A formula-fed 10-month-old with secondary lactose intolerance is being discharged. The nurse should instruct the mother to avoid giving the infant which of the following?


• Secondary lactose intolerance (lactase deficiency): The most common cause of temporary lactose intolerance in infants and young children is infection or inflammation that affects the gastrointestinal tract and can damage the lining of the small intestine, resulting in temporary lactose intolerance. Once the underlying condition is treated, the lactase deficiency will resolve, usually within three to four weeks.

• With secondary lactose intolerance, lactose is not digested properly in the small intestine, instead passing whole into the large intestine or colon. Upon reaching the colon, lactose is broken down by the normal colon bacteria. This breakdown results in the production of carbon dioxide and hydrogen gases. The gas production can lead to abdominal distension and pain, burping, diarrhea, and gas.

• With secondary lactose intolerance, the infant is unable to consume any commercial dairy products. A formula-fed infant will need to be introduced to a lactose-free formula before slowly returning cow's milk to the diet when the illness resolves.

• Primary lactase deficiency is very rare. It occurs when babies are born with a deficiency or absence of the enzyme lactase. Such babies require a specialized formula with another type of sugar such as sucrose (present in table sugar), which they are able to digest.

• The foods to which a baby is allergic or intolerant can pass through the mother's breast milk. In some cases, the mother must abstain from eating the foods to which the infant is intolerant. When the cause of the damage to the gut is removed, the gut will heal, even if the baby is still fed breast milk. It is rare, except in cases of congential lactase deficiency, for an infant to be unable to tolerate breast milk once the mother's diet has been addressed.

• Rice and wheat do not contain lactose and can be eaten freely.

• Celiac disease, or celiac sprue, is an injury to the mucosa of the small intestine caused by the ingestion of gluten (a toxic protein component) from oats, wheat, rye, barley, and related grains. It is different in that it is not expected to resolve and requires a lifelong gluten-free diet.

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