“If the baby has a stomach ache, the whole family suffers” — many young mothers and fathers will agree with this statement, because intestinal colic can really be a real disaster for parents. A child with frequent spasms and pains in the abdomen cries a lot and continuously, and it can be almost impossible to calm him down during these periods. However, do not worry ahead of time, a competent approach to the treatment of colic will help you forget about sleepless nights forever and protect the newborn from discomfort and possible complications.
h2>Why does colic occur?
Identifying the cause of colic is sometimes not as easy as it might seem. They affect up to 40% of all newborns¹, and both digestive disorders and some external factors can cause colic. However, there are several signs that will tell parents what the root of evil is.
Early colic, which occurs spontaneously, does not last long and disappears after stroking the abdomen or applying heat, usually does not require special treatment and eventually subsides. spasms often occur. In the same period, the composition of the children's intestinal microflora undergoes global changes, it is formed gradually, and a temporary lack of beneficial microorganisms affects the well-being. In addition, heartburn can be provoked by a sudden change of scenery, loud noises or bright lights. The nervous system of babies is extremely sensitive to stress, do not forget about it.
It is a completely different matter when colic pursues a child regularly, and their appearance is associated with meals. Pain, flatulence and belching immediately after feeding are a reason to suspect digestive problems that can and should be dealt with.
Often the cause of colic lies in the inability of the baby's digestive tract to digest breast milk or formula. Two options are possible here: intolerance to milk protein (casein) or lactase deficiency. The second disorder is associated with a lack of the lactase enzyme in newborns, which is normally produced in the small intestine and serves to break down the milk sugar lactose into easily digestible monomers — glucose and galactose.
Lactase deficiency: problem and solution
Lack of the enzyme lactase in the child's body does not allow milk to be properly digested and leads to the accumulation of hydrogen and lactic acid in the large intestine (Fig. 1). The latter, in turn, provokes the appearance of wounds on the mucous membrane, causes a burning sensation in the anus. At the same time, the baby suffers from pain and bloating due to an excess of gases, sleeps poorly and loses appetite. Of course, most often the lack of the enzyme is replenished by 3-4 months by itself, when the child grows up, but expectant tactics in this case can play a cruel joke. Refusal to eat due to constant painful colic can cause dehydration at a very early age and affect the development of the child's nervous system.
Figure 1. The development of colic in lactase deficiency. Source: MedPortal
What to do if the body of a newborn cannot digest lactose from milk on its own? The approach to the problem here can be complex. Typically pediatricians advise:
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Review the nutrition of a nursing mother. A change in diet can help alleviate the symptoms of colic. To make breast milk less irritating to the baby's intestines, the mother should give up milk and minimize the use of fermented milk products — kefir, yogurt, curdled milk and fermented baked milk.
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Consider taking anti-gas medications. In the fight against colic, drugs with antispasmodic action can help, which increase intestinal motility and improve gas discharge, reduce heartburn and pain.
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Start treating the cause of colic by adding lactase enzyme to milk. This enzyme is available on the market both in the form of dry powder in capsules and in the form of drops. The second option is more convenient, since the drops are easier to mix with milk, and they work faster.
Why don't WHO recommend not breastfeeding?
A lack of lactase in a newborn should not be a reason to stop breastfeeding. Mother's milk is recognized as the «gold standard» of nutrition for infants, it contains all the substances necessary for growth and development, as well as components that ensure the formation of a healthy intestinal microflora in children, in particular, more than 200 types of oligosaccharides that improve the composition of the intestinal microbiome.³ Last It is necessary not only for the absorption of nutrients, but also for protecting the body from pathogenic bacteria and their toxins.
For optimal baby development, the World Health Organization recommends starting breastfeeding within the first 6 months due to⁴:
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Milk contains antibodies that protect against diarrhea and pneumonia — two leading causes of death of children in the world. Infant formulas are devoid of antibodies, only the mother can pass them on to the baby.
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Reducing the likelihood of children developing obesity and type II diabetes, as well as the positive impact of breastfeeding on intellectual development.
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Reducing the risk of developing breast and ovarian cancer, diabetes Type II and postpartum depression in the mother.
Manifestations of lactase deficiency have their own characteristics:
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Except for pain in the abdomen, the child is tormented by bloating and flatulence.
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Stools are frequent, up to 8-10 times a day, liquid, frothy, green in color, with a sour smell.
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The baby has a good appetite, but after a few minutes of feeding, he chokes on tears, stops eating, and pulls his legs up to his stomach, writhing in pain.
