Long-term constipation in a 2-year-old child. Children after the age of one year. Features of the act of defecation. When is constipation a life-threatening condition

03.07.2019

Constipation is a common problem in pediatrics. Since the work of the child's intestines is at the stage of formation and is imperfect, then parents often have increased attention to the child's stool. There are constant worries about difficulties with stool, or about the absence of defecation for a long time. Next, we will try to deal with such a problem as constipation and methods of dealing with it.

First, you should find out what should be considered constipation. First, you need to know that it is not the frequency of the stool that is more important for constipation, but its consistency. In children in the early stages of life, stool completely depends on the type of nutrition. It is considered normal if the act of defecation in infants occurs after each feeding, on average about five to seven times a day (possibly more often), the volume is about a tablespoon, more volume can be in the case when the child empties the intestines once or twice a day. From the fourth to sixth weeks of life, the baby's bowel movements are more rare.

During this period, the enzyme system is improved, milk is almost completely absorbed. Large amounts of bowel movements every few days may be the norm. Everything can be explained by the fact that the release of stool occurs reflexively, a certain volume and pressure are created in the rectum. You can talk about the tendency to constipation in situations where the consistency of the stool looks like a soft sausage. With common constipation, the feces, as a rule, are dense, like "sheep balls" or raw smoked sausage. But such situations in infants occur very rarely, unless with dehydration or other health problems.

Very often mothers of art children turn to pediatricians with the problem of the child's absence of a chair for two days. This can be explained by the fact that the mixtures are absorbed by the child's body much more difficult than breast milk. Therefore, in such children, rare stools almost become the norm, as well as in the form of balls, sausages (even with regular emptying). Such situations should be regarded as constipation. If an infant in the first months of life grunts, strains or cries during a bowel movement, this indicates constipation.

Already after the sixth to ninth months, after the introduction of complementary foods, defecation becomes more regular (approximately once or twice a day) and more formalized (in the form of gruel or sausage). When the child reaches the first year of life, the chair becomes regular, as a rule, it is 1 - 2 times throughout the day, in the form of sausage, but gruel is also acceptable (only after breakfast, in the morning). In the second year of life, defecation becomes formalized and regular. If there is a delay of more than 2 days, then this should be regarded as constipation. Constipation can also be considered regular stools, but dense, very dry, in the form of large-diameter cylinders.

The mechanism of constipation

Only after we get acquainted with the peculiarities of the baby's intestines, we will be able to understand the causes of constipation. A child is born with a completely immature digestive system. Initially, it is a hollow tube about 3-4 meters long. All feces are produced in the large intestine.

The food slurry passes through the large intestine, which absorbs all the necessary nutrients, with the exception of certain vitamins and water. It is considered normal if peristalsis occurs - under the influence of nerve impulses, muscle contraction (wavy) occurs. It is due to the suction of water that the waves move and compact the contents.

Increased peristalsis occurs as a result of nerve irritation (for example, microbial toxins or fiber). The contents begin to move faster and become more liquid - water does not have time to be absorbed. Fecal masses become more compacted with abundant absorption of water, and this occurs after disturbances in the parts of the nervous system or a decrease in impulses due to soft food.

After pressure on the sphincter of the anus, and stretching of the rectum, the urge to defecate begins. Children over the age of 1.5 - 2 years control bowel movements independently. In the elderly, the cerebral cortex is in control; boys are consciously able to retain stool.

Constipation reasons

All constipation is usually divided into two groups - functional and organic.

Organic - these are those constipation, the cause of which is considered to be a violation of the structure of the intestine, in the presence of acquired or congenital problems. Fortunately, they are very rare.

For instance:

Hirschsprung's disease- the work of the intestines is disrupted due to an insufficient number of nerve fibers. The tone of the walls is not maintained through the contraction of impulses, the intestinal lumen expands and the stool is delayed;
megacolon and dolichosigma- a malformation of the intestine (the intestine is enlarged or elongated);
adhesions, polyps, tumors.

