Diseases of the digestive system. Children's gastroenterologist. Tips for breastfeeding or bottle feeding. Causes of functional disorders of the gastrointestinal tract in children
Colic in newborns is quite common, in about 30-50% of children, regardless of gender, race and place of residence. Young parents, due to the lack of proper experience in caring for children, have no idea why the baby has intestinal colic, and how to alleviate his condition. Naturally, the only correct solution in such a situation is to consult a pediatrician. They diagnose intestinal colic in newborns according to the following signs: the child cries for a long time and restlessly, screams, it is almost impossible to calm him down, he bends and twists his legs. Relief of the condition occurs after a bowel movement or discharge of gas.
Most pediatricians previously tended to believe that colic in a newborn appears as a result of a violation of the baby's feeding regime, errors in the mother's nutrition, etc. Today, the first place among the factors contributing to the development of intestinal colic in children is the immaturity of the gastrointestinal tract.
Why do newborns have colic? The crux of the problem is ...
Perhaps we should start with the fact that colic in children in the first months of life is considered normal, and, as a rule, does not require treatment. However, not a single parent will be able to calmly watch a child screaming and crying in pain. For a while, it is possible to alleviate the baby's condition with the help of symptomatic therapy, but more on that later. In order for colic in a newborn to cease to be the main problem, it is necessary to know the nature of their occurrence.
Immaturity of the gastrointestinal tract (GIT).
Due to the fact that at birth the baby's gastrointestinal tract is absolutely sterile, in the first few days it is colonized by microorganisms, which subsequently form the intestinal microflora. Digestive problems and colic in a newborn are often associated with a violation of the intestinal microflora, as a result of which it becomes difficult to digest food. And if, to everything else, we add the immaturity of the enzymatic system, problems with peristalsis (impaired motility) and errors in the mother's nutrition - the appearance of intestinal colic in a newborn will become quite a natural phenomenon.
IMPORTANT! Violation of the intestinal microflora is most typical for children who are bottle-fed. This is due to the fact that breast milk contains bifidus factor, which promotes colonization of the intestine with bifidobacteria.
Why is the intestinal microflora disturbed in a newborn? The fact is that normally both "good" and conditionally pathogenic microorganisms live in the intestines. The "good" microbes include E. coli, lactobacilli and bifidobacteria, which are responsible not only for the quality of food digestion, but also participate in the formation of the body's immune defense. If, for some reason, the content of beneficial bacteria decreases, opportunistic microorganisms begin to multiply actively and prevail in quantity. As a result, food is poorly digested, and the child suffers from cramps, flatulence and constipation.
IMPORTANT! This is not to say that it is the mother's malnutrition that causes intestinal colic in the child, but this is his small merit. The consumption of foods that contribute to constipation (rice, blueberries) and increased gas production (cabbage, legumes, flour, dairy products, raw vegetables and fruits) by a nursing mother aggravates the course of colic in a child.
What to do?
With the appearance of intestinal colic in a newborn, first of all, the development of dysbiosis should be excluded - a condition in which the ratio of bifidobacteria and conditionally pathogenic microflora is disturbed towards the prevalence of the latter, due to the use of antibiotics, prolonged illness, and other factors that contribute to a decrease in the immune properties of the body. The reason for the development of dysbiosis in the first days of life is often the close contact of the child with the medical staff, as a result of which representatives of a nosocomial infection (streptococcus, hemolytic staphylococcus, etc.) colonize his intestines.
For this purpose, feces are analyzed for dysbiosis, the main indication for which is stool disorders: constipation, liquid bowel movements for three or more days, an admixture of mucus or undigested food, frothy stools, etc.
Analysis of feces for dysbiosis allows you to assess the ratio of the number of beneficial bifidobacteria (as well as lactobacilli and E. coli) to the number of opportunistic microorganisms (fungi, clostridia, enterobacteria). In addition, this assay can detect bacteria that can cause serious illness, such as salmonellosis or shigellosis.
IMPORTANT! Most probiotics are available over the counter without a prescription, but the prescribing physician should only make the decision to prescribe medications.
Improper attachment to the breast.
Colic often develops in newborns as a result of swallowing large amounts of air during feeding. This happens in situations where the baby has not fully or incorrectly captured the breast - only the nipple without a halo. With this attachment, it is very difficult for a child to suck, he quickly gets tired and falls asleep, having time to swallow air, which "bursts" the intestines, provoking the appearance of pain.
What to do?
Make sure that the baby fully engages the nipple. The surest sign of correct attachment: the child rests his nose against his mother's chest. The appearance of cracks on the nipples indicates improper attachment of the baby to the breast. In this case, it is recommended to consult a breastfeeding consultant.
