Children lack digestive enzymes and show malabsorption

The article was professionally consulted by Master, Doctor Dang Huy Toan - Pediatrician - Neonatologist - Department of Pediatrics - Neonatology - Vinmec Nha Trang International General Hospital

Digestive enzymes are an indispensable component for the digestive system, especially the immature digestive system of young children. Digestive enzymes are biological catalysts of protein nature that catalyze most of the reactions of food metabolism. Under the action of digestive enzymes, food will be broken down into an emulsion, with this form the intestinal villi can easily absorb nutrients into the blood, giving children a feeling of hunger, appetite, and less fullness. gas, bloating, indigestion.
Digestive enzymes are secreted in many parts of the digestive system, each enzyme will have its own role and function. Digestive enzymes include many types: protease, amylase, lactase, cellulase, lipase...

Digestive enzymes secreted by the pancreas (including lipase, colipase) are responsible for breaking down long-chain triglyceride molecules into fatty acids and monoglycerides. These products then combine with bile acids and phospholipids to form micelles, which are absorbed through enterocytes in the jejunum. Fat molecules after being absorbed will be combined with proteins, cholesterol and phospholipids by the body, forming chylomicron particles and transported through the lymphatic system.
In addition to long chain triglycerides, medium chain triglycerides will be absorbed directly without going through the above processes.
Children with malabsorption of fats may be deficient in fat-soluble vitamins (including vitamins A, D, E, K) and some other minerals. In addition to the lack of digestive enzymes, bacterial overgrowth leading to breakdown and hydroxylation of bile salts is also a cause of fat absorption restriction. Unabsorbed bile salts can stimulate water secretion in the colon leading to diarrhea.

Amylase is a digestive enzyme secreted by the pancreas, often combined with enzymes in the cilia on the intestinal microvilli, responsible for breaking down carbohydrates and disaccharides into monosaccharides.
Unabsorbed carbohydrates are fermented by the intestinal flora and form carbon dioxide, methane, hydrogen and short-chain fatty acids (such as butyrate, propionate, acetate and lactate). Lack of amylase digestive enzyme leads to an excess of the fatty acids mentioned above, making children prone to diarrhea, gas and bloating due to gas retention in the colon.

Pepsin has the effect of digesting proteins right in the stomach, and at the same time stimulates the release of cholecystokinin, which contributes to the secretion of pancreatic enzymes. Enterokinase is another digestive enzyme secreted in the brush border that converts trypsinogen to trypsin and converts many pancreatic proteases to the active form. Activated pancreatic enzymes hydrolyze proteins into oligopeptides, which can then be absorbed directly or hydrolyzed into amino acids.

The causes of children's malabsorption and slow weight gain are diverse, which can be directly or indirectly affecting the functioning of the digestive system. In particular, the most common cause is because the digestive system of children is not fully developed. One of the manifestations of this condition is the lack of endogenous digestive enzymes secreted by the cells of the digestive system, thereby affecting the ability to break down and absorb nutrients.
If the child develops normally, his digestive system will contain all the necessary digestive enzymes. However, there are many cases where the amount of endogenous enzymes excreted by the body is not enough, leading to deficiency. Some common cases include:
Young children's bodies are still immature, the amount of endogenous digestive enzymes is not stable; The child has just experienced a certain illness; Anorexia baby; Malnourished children ; Children with long-term digestive disorders; Children eat too much at each meal or eat too many meals a day, leading to the secretion of digestive enzymes that do not meet the amount of food intake... Some manifestations and consequences of poor absorption in children collection includes:
Abdominal pain, nausea, vomiting; Diarrhea, loose, foul-smelling stools; Weak resistance, children are very susceptible to infections; Weight loss or slow weight gain; Dry skin, easy to bruise on light impact; Children are prone to mood swings, irritability, and fussiness.

There are many parents who think that to overcome the child's malabsorption, anorexia and prolonged digestive disorders, just adding digestive enzymes or Probiotics (good bacteria) is enough. However, in order to have a comprehensive effect, parents should supplement both Digestive Enzymes and Probiotics at the same time to enhance the mutual ability.
Digestive enzymes help food to be broken down, broken down into an emulsion and help intestinal villi cells to be absorbed into the bloodstream. Probiotic bacteria promote intestinal health and of course the absorption of nutrients will take place more smoothly.
If there is a lack of digestive enzymes, food will not be absorbed, leading to stagnation in the intestinal tract and for a long time will produce toxins that destroy the intestinal flora. On the contrary, when the intestinal microflora is out of balance, the lack of beneficial bacteria strains can cause a decrease in the secretion of some digestive enzymes, making the child less able to absorb them.
The problem to keep in mind when supplementing with digestive enzymes and Probiotics is that it is necessary to use an appropriate dose between the two to create a balance in the process of digestion and absorption of nutrients.

Parents need to build a scientific, reasonable and hygienic diet for their children. The basic requirements include eating cooked and drinking boiling water, balanced food and full of all 4 groups of substances: protein, fat, starch, vitamins and minerals. Besides, the addition of fiber is extremely necessary to support digestion and limit constipation. To increase the ability to absorb food, parents should prepare food according to their preferences with an appropriate amount based on the age of the baby; Increasing physical activity is a useful way to both promote height growth, detoxify and speed up metabolism and burn energy. Therefore, young children need to have a regimen of exercise and play every day to stimulate digestion and maximize nutrient absorption; Keep clean: Children need to wash their hands and feet before eating and after going to the toilet, bathing, and brushing their teeth every day. With breastfed babies, mothers need to clean hands, feet and breasts before breastfeeding. In addition, the surrounding living environment needs to be kept clean and cool, which will contribute to limiting the child's malabsorption. Children with malabsorption are often very thin, sick, or tired because they are always flat, many children still have diarrhea, they pass raw stools very often... Therefore, parents need to pay attention to building a regime. proper nutrition for children, increase physical activities and maintain good hygiene for children.
Besides, parents also need to pay attention to supplement the necessary micronutrients: Selenium, Chromium, Vitamins B1 and B6, Ginger, acerola fruit extract (vitamin C),... especially biological zinc. to improve the taste, help children eat well, reach the correct height and weight, and exceed the standard, have a good immune system, strengthen resistance to less sickness and less digestive problems.
For more nutritional knowledge and child care for each age, parents should regularly visit the website vimec.com and make an appointment with the leading doctors, pediatric and nutrition experts of the National General Hospital. Vinmec when needing advice on children's health.