zucchini are allowed. Baked apples perfectly normalize stool. Bananas are good for you.
• Jelly and fermented milk products will help in restoring the body.

Prevention

The main and most common cause of diarrhea is poor hygiene. Therefore it is important:

• Teach your child to wash their hands thoroughly. The process should take about 15-20 seconds. Show him by example what to do and how to do it. Use soap on the entire surface of your hands, including the surface between the fingers and their tips.
• Teach your child to wash their hands immediately after going outside, before each meal and after using the toilet.
• Wash fruits and vegetables thoroughly. You can use special tools for this. Soak greens in water before using them in salads and other dishes.
• Subject products to thorough heat treatment.
• Make sure that your child does not put everything in his mouth while walking and playing at home.
• Boost your baby's immunity by giving him vitamins and minerals. Let his nutrition be complete and balanced.

Nutrition for lactase deficiency

Want more new information on nutrition issues? Subscribe to the informational and practical magazine “Practical Dietetics”!

SUBSCRIBE

With primary (constitutional) lactase deficiency, the amount of lactose in the diet is reduced, up to its complete exclusion for life. You can reduce the amount of lactose in your diet by reducing or completely eliminating the consumption of lactose-containing products, primarily whole milk (see Table 1). This method is suitable for adults and older children with adult-type lactase deficiency.

It is important to note that neither in adults nor in children is there a correlation between the level of lactase activity and the severity of clinical symptoms. With the same degree of enzyme deficiency, there is great variability in symptoms (including diarrhea, flatulence and abdominal pain). However, in each individual patient, clinical manifestations depend on the amount of lactose in the diet (dose-dependent effect).

In case of secondary lactase deficiency, the use of fermented milk products, butter, and hard cheeses is allowed. Pasteurized fermented milk yoghurts are absorbed worse by patients, since the microbiological effect of lactase is destroyed during heat treatment. You should buy products with live lactic acid bacteria because the bacteria in yogurt have already digested some of the lactose. It is advisable to eat yogurt, or acidophilus, or yogurt every day.

Cheeses are divided according to the degree of ripening: the longer the cheese ripens, the less milk sugar remains in it. Consequently, hard and semi-hard cheeses (Swiss, cheddar) lose most of the lactose.

Fats and half-fat cream contain less lactose than milk, so their consumption in small quantities is allowed in exceptional cases. The higher the fat content of a product, the less lactose it contains. A glass of milk contains 12 g of lactose. If necessary, milk and milk cheese can be replaced with soy milk and soy cheese.

It is advisable to combine dairy products, for example, with grain foods, breads, and pies, writes Edward Claflin in his book “The Home Doctor for Children” (1997).

A dairy-free diet may reduce calcium intake.

Infancy and lactase deficiency

In infancy, the problem of correcting the diet for lactase deficiency becomes more complex. If the child is breastfed, then reducing the amount of breast milk in the diet is undesirable. In this case, the best option is to use lactase preparations, which are mixed with expressed breast milk and break down lactose without affecting the other properties of breast milk. If it is impossible to use lactase preparations, the issue of using low-lactose mixtures is resolved.

For bottle-fed children, the formula is selected with the maximum amount of lactose that does not cause the appearance of clinical symptoms and an increase in carbohydrates in the feces. If the child’s condition is not impaired, then you can start with a diet containing up to ⅔ carbohydrates in the form of lactose. This ratio can be achieved by combining a regular adapted formula with a low-lactose or lactose-free formula, or by prescribing a fermented milk mixture. If you use two mixtures, distribute them evenly throughout the day. For example: at each feeding - 40 ml of a low-lactose mixture and 80 ml of a standard one. After changing your diet, you should check the carbohydrate content in your stool. After 1 week, decide on the need to further reduce the amount of lactose.

In cases of severe lactase deficiency and no effect when the amount of lactose is reduced by half, it is recommended to use low-lactose mixtures as the main food product.

There are several types of low-lactose products:

• milk formula with malt extract for feeding children during the first 2 months of life;
• milk mixture with flour (rice, buckwheat, oatmeal) or oatmeal for feeding children from 2 to 6 months;
• low-lactose milk for feeding children over 6 months and for preparing dishes instead of natural milk;
• You can prepare your own low-lactose mixture based on eggs with sugar, margarine and rice flour.