Lactase deficiency.
As mentioned above, the immaturity of the enzymatic system leads to poor digestion of food, which contributes to the development of fermentation processes in the intestine and, as a result, increased gas production.
Lactose is an enzyme designed to break down milk sugar - lactose. When colic appears in a newborn, it is lactase deficiency that should be suspected, which is also manifested by stool instability, weight loss, and the development of dysbiosis. Lactase deficiency can be acquired (hypolactasia), against the background of infectious bowel diseases, allergic reactions, etc. The cause of congenital lactase deficiency can be aggravated heredity (intolerance to cow's milk protein in close relatives), as well as prematurity.
What to do?
To exclude lactase deficiency, as one of the causes of colic in a newborn, it is necessary to analyze the feces to determine carbohydrates and acidity levels. Normally, the amount of carbohydrates in the stool of a newborn does not exceed 0.25%, while the pH of the stool should be more than 4. When a diagnosis of lactase deficiency is made, further treatment tactics will be known only after a complete examination. Thanks to the appointment of lactase preparations, in most cases it is possible to preserve breastfeeding and normalize the baby's digestive tract.
In addition, the reasons for the development of colic in a newborn can be:
- throwing hydrochloric acid from the stomach into the esophagus (if the baby stays in a horizontal position most of the time after feeding);
- emotional lability of the mother;
- unfavorable environment in the house (loud noise, bright light, prolonged separation from the mother), etc.
Colic in newborns. First aid means.
Until the cause of the development of intestinal colic in the baby is precisely established, it is possible to alleviate his condition with the help of:
- carminative agents (dill water, tea with fennel, chamomile decoction);
- laying out the baby on the tummy;
- light massage of the tummy in a clockwise direction, alternate bending of the legs in the knee and hip joints;
- applying a warm diaper to the baby's tummy.
If the above methods of helping with colic in a child are ineffective, you can use a gas outlet tube, having previously lubricated the tip with petroleum jelly or baby cream.
Colic in newborns is a difficult period in the life of a young family, which you just need to go through. In the absence of serious health problems, colic in a child independently passes by three to four months of life, so it is advisable to be patient and choose a wait and see tactic.
Who among adults at least once in their life did not suffer from constipation. Therefore, many mothers, knowing what it is in practice, apply their life experience in a situation where constipation develops in babies. It is not right. The body of a newborn is so different from that of an adult that it is sometimes difficult to understand where the norm is and when it is worth starting to worry.
In this article, you will learn:
The medical definition of constipation for any age is as follows: it is a painful condition characterized by slowing and difficult bowel movements.
If in relation to the adult body everything is very clear: the diagnosis is made on the basis of symptoms that any patient who has had a chance to spend enough time in the toilet will colorfully describe, then these criteria do not work for a newborn.
The kid is not able to complain, therefore, in order to understand what condition can be considered constipation in an infant, it is necessary to understand in detail how the digestive system of a healthy child works at different periods of his life.
From intrauterine life to independence
From the desquamated cells of the mucous membrane of the digestive tract and the dry residue of amniotic fluid in the intestine of the fetus, the first feces are formed, which are called meconium. Immediately after birth, he begins to move away, gradually being replaced by normal stools formed during the digestion of milk. Meconium has a black-brown color, elastic consistency, stands out like a toothpaste from a tube, almost does not smell, and is poorly washed from diapers.
The frequency of bowel movements in a child in the first 2 days of life usually does not exceed 3 times.
Firstly, this is due to insufficient intestinal motility, which is just learning to promote food.
Secondly - with a small amount of colostrum, which serves as food for the baby these days. During this time, the original stool has time to completely come out. Subsequently, the nature and frequency of bowel movements depends on what kind of feeding the baby will be.
Growing up together in the intestines
As colostrum is replaced by mature milk, the amount of which increases significantly, a fully breastfed newborn begins to empty the intestines 2-6 times a day. It is considered normal, even if it occurs after each latch to the breast.
The consistency of the stool should be watery, it resembles mustard, it smells like sour milk, it can be easily washed from the diapers. A small presence of foam, greens and undigested lumps is acceptable, which is not associated with illness, but with the immaturity of digestive enzymes.
Some babies digest breast milk so well that they may not poop for 2-3 days. This is considered normal at the age of 2 to 6 months, if at the same time the child feels good, sucks with appetite and sleeps peacefully. In this case, feces should be separated without tension, in large quantities and not have an unpleasant odor.
