Food Intolerance In Children

  • Amina Qayyum Bachelor of Science - BS, Neuroscience, Keele University

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Introduction

As your child grows and expands their taste palate, it is important to be aware and prepared for any onset reactions. Unlike food allergies, which are an immediate reaction from the immune system, food intolerance is a condition where you have difficulty digesting a particular food or ingredient.1 As a result, this can make you feel sick among other symptoms. It is reported that 15 to 20% of the population is affected by food intolerance, with 50 to 84% of individuals suffering from irritable bowel syndrome, experiencing persistent issues with specific foods.2 

Recognising early signs of food intolerance and managing any potential triggers will help to prevent long-term complications, and allow your child to grow healthy and nourished with all the necessary nutrients. 

Difference between food intolerance vs. food allergies

Many people are unaware of the difference between a food intolerance and a food allergy. The main difference between these two terminologies lies with the cause. 

A food allergy is a response due to an immunological effect, meaning that the body’s defence system attacks itself by releasing antibodies (proteins) in response to mistaking the food substance as a threat. Even a small amount can result in mild to serious symptoms. The exact cause for these allergies is unclear, but a child may have a higher risk of developing certain allergies if they are already found in the family.3 

On the other hand, food intolerances do not affect the immune system, but instead affect the digestive system. It will not show up in an allergy test nor does it cause any severe or life-threatening reactions. The development of intolerance occurs when there are insufficient enzymes (proteins that help to speed up reactions in your body) to break down food. 

Types of food intolerance 

Lactose

Lactose is the main sugar in human and mammalian dairy, and 65% of the world suffers from lactose intolerance.

It is found in:

  • Milk
  • Cheese
  • Butter
  • Ice cream
  • Processed food, such as bread and biscuits

Lactose intolerance is caused by the inadequate production of the lactase enzyme, which aids in the digestion of lactose. Many lactose-intolerant individuals may tolerate small amounts of lactose without experiencing any symptoms. However, the amount of lactose a person can ingest before experiencing symptoms varies. It is important to note that this intolerance can occur at any age, and develop at later stages of life.4 

Gluten 

Gluten intolerance, or non-coeliac gluten sensitivity (NCGS), is a condition where individuals are sensitive to gluten. Gluten is a group of proteins found in grains. The exact number of individuals with this condition is unknown to researchers, while some estimates range from 0.5 to 13%. 

Gluten is found in:5

  • Wheat
  • Barley 
  • Rye
  • Couscous
  • Processed food, such as bread, flour, and cereals

This condition is similar to coeliac disease, which is an autoimmune disorder that attacks the gut tissues when consuming food containing gluten. It prevents the body from breaking down the food properly disrupting the body from absorbing key nutrients. 

However, unlike gluten intolerance, complications may arise for individuals suffering from coeliac disease if left neglected or unseen – including the development of:

Fructose

Fructose is a natural sugar that is found in: 

  • Fruits
  • Vegetables
  • Fruit juices and fizzy drinks
  • Honey
  • Other sweeteners such as agave and maple syrup

There are 2 main types of fructose intolerance: hereditary and dietary.

Hereditary

This type of fructose intolerance is genetic (meaning it runs in the family) and occurs when the enzyme aldolase B malfunctions. Aldolase B breaks down important molecules in the liver to convert sugar into glucose (your body’s main energy source). It is rare for adults to be diagnosed with this intolerance, as it is more commonly found in infancy/childhood when the child is introduced to food high in fructose. Some specific symptoms that a child may present include: 

  • Jaundice
  • Stunted growth
  • Dislike of sweet food

If undiagnosed, fructose will not be broken down and therefore be stored in the body. This is dangerous as it can lead to serious health problems, such as damage to your kidneys and liver, which could potentially develop into organ failure.6

Dietary

Also known as fructose malabsorption, dietary fructose intolerance occurs when an individual cannot fully digest fructose in the small intestine. The undigested fructose is transported to the colon, where it is consumed by bacteria. During this process, the bacteria create gases, which cause the intestines to expand. As a result, symptoms of gas, bloating, and cramps can occur.7

It is worth highlighting that fructose intolerance mimics other conditions such as irritable bowel syndrome and other intolerances discussed previously.

Symptoms

Children may exhibit different symptoms depending on the type of food they have consumed. Typically, these symptoms start within a few hours, however, a delayed reaction of 3-4 days can occur if the child has difficulty digesting the food. Depending on the individual, these reactions might not happen until a particular amount (threshold level) of the meal is consumed. Some of the common symptoms include:

These symptoms are not to be confused with a food allergy. Symptoms of food allergy can range from mild to severe. Although these are similar to food intolerance, allergies occur within minutes of consumption, contact, or even inhalation of the allergen. This includes but is not limited to: 

  • Wheezing, coughing, and/or difficulty breathing
  • Nasal congestion
  • Hives
  • Dizziness and/or fainting
  • Tingling and/or itching 
  • Swollen airways

It is important to keep an eye out for allergic reactions, as these can escalate and become life-threatening if left unattended. Seek immediate emergency medical attention if you suspect that a child is undergoing anaphylactic shock.8

Diagnosis

Your doctor may consider several factors, such as your family’s history of allergies/intolerances, and the symptoms presented. One of the ways to find out which food triggers the symptoms is by an elimination diet. This diet requires you to stop consuming common food allergens for 4-6 weeks.9 The six-food elimination diet (6-FED) is the most frequently employed approach, which involves temporarily eliminating the following foods from your diet: 

  • Milk
  • Eggs
  • Wheat
  • Soy
  • Nuts
  • Fish 

During this diet, you and your child may be asked to keep a symptom diary to keep track of any side effects. You will then be asked to slowly reintroduce each food into the diet. Once an intolerance is identified, the patient can “eliminate” that particular food. 