All of the above problems can only be cured by surgery.

The main reasons for the development of functional-type constipation are considered to be violations that are associated with impaired coordination or temporary disturbances in the functioning of the intestinal walls due to immaturity.

The normal functioning of the intestines is disrupted with a quick, early transfer of the infant to a formula, or abrupt changes in mixtures, a lack of fluid during feeding. Frequent causes of constipation after the introduction of complementary foods are underdrinking or too thick complementary foods (mashed potatoes, cereals, meat), or irrational feeding with excess fat or protein.

The causes of constipation are also: helminthic invasions, thyroid disorders, the affected nervous system during pregnancy or childbirth, the psychological state of the child, improper use of drugs (diuretics, antibiotics, enzymes, sorbents, antispasmodics).

The work of the muscle tone of the intestine, as a result of the influence of the above reasons, is disrupted. With an increase in intestinal tone, a temporary spasm occurs, the areas of the intestine are narrowed and the process of passing through these areas becomes more difficult for the feces. The result of spastic constipation is dense, fragmented feces ("sheep").

With a decrease in intestinal tone - intestinal atony, peristalsis slows down, and the walls of the intestine expand, feces are formed dense, large cylinder diameters.

How does constipation affect the body?

The result of reduced peristalsis and stagnation of contents is the occurrence of dysbiosis and a violation of the microbial flora. In other words, the pathogenic flora actively reproduces and produces harmful substances. Toxins gradually begin to be absorbed into the bloodstream, thereby poisoning the body. With chronic constipation, the child becomes weak, lethargic, pale, appetite is disturbed.

It is advisable to boil the meat in whole pieces, or as goulash. Bread - either with or dark. Bran can be used as an additive to main dishes (soups, cereals, vegetable juices).

Fermented milk products must necessarily be in the child's daily diet (fermented baked milk, cottage cheese, yogurt, yogurt, kefir). They are advised to consume them at night or in the morning on an empty stomach. Legumes, whole milk, sweets, bananas should be excluded from the diet, since they have a strengthening and gas-forming effect.

Drinking regimen

A child's drinking regime for constipation is very important. After complementary foods have been introduced, it is required to additionally consume liquid (about 50 ml after a meal). The kid should drink at least two glasses of liquid a day, of which 100-150 ml should be water, in the morning and on an empty stomach.

The liquid can be in the form of compotes, fruit drinks, juices (diluted), water. Carbonated drinks and strong teas are prohibited.

Medication for childhood constipation

In some cases, with constipation, there is a need for medical correction.

1) The first group of drugs includes laxatives. These include bisacodyl, buckthorn, senna, saline laxatives, and many others. But, despite the variety, such drugs can cause side effects that manifest themselves in the form of allergic reactions, intestinal obstruction, dysbiosis, endocrine disorders and many others. It is because of this that it is necessary to use laxatives in children for short courses (no more than 10-14 days).

Chronic constipation in children requires long-term therapy. For this, lactulose preparations are used, which, according to the mechanism of action, are classified as prebiotics. One of these drugs is dufalac, which is inherently safe to regulate intestinal motor function.

2) The second group of drugs is represented by prokinetics. They have a stimulating effect on the colon. Previously, metoclopramide (cerucal, raglan) was used most often from this group of drugs. It tends to coordinate the disturbed state of the kinetics and tone of the stomach, normalizing the evacuation.

But, unfortunately, the drug gives many side effects, such as headaches, fatigue, drowsiness, esophageal spasm, dystonia phenomena, fears, bulbar disorders. In recent years, domperidone, a new generation prokinetic, has been used. Since this drug does not have such pronounced side effects as metoclopramide, it began to be widely used to treat constipation in children.

3) The third group of drugs - choleretic agents of plant origin (hepabene, flamin, hophytol, etc.). They are the components of laxatives. Bile acids are natural detergents. In children suffering from chronic constipation, cholestasis is noted, in which choleretic drugs are indicated.