If a pediatrician suspects a lactase deficiency in a child, he can prescribe a fecal analysis for carbohydrates, the increased content of which in the biomaterial will confirm the diagnosis.
Colif Drops for Children — From Clinical Trials to No. 1 Lactase in the UK and Ireland
Increased flatulence during breastfeeding in preterm infants was first identified in the early 1990s. Even then, this was associated with the immaturity of the children's small intestine, which normally produces the enzyme lactase, which breaks down milk sugar lactose — the main source of energy for infants. Further research has established that lactase deficiency can cause painful colic in children.⁵
In an effort to solve this problem, Irish scientists were able to isolate the enzyme lactase from the yeast Kluveromyces lactis, which lives in nature in a lactic acid environment, and obtain the drug Kolif Drops for Children on its basis. The work done has fully justified itself. Studies at the Center for Prematurity in Ireland (Cork University Hospital) showed an 80% reduction in the duration of crying in children who were given the drug in breast milk some time before feeding. Subsequently, the effectiveness of the drops was repeatedly confirmed (Fig. 2).
«. Source: www.coliefUSA.comaption
Benefits of Kolif Lactase Drops
In Russia, the preparation «Colief» (Colief® Infant Drops) appeared not so long ago, while in Europe and the USA it has been successfully used for many years. The drops are based on natural ingredients, therefore they do not cause side effects and allergic reactions, and their effectiveness and safety are confirmed by clinical studies.
Among the advantages of the Kolif Drops for Children lactase preparation:
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#1 in the UK — 20 years worldwide, including UK, USA, Canada, Australia, China
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High efficiency and safety — the only lactase in Russia for children from birth that has successfully passed international clinical trials. Colic usually goes away 2-3 days after starting to use the drops.
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No need to wait — when breastfeeding after adding the drug to milk, you can immediately breastfeed. Taking lactase in powder is inconvenient in that you must first break the capsule, measure the dose of powder by eye with a knife (because not everyone needs a full capsule), pour the powder into expressed milk, then wait 5-10 minutes until the enzyme is activated, and only after that give the child. At night, when mom does not get enough sleep, it is very painful psychologically and physically. All this time the child is tearing himself up from crying, waking up the whole family. Moreover, even the enzyme from the capsule may not be activated, and then you have to do everything all over again. Using drops is much easier — you need to drip 4 drops into a teaspoon of expressed milk, stir and immediately give to the child, and then breastfeed as usual. Drops can also be added to warm milk formula.
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Only natural ingredients — contains the enzyme lactase, glycerin and water.
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Free of: colors, preservatives, artificial flavors, lactose, gluten, soy, milk protein, seafood, egg white, GMOs.
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European quality — made in Ireland according to GMP requirements.
Comparison with other well-known lactase preparations speaks in favor of Kolif drops (Fig. 3). Lactase preparations in powders (“Lactazar”, “Lactase baby”), presented on the Russian market, either act with less efficiency or worsen the condition. This is due to the fact that the lyophilized lactase enzyme contained in them does not completely restore its active structure. The lactase enzyme in Kolif, on the contrary, is stabilized in glycerol and is always active. The alternative in Baby Doc drops is available in a small volume of 10 ml and has a high price. A vial lasts 2-3 days, while Kolif lasts 10-12 days.
Figure 3. Comparison of popular drugs lactase for children. Source: MedPortal
Thus, Kolif drops can serve as the drug of choice for colic caused by lactase deficiency in infants.
Combating colic: questions for doctors
Questions about how to deal with childhood colic caused by lactase deficiency are answered by Tatyana Viktorovna Kucherya (Russian National Research Medical University named after N.I. Pirogov, Department of Pediatrics with Infectious Diseases in Children, FDPO, Associate Professor, Candidate of Medical Sciences) and Anna Karpova Lvovna (GBUZKO «Kaluga Regional Clinical Hospital», Deputy Chief Physician for Childhood, Chief Freelance Specialist Neonatologist of the Ministry of Health of the Kaluga Region, Ph.D.)
Is colic dangerous for a child? Can they affect the health of the child in the future?
Kucherya T.V.:
It all depends on the reasons they are caused. If these are ordinary colic caused by transient immaturity or lactase deficiency, then in principle, there will be no further consequences. But if a child was born with some kind of pathology or suffered intrauterine hypoxia, colic can be caused by neurological causes that impair motor functions. These colic can have consequences, including for the development of the gastrointestinal tract, the innervation of the intestine. Such children are prone to constipation precisely because the cause of colic is not functional, but is associated with the activity of the nervous system.
