A similar dietetic approach is used in the management of lactose intolerance in both children and adults. In this condition, individuals have insufficient amounts of the enzyme lactase to breakdown lactose. Lactose intolerance affects only a small percentage of people of caucasian background (2-15%) but a larger percentage (50%-90%) of Asian, Mexican or African-American people are affected.
In both children and adults, small amounts of lactose can still be tolerated; therefore dairy products do not need not be completely avoided. In a small percentage of children, there may be transient lactose malabsorption due to gastroenteritis, parasitic infection or untreated coeliac disease. It’s therefore important that children are re-challenged, as lactose tolerance may improve once the epithelium heals. It’s important to keep in mind that in babies, symptoms of lactose intolerance and cow’s milk protein allergy can be similar. Appropriate diagnosis is therefore essential.
The management of IBS may differ slightly in children and adults. Compared to adults, children tend to eat more bread, breakfast cereals and fruit. As a result, their overall fibre and FODMAPs intake may be high. Making some first-line IBS dietary interventions (i.e. modifying fibre intake or eating less fruit) may be sufficient to manage their overall symptoms.
Adults requiring a secondary-line dietary intervention for the management of IBS may need to strictly adhere to the low FODMAP Diet (LFD). The LFD is a common approach which restricts certain foods containing short-chain carbohydrates as a management tool in patients with IBS. A more simplified LFD approach may be sufficient in children to identify any trigger foods leading to constipation or diarrhoea in children. As with other functional gut disorders, a careful medical diagnosis is always essential to avoid misdiagnosis. Additionally, the LFD must be overseen by a paediatric dietitian with relevant expertise.