The majority of children can tolerate lactose during a diarrheal episode. A small proportion of children with diarrhea may not be able to digest lactose and are therefore not tolerant of milk- and lactose-containing formulas. This is more likely to occur among young children who only receive animal milk or formula in their diet and who have persistent diarrhea, and it rarely occurs in children on a diet of breast milk. In a lactose-intolerant child, milk- and lactose-containing formulas result in a significant increase in stool output. Stool output reduces dramatically when the milk- or lactose-containing formula is stopped. The warning signs of lactose intolerance include deterioration of the child's clinical condition, signs of dehydration, and an increase in the stool volume when milk feedings are given. However, only when the child is not gaining weight, eating less, and not fully alert is this a real cause for concern. This condition can be managed by continuing breast feeding. If the child is not yet in the weaning period but takes animal milk, yogurt or diluted milk (equal water and milk) or soy milk can be used as a substitute given in small feedings. The child should be taken to a health care provider if the condition does not improve in 2 days.
If the child eats soft or solid foods, the lactose in the diet should be substituted in the same manner as for the infant (with diluted milk or soy milk) but mixed with cooked cereals and vegetables. If this does not improve the condition of the child, all animal milk should be excluded from the diet, and protein- and energy-rich foods such as finely ground chicken should be given. The treatment should be continued for a few days after the cessation of the diarrhea, when the milk is slowly replaced in the diet.
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