If this condition is caused by a food allergy, then without treatment, the consequences can be quite serious. For example, in the future, food or pollen allergies may form, and even bronchial asthma may develop. Therefore, much depends on whether the doctor correctly diagnosed and prescribed treatment.
Karpova A.L.:
Colic causes a lot of anxiety in parents, because the child cannot calm down from pain. Of course, painful sensations in a child can form and become fixed, but there should not be serious health problems in the future. Another thing is that the pain from colic can disrupt the child's appetite, so he will eat worse and, accordingly, grow worse. In premature boys, flatulence and colic can lead to the development of an inguinal-scrotal hernia, which can also disturb the child.
If a child has colic, is it just milk sugar — lactose? Or could the milk proteins be the culprit? Or something else?
T.V. cow's milk, for example, if the mother consumes a lot of dairy products or if the baby was transferred to artificial feeding with mixtures based on cow's milk.
The cause of colic can also be an incorrect feeding technique, when the child does not grasp the nipple correctly, swallowing a lot of air, which then bursts the intestine. The accumulation of gases in the intestine can be facilitated by morphological immaturity, an insufficient amount of enzymes that break down not only lactose, but also other sugars and fats.
As I said, a violation of motor functions that cause pain, and an increase in gas formation against the background of a slow discharge of gases, has a great influence.
Finally, colic can even be caused by the mother's bad habits (such as smoking) and her emotional state. Severe stress is always accompanied by the release of various hormones, and all this affects the well-being of the child.
What to look for when choosing anti-colic drugs? What drugs would you recommend to patients and why?
T.V. Kucherya:
It all depends on the cause that causes colic. There is lactase deficiency, we prescribe lactase preparations. If you are allergic to cow's milk protein, accordingly, we exclude products containing it. In the case of neurological problems, the neurologist prescribes his own treatment. When colic is caused by a disruption in the gut microbiota, we recommend additional pre- and probiotics. We also prescribe so-called carminative drugs that reduce colic by collapsing gas bubbles. These medicines do not affect the gas formation itself, but relieve the symptoms.
Currently, there are many lactase preparations available on the pharmaceutical market, among them I would like to highlight «KOLIF drops for children». This is an Irish-made drug of European quality, about 20 years of experience in Europe. Its most important advantage is that the lactase contained in it is already pre-activated and, unlike analogues, does not require long-term activation before feeding. Therefore, it can be added to breast milk five minutes before feeding, and not half an hour, as is necessary with other lactase preparations. It is very easy to use thanks to its liquid form. What is very important, this is a natural supplement that contains only lactase isolated from yeast, glycerin and water, without dyes, preservatives and artificial additives.
According to my clinical observations, KOLIF Drops for Children is effective from the first days of use, copes well with colic caused by lactase deficiency, is well tolerated and has practically no side effects. The standard dose is 4 drops 8 times a day, it can be increased to 8 drops per feeding. In a standard dose (4 drops) of this drug, the amount of lactase is 810 units, which is more than in analogues.
Karpova A.L.:
The choice of medication for a newborn and infant primarily depends on the convenience of the dosage form. The most optimal for young children is the liquid form of the drug with a convenient dosing method (for example, in droplets). In this regard, the drug «KOLIF drops for children», which is available in liquid form, has undeniable advantages over the enzyme, which is available in the form of capsules, since it is impossible to give a capsule entirely to a small child, it must be divided, dissolved in milk.
< p>How common is lactase deficiency in children? Do all premature babies suffer from lactase deficiency?
T.V. Kucherya:
If we talk about premature babies, then almost all of them suffer from lactase deficiency. Another group consists of children who are considered full-term in terms of gestation, but by the time of birth their enzymatic system has not yet matured — about 15-20% of them. There are also isolated cases of primary lactase deficiency, that is, genetically determined, and it is impossible to cure it.
Karpova A.L.:
I work mainly with newborns, less often with infants. In our reality, I don’t have any more complete statistics on children in the first year of life, approximately somewhere in every third, maybe every second premature newborn with a body weight of less than 1500 grams has lactase deficiency. Its degree of expression varies. Lactase deficiency in premature babies is primarily associated with immaturity. In children who are more mature, other factors also play a role, such as family predisposition to this disease.
Are there other risk factors for lactase deficiency in children and adults?
T.V. Kucherya:
I have already mentioned that there are two types of lactase deficiency: primary and secondary. Primary — congenital, genetically determined, and largely depends on race or ethnicity. For example, Africans and Asians have a very high percentage of congenital lactase deficiency in the population. In adults, lactase deficiency can develop due to the fact that a person began to consume much less milk, and the number of enzymes necessary for the absorption of lactose has decreased.