The ready-made low-lactose mixture is a powder that resembles powdered milk in appearance and taste. The composition of such mixtures includes corn oil and milk fats in a ratio of 25:75, sucrose, malt extract or dextrin-maltose, starch, flour for baby and dietary food, vitamins A, D, E, PP, C, group B, macro- and microelements (iron, sodium, potassium, calcium, phosphorus, magnesium).

Packages of lactose-free formulas are marked “SL” (sine lactose) or “LF” (lactose free). Soy-based mixtures that do not contain lactose can be used. Low-lactose mixtures can be developed based on casein, soy and milk protein hydrolysates.

With secondary hypolactasia, the symptoms of lactase deficiency are transient. If a child has signs of severe disruption of the digestion and absorption of nutrients, in particular fats, the baby is not gaining weight well, unstable stools are observed for a long time, then it is better to use lactose-free mixtures based on protein hydrolysates with the addition of medium chain triglycerides, which are well absorbed and contribute to good weight gain bodies. If lactase deficiency persists in a child older than 1 year (or occurs after intestinal infections and parasitic diseases), then when preparing a diet, you can be guided by the recommendations presented in table. 1.

Table 1. Set of foods that are allowed and excluded from the diet for lactase deficiency in children (A. I. Kliorin et al., 1980)

The first complementary food for a baby with lactase deficiency may be pureed vegetables. It contains pectin, vitamins, and mineral components. It is advisable to give preference to zucchini, potatoes, cauliflower, carrots, and pumpkin. Only one type of vegetable should be introduced and not mixed until all vegetables have been tried one by one. Monitor the child's well-being.

It is allowed to use baby kefir. It should be given to a child with lactase deficiency on the third day after preparation. You can use cottage cheese, well purified from whey.

Complementary feeding dishes (porridge, vegetable purees) for children of the first year of life with lactase deficiency are prepared not with milk, but with a low- or lactose-free product. You can use canned baby food. Fruit juices are introduced into children’s diets later, usually in the second half of life. Industrially produced fruit purees are prescribed from 3–4 months of age. Sick children over 1 year of age and adults usually tolerate fermented milk products (kefir, yogurt) well. Condensed and concentrated milk is excluded from the patient’s diet.

The duration of therapy is determined by the genesis of the disease.

In case of primary congenital lactase deficiency, a low-lactose diet is prescribed for life. With transient lactase deficiency in premature infants, usually by 3–4 months of life (by postconceptional age 36–40 weeks or more), children regain the ability to tolerate lactose. Full-term infants who are immature for gestational age require treatment for 1–2 months.

The indication for gradual withdrawal of therapy is the reduction of stools and their thickening in consistency.

With secondary hypolactasia, the symptoms of lactase deficiency are transient. Therefore, when the underlying disease resolves (reaches remission) after 1–3 months, the diet should be gradually expanded by introducing lactose-containing dairy products, under the control of clinical symptoms (diarrhea, flatulence) and excretion of carbohydrates in feces. If lactose intolerance persists, one should think about whether the patient has primary (constitutional) lactase deficiency.

Sample menu lactose-free

Breakfast

• Porridge made with water or soy milk, with the addition of fruits or dried fruits.
• Egg or scrambled eggs (without milk) in vegetable oil.
• Whole wheat bread.
• Tea with sugar or honey.

Snack

• Coffee without milk.
• Sandwich with boiled meat and herbs.
• Apple.

Dinner

• Vegetable soup.
• Fish (boiled or fried) or poultry (boiled or baked).
• Steamed vegetables with vegetable oil.
• Juice or compote from fruits (dried fruits).

Snack

• Yogurt.

Dinner

• Rice with vegetables or vermicelli with vegetables, vegetable oil.
• Canned tuna or salmon.
• Tea with jam.
• Fruits.

Metabolic disorders when following a lactose-free or low-lactose diet

Excluding milk and dairy products from the diet leads to a decrease in calcium intake, which is so necessary during the child’s growth period. Adults, especially women, need calcium to strengthen bones and reduce the risk of osteoporosis.

Non-dairy foods that contain calcium include:

• Broccoli (100 g - 90 mg), okra, brown cole, spinach, kale, turnip greens, lettuce (50 g - 10 mg).
• Canned sardines (100 g - 250 mg), tuna (100 g - 10 mg), salmon (100 g - 205 mg).
• Oranges (1 piece - 50 mg).
• Calcium-fortified juices - orange juice (100 g - 308-344 mg).
• Calcium-fortified soy products, cereals.
• Beans (50 g - 40 mg).
• Almond.