Physical exercise

Physical activity is one of the main components of treatment. It is needed to strengthen the abdominal muscles and stimulate the bowel movement. Remember the benefits of hiking, morning gymnastics, outdoor games, skiing, skating and swimming.

It is advisable to build all classes in the form of a game. For example, throw toys around and ask for help with putting them together.

Exercises with the tummy are useful for the intestines - inflating and protruding, pulling in, cycling, crawling on the stomach, lowering and raising the legs.

Prevention of constipation

It is necessary to prevent constipation from infancy by properly organizing the diet: keep breastfeeding as long as possible, do not rush to complementary foods, introduce foods gradually, leaving some time for the intestines to adapt.

Remember the importance of adhering to your drinking regime, especially after complementary foods. Meals should be balanced around the clock, with the maximum addition of vegetables and fruits.

Play active, active games with your child. Remind you of the need to go to the toilet (potty) regularly.

Constipation is not an easy problem, but if you recognize it in time and consult a doctor, and then follow the necessary measures, then it can be eliminated delicately and quickly enough.

The most frequently asked questions from parents of young children are about digestion and bowel movements. Constipation in children of any age is a common and very delicate problem.

Not every child is able to complain about the absence of stool for several days and abdominal pain. If the year-old refuses the pot, and at an older age the child ignores questions about the toilet, parents should not try to treat the child on their own, but be sure to consult a doctor.

Even in "adult" children - not infants - parents are required to control the process of defecation

What is constipation and what are the causes of it in children?

Constipation (constipation) is called a dysfunction of the colon, in which there is no ability to systematically and fully empty the intestines. The normal stool frequency in children is:

from 0 to 4 months - from 1 to 7-10 bowel movements per day;
from 4 months to 2 years - from 1 to 3 times;
over 2 years old is allowed from 2 times a day to 1 time in 2 days.

The absence of stool for three days or more, the complexity of the act of defecation (at normal frequency) are dangerous for the health of a person of any age, and first of all for children.

Irregularities in nutrition, physical inactivity, low intake of pure water, especially in infants of the first month of life, as well as other, more serious causes and diseases, cause constipation in a child. These include rickets, dysbiosis, food allergies, congenital hypothyroidism, and disturbances in the nervous regulation of the intestinal tube function.

Types and forms of constipation

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According to the pathogenetic principle, there are:

False (alimentary, pseudo constipation). A condition that develops mainly in infants due to an increase or insufficient absorption of breast milk or formula in an infant. Such problems pass without intervention in the ordering of feeding.
Functional (dyskinetic). They are due to the not yet perfect mode of operation of the intestines of infants.
Periodic (alimentary episodic). Temporarily emerging conditions in infectious diseases in children of any age. An increase in body temperature leads to general dehydration of the body and feces, which makes it difficult to defecate.
Organic (mechanical). The most dangerous constipation is due to congenital malformations or acquired abnormalities of the digestive system. Such ailments include atresia and stenosis of the colon, its cystic duplication, Hirschsprung's disease, intestinal intussusception, causing intestinal obstruction.

Bristol Chair Scale

According to the duration of existence, constipation is divided into acute and chronic:

Acute (transient) constipation is a situation when, against the background of systematic bowel movements, there is a stool retention for 1 or several days. As a rule, the cause of acute constipation is easy to detect and quickly corrected.
Chronic (persistent) constipation is described by difficulty in defecation, hard, dry, fragmented stool, irregularity, and long periods of time between going to the toilet for at least 3 months. It is the constant constipation that significantly reduces the quality of life of the child.

Symptoms

The complex of symptoms of constipation does not differ in variety. First of all, it is stool retention and violation of the act of defecation (see also:). The child experiences bursting abdominal pains, colic, flatulence, and signs of general intoxication may develop. However, there are some differences depending on age.

In babies

In infants up to 6 months of age, constipation is manifested by the lack of self-defecation, but at the same time by the appearance of formalized bowel movements. Regurgitation and vomiting are common. Constipation in a one-year-old child is characterized by anxiety more than usual and crying during bowel movements, pulling the legs up to the tummy, abandoning the pot, and reddening of the face.