Babies receiving formula milk must have a bowel movement at least 1 time per day. Unlike breastfed babies, they do not stain their diapers after each formula intake. The characteristics of their feces are also different, they are more like the stool of an adult than that of an infant: denser, brown in color, with a characteristic odor.
With a gradual transition to adult food, the frequency of bowel movements is reduced, setting by 1–2 times a day. This is typical for babies from 6 to 12 months.
Thus, mothers and fathers must clearly learn the basic rule of the digestive system of an infant from birth to one year:
- If the baby is breastfed, then it is not the number of bowel movements per day or the absence of stool that matters, but the general condition of the child (mood, appetite, sleep, anxiety during feeding) and monthly weight gain .
- For babies on artificial and mixed feeding, the rules of an adult apply - there must be a chair every day.
Doctor Komarovsky. Constipation in infants during breastfeeding (video)
The line between norm and disease
Guided by the above conclusions, you can accurately determine whether the baby actually has constipation or everything is within the normal range.
Constipation can only be suspected if stool retention in the newborn is accompanied by the following symptoms:
- bad mood, moodiness, tearfulness, refusal to breast or bottle;
- strong straining and screaming while trying to "go big";
- crying, pressing the legs to the stomach, suddenly stopping sucking during feeding;
- gases with an unpleasant odor, the outgoing stool is hard, in small quantities;
- weight loss or underweight based on the results of the monthly weighing of the child.
Understanding the cause is half the cure
The reasons that can lead to the development of constipation in infants can be divided into 2 categories:
- Common, which are typical for both breastfed babies and "artificial";
- Private, which differ in these two groups of newborns.
Common reasons include:
- congenital anomalies in the development of the digestive system;
- diseases of the endocrine glands, nervous system, lack of vitamins and minerals;
- immaturity of the intestinal motor function;
- accumulation of gases in the intestinal lumen.
Congenital malformations of the digestive system
They occur when the digestive tract is laid in the prenatal period. They can be the result of a negative impact on the fetus of ecology and bad habits. Most often, the colon is affected with the development of Hirschsprung's disease, the sigmoid colon with the formation of its additional loops, and the rectum, when an overgrown anus is observed.
Diseases of the endocrine glands, nervous system, lack of vitamins and minerals
Common causes of constipation in infants are diseases of the endocrine system. For example, this is observed with insufficient thyroid function - hypothyroidism... In babies with lesions of the central nervous system, including those with Cerebral palsy, there may be a violation of the motor function of the intestine with the development of constipation. Vitamin D deficiency and associated disease rickets also accompanied by impaired bowel movement.
Immaturity of intestinal motor function
The movements of the intestinal wall, which push its contents towards the rectum, are provided by complex nervous regulation. In babies up to 2 months of age, especially in premature babies, there may be insufficient development of nerve endings in the wall of the digestive tract. As a result, the intestine does not respond to filling its lumen with food gruel and does not push it forward. This is a physiological phenomenon that disappears as the child grows up and does not require special treatment.
Accumulation of gases in the intestinal lumen
Gas bubbles can interfere with the movement of the food gruel through the intestines. This can occur if:
- a nursing mother eats foods that cause intestinal fermentation (carbonated drinks, cucumbers, chocolate, raw onions, cabbage, legumes, grapes, bananas);
- intestinal dysbiosis occurs;
Particular reasons for fully breastfed babies include the mother's nutrition and the medicines she takes.
Mom's newborn baby's diet
Known products and medicines, the active substances of which, passing into milk, cause the development of constipation in infants. Among them:
- whole dairy products, cheeses;
- fat meat;
- saturated meat broths;
- baking;
- medicines (antispasmodics - noshpa, diuretics, medicines for the treatment of anemia, medicines for heartburn based on aluminum - almagel).
The particular causes of constipation in formula-fed and mixed-fed babies are:
- unsuitable formula milk;
- a sharp change in the mixture;
- underdrinking.
If everything is more or less clear with the choice of mixture, then underdrinking still raises many questions from parents.
In accordance with WHO recommendations, exclusively breastfed infants should not be supplemented with water until 6 months of age. Except in special cases: fever, fever, vomiting, diarrhea.
Feeding infants receiving formula milk is mandatory. This is due to the fact that no matter how adapted the mixture is, it cannot be compared in quality with breast milk, and the baby's body needs additional liquid to digest it. With a lack of water, severe constipation develops.
How to help your baby
Understandably, the desire of parents to alleviate the condition of their baby when he develops constipation, but the first and best thing they can do for him is to seek advice from a pediatrician. Among the conditions that cause a violation of the motor function of the intestine, there are those that threaten not only the health, but also the life of the newborn.