Secondary lactase deficiency can be caused by many reasons. If we talk about babies, then premature and immature children are primarily susceptible to it. Various intestinal infections and inflammatory bowel diseases, food allergies, celiac disease, antibiotic treatment can also affect.
Do you advise to abandon breastfeeding and switch to formula for feeding in case of problems with the absorption of lactose by the child? If not, why not?
T.V. Kucherya:
Our main approach is that we keep breastfeeding and prescribe lactase supplements. Since we need lactose for the formation of the nervous system, especially the organs of vision, including the formation of the retina, the transfer to lactose-free mixtures can affect the health of the child. On artificial feeding, he will also not receive antibodies and immune protection from breast milk. As the professor I studied with said: cow's milk is food for the calf, not for the baby, so cow's milk based formulas will never be digested and provide all the necessary nutrients. Only in the most extreme cases do we resort to this measure.
Karpova A.L.:
I do this as a last resort. I try to keep breastfeeding as much as possible, nothing is better than it. But in exceptional situations it is necessary to resort to this measure when other means do not help. In my practice, refusal of breastfeeding due to pronounced manifestations of lactase deficiency is very rare.
If there is colic caused by a lack of lactase, will it be necessary to continue taking preparations containing it throughout the feeding period? Or over time, the baby's intestines adapt to breast milk?
Kucherya T.V.:
Of course, the baby's intestines adapt to breast milk. In addition, if we are talking about immature and premature babies, the amount of lactase they produce gradually increases. When the adaptation period passes, the lactase preparation can be gradually removed. There are cases of primary lactase deficiency, that is, when it is not produced due to genetic disorders, then the consumption of lactose-free products is necessary.
Karpova A.L.:
Over time, the enzymatic system gradually matures and the situation normalizes, colic will not necessarily continue throughout the feeding period. However, there are individual characteristics, each child's intestines are configured in their own way.
Can lactase intake slow down the process of adaptation of the gastrointestinal tract of newborns to mother's milk?
Kucherya T.V.:
No, it can't. These are different processes.
Karpova A.L.:
I did not notice that the use of the enzyme inhibited the development of the intestine.
If the child has colic, should I take any tests for lactase deficiency? Or can I immediately start taking lactase preparations without a prescription?
Kucherya T.V.:
The easiest way to determine if lactase deficiency is the cause of colic is to try lactase supplementation for 2 weeks. If there is an improvement, then most likely the reason is clear. Also, as a rule, we prescribe an analysis for the content of carbohydrates in feces, this is the most affordable test. It determines the insufficiency of the breakdown of carbohydrates in general, and not just lactose. More accurate methods are the determination of lactase activity in intestinal biopsies, a hydrogen test or a lactose load test, but these methods are laborious and not very applicable in outpatient practice.
It must be understood that symptoms may depend on individual visceral sensitivity. It happens that one child with a high degree of lactase deficiency feels great, except that the stool is watery, while the other has a low level of deficiency, but the child suffers from colic every day for several hours.
Karpova A.L.:
Colic in itself is not an absolute sign of lactase deficiency, there are other reasons for its development. Lactase deficiency has a number of characteristic symptoms, in the presence of which a special examination is indicated. Usually, the doctor evaluates the totality of symptoms and decides on the examination.
Do lactase preparations have side effects that you warn parents about?
T.V. Kucherya:
As a rule, pronounced side effects there are no effects, but we always warn about possible individual intolerance to the drug. But such cases are quite rare.
Karpova A.L.:
One of the main side effects in case of an overdose is constipation.
Sources:
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Jeremy D. Johnson, Kathrine Cocker, Elisabeth Chang. Infantile Colic: Recognition and Treatment. Am. fam. Physician. -2015, 1;92(7):577-582.
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Uptodate.com. Infantile colic: Management and outcome
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Clemens Kunz. (2012). Historical Aspects of Human Milk Oligosaccharides. Advances in Nutrition. 3, 430S-439S
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WHO. Maternal, newborn, child and adolescent health. Breastfeeding
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D. Kanabar, M. Randhawa, P. Clayton. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J. Hum. Nutr. Diet. 2001, 14(5):359-63. DOI: 10.1046/j.1365-277x.2001.00304.x
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Peter James Kearney et all. A trial of lactase management of infant colic. 1999. Topics in Clinical Nutrition 14(2):85. DOI:10.1097/00008486-199903000-00015