To absorb calcium, the body needs vitamin D, which is found in soy milk, butter, margarine, egg yolks, and liver.

If necessary, it is recommended to take calcium and lactase enzyme supplements or nutritional supplements.

Main criteria for treatment effectiveness

1. Clinical signs: normalization of stool, reduction and disappearance of flatulence and abdominal pain.
2. In children: age-appropriate rates of weight gain, normal indicators of physical and motor development.
3. Reducing and normalizing the excretion of carbohydrates (lactose) in feces.

The role of therapeutic nutrition in acute intestinal infections in children

All intestinal infections can be divided into 3 groups1:

• intestinal infections of a bacterial nature (shigellosis, salmonellosis, yersiniosis, cholera, etc.);
• intestinal infections of a viral nature (rotavirus infection caused by adeno-, enteroviruses, Norfolk group viruses, etc.);
• intestinal infections of protozoal etiology (amebic dysentery, etc.).

The summer-autumn period (peak – August–September) is characterized by bacterial acute intestinal infections, and viral acute intestinal infections are more common in the cold season: late autumn, winter and spring.

The main mechanism of transmission of intestinal infection is fecal-oral, carried out through food, water and household contact. Moreover, in the case of bacterial infections, the food and water routes are of greater importance, and in the case of viral diarrhea, water and contact routes are of greater importance. In the warm season, potential bacterial pathogens have more opportunities to multiply in food products, and there is a higher likelihood of consuming contaminated fruits, vegetables, herbs, and poor-quality water.

In a situation where etiological diagnosis is difficult, as well as in the first hours of the disease, clinical manifestations can suggest a bacterial or viral etiology of acute intestinal infections, which is important for the correct management of the patient.

Knowing the pathogen is of great importance. Bacterial or viral acute intestinal infection are two different variants of the course of intestinal infection; naturally, the therapy is also different. The pathogenetic mechanisms of development of bacterial and viral infections also differ.

Based on the type of diarrhea, intestinal infections are divided into 3 pathophysiological options:

• osmotic;
• secretory;
• invasive.

Bacterial pathogens usually cause invasive and secretory diarrhea, while viral pathogens usually cause osmotic diarrhea. A mixed version of diarrhea is possible.

Invasive diarrhea is initiated by the introduction and invasion of pathogens into the intestinal wall, which is accompanied by the development of local inflammation and increased permeability of cell membranes. As a rule, the pathological process is localized in the large intestine. Invasive diarrhea is characterized not so much by copious stools, but by various inclusions in the form of pus, blood, mucus, and greens. Stool may be frequent, but not large. Severe intoxication, fever, pain mainly along the colon, and tenesmus are typical.

In contrast to invasive diarrhea, the secretory and osmotic variants are watery diarrhea.

Secretory diarrhea is accompanied by intestinal hypersecretion associated with impaired electrolyte transport in the intestine and caused by bacterial exotoxins. The pathological process is usually localized in the small intestine. Secretory diarrhea is clinically manifested by frequent watery loose stools with undigested food debris, water and electrolyte imbalances, moderate manifestations of intoxication, and a slight increase in temperature.

Osmotic diarrhea, usually viral, is caused by the formation in the intestine of osmotically active substances (disaccharides, including lactose), due to the development of secondary disaccharidase (lactase) deficiency, which retain fluid in the intestinal cavity. This diarrhea is characterized by bloating, a moderate increase in stool volume, and frequent, foamy stools with remnants of undigested food.

The next difference that helps distinguish a bacterial infection from a viral one is the location of the lesion. Viral infections, as a rule, occur in the form of acute gastritis, gastroenteritis (vomiting, watery diarrhea). Bacterial diarrhea (secretory, invasive, mixed) can also occur as gastritis and gastroenteritis, but the lower intestine is often affected, that is, enterocolitis and colitis are more typical for bacterial intestinal infections. Thus, depending on the clinical manifestations, we can assume the localization of the lesion (gastritis, gastroenteritis or, for example, enterocolitis) and the possible pathogen. After this, depending on the severity of the disease, certain therapeutic measures are carried out2.

Acute intestinal infections are often accompanied by the development of secondary digestion and absorption disorders (secondary enzymopathies), which can aggravate the situation and contribute to the development of prolonged diarrhea and exhaustion of the body.