Trying to start treatment without knowing the true cause of constipation is a big mistake. Only a doctor, on the basis of examination and additional examination methods, which he will prescribe if necessary, will be able to accurately establish a diagnosis and recommend an effective and safe treatment.
But what to do if the test results and examination did not reveal any violations, and the baby continues to suffer from the inability to empty the intestines. In this case, constipation is most likely associated with the immaturity of perturbation, the mother's dietary habits, or the quality of the milk formula. There are several ways to help the baby gently and safely in this situation:
- Massage and special exercises for newborns, including fitball;
- Changing the diet of a nursing mother or more careful selection of milk formula;
- Laxative medicines approved for use in infants;
- Mechanical methods of bowel stimulation (enema, gas outlet tube, glycerin suppositories).
Massage and special exercises
They are the safest and most affordable method that stimulates intestinal motility in the event that constipation is caused by the underdevelopment of the motor function of the digestive tract and enzymes. The massage is performed one hour after feeding, while the baby is awake and in a good mood. It is unacceptable to perform massage and exercises with a crying baby, during illness, in a dream.
Changing the diet of a nursing mother and the selection of milk formula
A nursing mother should be careful about drawing up a day's menu. Products that contribute to the development of constipation in infants and cause increased gas production should be excluded from it. In addition, it is recommended to consume foods that have a natural laxative effect:
- dried apricots;
- boiled beets, pumpkin;
- vegetable oil;
- porridge;
- unsweetened fermented milk products;
- prunes;
- vegetable soups;
- chicken breast.
When constipation occurs in a bottle-fed baby, the reason most often lies in an incorrectly selected mixture. It must be strictly age appropriate and adaptable. Attention should be paid to the daily volume of the mixture. For the "artificial" feeding on demand is unacceptable, the bottle must be given strictly by the hour. It is impossible to exceed the recommended norms.
All babies receiving the mixture should be supplemented with boiled water at the rate of 10 ml (2 tsp) for 1 month of life per day.
Laxative Medicines Approved in Newborns
In some cases, after consulting a doctor, it is possible to use medicines that help intestinal motility. These include:
- duphalac - acts as a laxative and as a medium for the growth of beneficial microflora;
- espumisan (subsimplex, bobotik) is a carminative that destroys the accumulation of gas bubbles in the intestines;
- plantex is a vegetable carminative.
When using any drug, you must strictly follow the instructions and do not exceed the recommended doses, even if the effect of the treatment is not visible. In the event that the medicine does not help, it is necessary to contact the pediatrician to select a replacement, and not listen to the advice of friends and "forums for young mothers".
Mechanical methods
Unfortunately, they are still the most popular method among inexperienced moms. They are simple and quick. BUT, under the seeming harmlessness, their destructive effect on the fragile digestive system of a newborn is hidden:
- Injury to the intestinal mucosa;
- Washing out beneficial bacteria, trace elements and vitamins;
- Overstretching of the walls;
- waste of the ability to self-emptying.
For all their speed, they should remain the last resort for constipation in infants when other methods do not help.
Mechanical methods include:
- enema with water-oil solution;
- microclysters microlax;
- gas outlet pipe;
- glycerin candles.
An important point!
For an enema in newborns, a syringe No. 1 with a soft tip is used. The syringe and vent tube must be boiled and cooled before use. The water temperature for the enema should be at least 30 C⁰.
Constipation in babies is a serious condition that should not be ignored by the mother's parents. The treatment started on time will allow the baby to develop healthy and cheerful.
When an infant who is under six months old falls ill, parents in many cases diagnose him with colic and do not pay much attention to the newborn's discomfort, waiting for it to outgrow the age of colic. In this way, serious illnesses go unnoticed and without treatment, and the health and life of the child are endangered.
In order not to confuse colic in newborns with something dangerous, you need to know their symptoms and be able to distinguish colic from other conditions.
Colic or not?
A variety of figures for the occurrence of infant colic are cited: from 3% to 70% of children. This condition develops in infants from the 3rd week of age to 3 months. If the baby was born prematurely, colic may start later and last up to 4-5 months of age.
It is easy enough for attentive parents to distinguish colic from other conditions. Infant colic is when a child cries loudly, inconsolably and seemingly for no reason for more than 3 hours a day, at least 3 days a week.
It all starts with an incomprehensible 15 minute cry that occurs several times a week. Gradually, the duration and frequency of attacks increases and reaches a maximum by the age of six weeks. In the most difficult period, the break between attacks can be 3-5 hours, and its duration can also be up to 3 hours. At about 3 months, the vivid symptoms of colic disappear, but the child can become anxious up to 6 months.