Other methods of diagnosis include:

Breath tests

This is used to assess lactose and fructose malabsorption using a hydrogen breath test. It is a simple medical test that measures the hydrogen gas (HO2) levels in the breath you exhale through a breathalyser machine.10

Blood tests

Blood tests are conducted to assess malabsorption or inflammation.

Treatment 

Currently, there is no treatment for food intolerance. Researchers are actively seeking a cure, however, in the meantime, your healthcare professional will most likely offer options to relieve or prevent symptoms (e.g., suggesting dietary changes, monitoring, or supplements).

Dietary changes

This includes reducing or limiting the intake of the trigger food. 

Monitoring

Regular appointments with your dietician will ensure that your child is having the right amount of key vitamins and minerals as they develop. Taking care in preparing meals, reading the labels of grocery food, and inquiring about the ingredients of a meal when eating out will help you avoid trigger foods and minimise symptoms. 

Supplements

For acid reflux and heartburn, antacid medications can be requested at your local pharmacy. Supplements like digestive enzymes or probiotics that aid in gut repair and nutrition absorption may also be helpful.

Summary

Every child is different, some may be sensitive to certain types of food, such as lactose and gluten, whilst others are not. Regardless, it is always important to be aware of the symptoms of food intolerance, such as nausea, vomiting, and diarrhoea/constipation. An early diagnosis can aid in avoiding unpleasant symptoms while ensuring children maintain an adequate nutritional intake. 

Although food intolerance has similar symptoms to a food allergy, the key difference between these two conditions is the cause. Food allergy is an immediate reaction of the immune system, whereas food intolerance is the inability to properly digest the food consumed; its symptoms may be expressed after a few hours to a couple of days. 

As there are no permanent cures for food intolerance, the best source of treatment would be to eliminate particular foods or reduce the quantity/frequency to prevent symptoms. 

If you suspect your child may be having an allergy reaction, seek medical attention. 

References

  1. Tuck CJ, Biesiekierski JR, Schmid-Grendelmeier P, Pohl D. Food intolerances. Nutrients [Internet]. 2019 Jul 22 [cited 2024 Oct 2];11(7):1684. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682924/ 
  2. Lomer MCE. Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther [Internet]. 2015 [cited 2024 Aug 15]; 41(3):262–75. Available from: https://onlinelibrary.wiley.com/doi/10.1111/apt.13041.
  3. Lee ECK, Trogen B, Brady K, Ford LS, Wang J. The Natural History and Risk Factors for the Development of Food Allergies in Children and Adults. Curr Allergy Asthma Rep [Internet]. 2024 [cited 2024 Aug 16]; 24(3):121–31. Available from: https://link.springer.com/10.1007/s11882-024-01131-3.
  4. Malik TF, Panuganti KK. Lactose Intolerance. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532285/.
  5. Barbaro MR, Cremon C, Stanghellini V, Barbara G. Recent advances in understanding non-celiac gluten sensitivity. F1000Res [Internet]. 2018 [cited 2024 Aug 18]; 7:1631. Available from: https://f1000research.com/articles/7-1631/v1.
  6. Hegde VS, Sharman T. Hereditary Fructose Intolerance. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 18]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559102/.
  7. Jung S, Bae H, Song W-S, Jang C. Dietary Fructose and Fructose-Induced Pathologies. Annu Rev Nutr [Internet]. 2022 [cited 2024 Aug 18]; 42(1):45–66. Available from: https://www.annualreviews.org/doi/10.1146/annurev-nutr-062220-025831.
  8. Onyimba F, Crowe SE, Johnson S, Leung J. Food Allergies and Intolerances: A Clinical Approach to the Diagnosis and Management of Adverse Reactions to Food. Clinical Gastroenterology and Hepatology [Internet]. 2021 [cited 2024 Aug 15]; 19(11):2230-2240.e1. Available from: https://doi.org/10.1016/j.cgh.2021.01.025
  9. Malone JC, Daley SF. Elimination Diets. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 18]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK599543/.
  10. Rana SV, Malik A. Hydrogen Breath Tests in Gastrointestinal Diseases. Ind J Clin Biochem [Internet]. 2014 [cited 2024 Aug 19]; 29(4):398–405. Available from: http://link.springer.com/10.1007/s12291-014-0426-4.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Amina Qayyum

Masters of Science – MSc Cognitive Neuroimaging and Data Science, University of Birmingham, UK

With a bachelor’s degree in Neuroscience, a master’s in Cognitive
Neuroimaging and Data Science, as well as an extensive experience in scientific writing and coding, Amina Qayyum is a life-long learner whose interest lies in neuroscience and neuroimaging research. Her exceptional commitment towards her undergraduate research project had led her to attain the Top Project Award, rewarded by the Royal Society of Biology. In addition, her background is further enriched by laboratory experience, marketing expertise, and qualitative research, enhancing her knowledge and skills.

Amina is dedicated to transforming complex subjects into clear and accessible insights, while ensuring her articles remain comprehensive and engaging for readers. Explore her writing to discover a fresh perspective on the latest cutting-edge developments in healthcare.

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