Symptoms of constipation in babies are recognized by any mother

In children 6-10 years old

At primary school age, a sign of constipation is considered to be the absence of a chair for a day or more. When emptying the intestines, the child is very nervous, pushing and crying (see also :). The stool is dense, dry, and may contain streaks of blood. There is pain in the abdomen, chest, bloody discharge from the anus.

In adolescents

In adolescent children with chronic constipation, in addition to stool retention, severe bloating and pain occur. They also complain of rectal bleeding, an unpleasant taste in the mouth, weakness, fatigue, lack of satisfaction after defecation, and other psycho-emotional disorders.

How dangerous is pathology?

Transient constipation, as a rule, does not lead to serious disturbances in well-being. Chronic constipation is much more dangerous. Mechanical stretching of the intestinal wall increases the likelihood of inflammation in it, which leads to the formation of colon diverticula. A conglomerate of feces, being in the intestine for a long time, hardens and injures the mucous membrane, forming cracks and ulcers.

A huge amount of toxins are released from fecal stones, which leads to fecal intoxication, deterioration of liver function, metabolic disorders, and decreased immunity.

Due to constant straining, the prolapse of hemorrhoids and rectum, the formation of an anal fissure is possible. Excessive stretching of the anal sphincter leads to fecal incontinence (we recommend reading :).

How is constipation diagnosed?

By itself, the diagnosis of constipation is extremely rare. More often, constipation is one of the symptoms of a disease. In the diagnostic search for the root cause of constipation in a child, such specialists as a pediatrician, a pediatric gastroenterologist, a neurologist, a pediatric surgeon, and a psychiatrist take part.

A thorough collection of anamnesis, starting with the course of pregnancy, includes the age of onset of the disease, the dynamics of the pathological process, the frequency and consistency of excrement. Examination and palpation of the abdomen reveals abdominal distention, the presence of fecal stones. Finger examination through the anus allows you to assess the condition of the ampulla of the rectum, anal sphincter, pathological discharge.

The laboratory-instrumental complex of examinations includes various studies of feces, coprograms, blood tests, ultrasound of the abdominal organs, gastroduodenoscopy, X-ray examination of the intestine with contrast. Why the child has constipation, in especially difficult cases, colonoscopy and irrigography, carried out in stationary conditions, help to understand.

Treatment regimen

In the treatment of constipation, it is necessary to take into account the root cause, nature and duration of the condition. How to help a child with constipation so as not to harm?

Constipation is easy to treat, but if there is a frequent lack of regular bowel movements, you should consult your doctor

It is possible to cure constipation by methodically following the prescriptions of doctors. Comprehensive therapy for constipation includes medication, massage and exercise, and a therapeutic diet.

Home emergency help

The need for immediate help usually makes sense for transient constipation. If the cause of acute constipation is not a serious pathology (for example, intestinal obstruction), then the treatment consists in stimulating the cleansing and emptying of the intestines:

The baby can be helped by inserting a suppository with glycerin into the anus - it is safe and effective.
From the first days of life, a laxative micro-enema (for example, Mikrolax) or an enema using a syringe will help to urgently cleanse the intestines. You can do it with cool water, chamomile decoction, a weak salt solution.

Medication

In the practice of treating constipation, several groups of drugs are used. Medicines are selected only by a doctor and for each child is strictly individual:

Laxatives... According to the recommendations, laxatives based on lactulose (Duphalac, Portalac, Normase) and macrogol (Forlax) are shown even in the first year of life. From 3 years old, it is possible to use the natural preparation Fitomucil, which contains the shell of plantain seeds and dried plum pulp. The use of products with senna extract (Senade, Senadexin, Regulax) is not recommended.