It has been noticed that colic usually comes at the same time, usually in the evening. In this regard, some theories of the occurrence of infant colic have arisen.
If you suspect your baby has colic, see your doctor. Let him confirm or deny your fears and rule out the disease.
Where does colic come from? Causes.
This great medical mystery remains unsolved. Among the alleged causes of colic, two are most seriously considered: the immaturity of the infant's digestive and nervous systems.
Immaturity of the digestive system.
When a baby is just born, he eats little, and his body easily assimilates food. After 2 weeks, the amount of milk or formula increases. Protein processing requires a lot of enzymes and bacteria, but they may not be enough. Then undigested food wanders in the intestines, a lot of gas is released, which the baby still cannot get rid of due to weak abdominal muscles. Gas pressure in the intestines causes discomfort and even pain - hence the crying.
Immaturity of the nervous system.
Particularly sensitive, impressionable children roll up evening "concerts" in order to get rid of the impressions and emotions accumulated during the day. The world around us constantly transmits information to the child's brain - about sights, sounds, smells. In the evening, the nervous system is overworked, which the child feels physically, and the only way to relieve this tension is crying. More often, nervous overstrain causes colic in children born with difficulty or prematurely.
Sensitivity to food.
Breast migraine.
Some experts argue that colic occurs from headaches that appear due to atmospheric phenomena.
It is believed that bottle-fed children are more likely to suffer from colic. Studies have shown that the likelihood of colic does not depend on the method of feeding, and the formulas themselves cause colic in very rare cases.
Newborn babies very often suffer from digestive problems: colic, regurgitation, constipation or loose stools.
From time to time, these unpleasant and very painful symptoms bother not only children, but also young parents, who, after several hours of motion sickness, accompanied by unrestrained crying, call an ambulance.
Why Do Newborns Have Digestive Problems?
It is worth noting that the appearance of problems with the digestive tract in babies is, in principle, normal, and occurs mainly at the age of 2 weeks to 3-6 months.
The causes of regurgitation, increased gas production, constipation or loose stools are:
Immaturity of the intestine - for the formation of its own microflora in the intestines of the child, it is necessary that the walls of the tract be populated with a certain amount of lacto- and bifidobacteria, other microorganisms, which, in addition to breaking down food, produce some vitamins and prevent the development of pathogenic microorganisms. During the period of gestation, the child is in a sterile environment, therefore, after birth, it takes a certain time, namely 3-6 months, for the intestinal walls to be populated with the necessary microflora;
The load on the intestines - after birth, the baby and its organs of the gastrointestinal tract are faced with the fact that to replenish the reserves of nutrients in the body, you will have to work hard - first, work on getting this food (from mother's breast or bottle), and then digest ... The internal organs of the crumbs, only over time, will begin to produce a sufficient amount of enzymes, therefore, in the first half of the life of infants, colic or constipation may occur, which are significantly aggravated by disturbed sleep and rest, overeating and during the period of feeding;
Weakness of the intestinal muscles, weak (immature) nervous regulation of their peristalsis and, as a result, difficulty in the movement of food through the gastrointestinal tract and the process of defecation;
Low physical activity and a long stay of the child in the supine position, which leads to weak pressure of feces on the sphincters.
How can I help my baby?
The best help for babies is early attachment to the breast and breastfeeding up to 3-6 months, without the introduction of any complementary foods. Breast milk has unique properties:
- easily absorbed by the baby's body and at the same time does not overload the immature digestive tract;
- helps to stimulate the production of enzymes;
- contains various immunoglobulins that prevent the development of pathogenic microorganisms;
- helps to create the most favorable conditions for the colonization of the intestinal walls with beneficial microflora.
In addition, in addition to breastfeeding, you must remember:
After each meal, the baby must be held in an upright position ("column") - this will help remove trapped air bubbles and reduce the number of regurgitation;
- when breastfeeding, the mother needs to monitor the state of her intestines and follow a rational diet, excluding foods that stimulate the formation of gases and disturbances in the digestive process;
- to carry out daily exercises with the baby, which will help stimulate the work of the intestinal muscles and improve its peristalsis. The exercises should include: swinging on a ball lying on your stomach, alternate bending of the legs, massage of the abdomen (carried out with light circular movements in a clockwise direction), laying the baby on the tummy in the interval between feedings.
If, after a set of measures, signs of a malfunction of the gastrointestinal tract persist, it is necessary to examine the child with the appropriate specialists.
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