First aid for acute intestinal infections is the fight against dehydration. Watery diarrhea, especially accompanied by high fever, is dangerous due to rapidly developing dehydration. Therefore, rehydration therapy, for which glucose-saline solutions are used, is of paramount importance. If a viral infection is suspected, then antibiotic therapy is not indicated. In the case of a suspected bacterial infection, in some cases, you should consider prescribing an antibacterial drug3,4.

In terms of diet, it is now believed that both infants and older children are advised to stick to their normal diet. If we are talking about infants, then, of course, it is best to drink breast milk; you can temporarily refuse complementary feeding. If we are talking about older children, then frequent meals in small portions are necessary. Avoid coarse fiber, fresh fruits and vegetables, all gas-forming foods, fried and fatty foods. Early return to a normal diet is thought to contribute to a shorter duration of illness. However, this is not always possible with OCI, since intoxication, fever, vomiting, and loose stools reduce appetite. In addition, damage to the gastrointestinal tract does not contribute to the normal digestion of foods. In this regard, the issue of adequate nutrition is of particular importance. In this case, the main condition for impaired functioning of the gastrointestinal tract is the easy digestibility of this food. Complete balanced formulas intended for children from 1 to 10 years old are Peptamen Junior and Clinutren Junior.

These mixtures can be used as a sole source of nutrition or as a supplement to regular food in children with various gastrointestinal problems. The protein component of the Peptamen Junior mixture is represented by peptides, which are obtained as a result of the hydrolysis of whey proteins, which eliminates the development of allergic reactions in children. Such protein is easier to digest and absorb, promotes rapid gastric emptying, which reduces the risk of vomiting. Due to the high level of cysteine, it provides an anti-inflammatory effect. Peptamen Junior contains fats (medium chain triglycerides), which do not require digestive enzymes for their absorption, but are a good source of energy for the body. The mixture contains an optimal ratio of omega 6: omega 3 (7:1) fatty acids, which helps the child’s body fight inflammation. The “sweet part” of the mixture is represented by broken down starch (maltodextrin), which any child can digest, even with damaged intestines. This mixture is preferably used during the acute period of the disease (ACI) not only as a nutritional, but also a therapeutic component, since it helps normalize water balance, helps restore the integrity of the intestinal mucosa, replenishes the lack of energy and vitamins necessary for the body, and reduces the severity of vomiting and diarrhea5.

In the end of the disease, after the acute symptoms have stopped, but weakness and asthenia remain, it is recommended to switch to Clinutren Junior for a quick recovery. The Clinutren Junior mixture contains easily digestible whole milk proteins (a mixture of caseins and 50% whey proteins), which are easily broken down and absorbed in the gastrointestinal tract, helping to strengthen the immune system. The “sweet part” is also represented by maltodextrin. Just like Peptamen, but in smaller quantities, Clinutren Junior contains medium-chain triglycerides - fats that are broken down and absorbed without the participation of pancreatic enzymes, while providing the body with “fast” energy. Both mixtures contain vitamins and microelements necessary for the child’s body. The most important role in maintaining immunity is played by vitamins A, C, E and the trace elements selenium and zinc. Clinutren Junior contains two probiotics (Lactobacillus paracasei, Bifidobacterium longum) and prebiotics (dietary fiber), which help increase the number of “good” bacteria in the child’s intestines, which also activates the immune system and improves the functioning of the gastrointestinal tract. It should be noted that both mixtures do not contain gluten and are low-lactose (contain minimal, clinically insignificant amounts of lactose), which is important for the development of secondary enzymopathies.

Equally important, especially in pediatric practice, are good tolerability and good organoleptic properties of these food products. Therapeutic mixtures Peptamen Junior and Clinutren Junior have physiological osmolarity. The vanilla flavor of the mixtures is of particular importance for children.

Thus, the use of these mixtures for acute intestinal infections promotes rapid recovery and restoration of the child’s body after an illness.

Bibliography:

1. Uchaikin V.F., Novokshenov A.A., Sokolova N.V. Etiopathogenetic therapy of acute intestinal infections in children at the present stage. Attending Physician 2010;1:7-13.
2. Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Mar 1996;97(3):424-35.
3. World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers - 4th revision.
4. Guarino A., Albano F., Ashkenasi S. et al. ESPGHAN/ESPID Evidence-based Guidelines for the Management of acute gastroenteritis in children in Europe. J Pediatric Gastroenter Nutr 2008;46(2):81-184.
5. Flack S., Lawson M., Milla P. (2003) Experience with a new hydrolysed feed in a pediatric gastroenterology clinic. J Hum Nutr Diet. 16:365-70.