Prebiotics and Probiotics. Preparations containing ready-made microorganisms for the treatment of intestinal dysbiosis and restoration of its normal microflora (Bifidumbacterin, Lactobacterin). They are used from the first days of life.
Antispasmodics... Eliminate intestinal spasms, relieve colic (Drotaverinum, Papaverinum, suppositories with Belladonna). Not used until the age of three.
Enzyme and choleretic agents... They optimize digestion, compensate for the lack of pancreatic secretions, and stimulate bile synthesis. Appointed from 5-6 years (Pancreatin, Panzinorm, Horfitol, Allohol).
Prokinetics... Stimulates motility and peristalsis of the intestinal tube. Allowed for use from the age of two, however, in practice, they are often used only from the age of 5 (Metoclopramide, Dompreridone).

Folk remedies

The arsenal of traditional medicine recipes for the treatment of constipation is huge. However, before giving a child any remedy, it is necessary to consult a doctor, since some can be given only from the age of one, and some - not earlier than 5 or even 8 years.

Oils (linseed, olive, sunflower) are actively used as laxatives in folk medicine. They are added a few drops to breast milk, formula, and any other food. For children aged 9–11 years and older, pure oil, 10 grams each morning and evening, is recommended.

If a child develops constipation at the age of 2, then you can give beet juice in its pure form or mix it with carrot juice. You should start taking with a few drops and gradually bring to a teaspoon. Good for chronic constipation raisin or prune water, decoction of plantain seeds, flax, hop fruits, children's tea with fennel fruits.

For constipation in infants, it is advisable to use tea with fennel fruits

Therapeutic diet

Rational nutrition in children with constipation is an obligatory part of therapy (see also:). The diet and properly selected foods will prevent constipation, improve the general condition of the child, and make up for the lack of essential vitamins and minerals. Adequate drinking water is essential.

In case of constipation in infants, a nursing mother should follow the diet (more in the article:). General recommendations - vegetables, fruits, dairy products, lean meat and fish. Breastfeeding babies will benefit from changing the formula.

A large number of salads, vinaigrettes, any vegetable dishes are included in the nutrition of one-year-old and preschool children. Fresh fruits, boiled meat and fish, fermented milk products, soft dried fruits, bran are required. Kefir is added to the diet of schoolchildren before bedtime, cereals and bread with grain shells.

Children of all ages and nursing mothers are strictly forbidden to eat fast food, chips and crackers, carbonated drinks. It is necessary to limit to a minimum (or it is better to completely exclude) strong tea, coffee, jelly, cereals from semolina and rice cereals, buns and white bread.

In case of problems with bowel movement, a rational balanced diet is one of the most important points of therapy

Exercise and massage

Physical activity and massage are essential in the treatment and prevention of constipation. Massage in the form of stroking the tummy in a clockwise direction several times a day increases the peristalsis of the baby's intestines.

Constipation in children is a difficulty in the process of defecation, the lack of self-emptying of the intestines throughout the day or longer, and for breastfed babies, defecation is less than 1-2 times a day.

Source: bolit.info

Constipation is registered in 15-30% of children, while children of preschool age are more susceptible to it. Regular constipation in children negatively affects the growth and development of the child, can lead to intoxication, hypovitaminosis, the development of other complications, and worsen the quality of life.

Constipation in children contributes to the onset of colitis, which, in turn, further aggravates the course of constipation, forming a vicious circle.

The main functions of the intestine are food digestion and absorption, as well as the excretion of unrealized products and substances that are toxic to the body. In children under 6 months old, the act of defecation normally occurs 1–6 times a day, from half a year to 2 years - 1–3 times a day, over 2 years old - at least 1 time a day. Approximately 40% of patients who had a tendency to constipation in childhood also suffer from it in adulthood.

In most cases of persistent constipation in children, there is no organic pathology. In patients with severe delayed psychomotor development, constipation occurs in about 50% of cases.

Forms of constipation in children

Constipation in children can be true or false (pseudo-constipation).

Depending on the etiological factor:

alimentary;
functional dyskinetic (spastic and hypotonic);
organic;
conditioned reflex;
intoxicating;
endocrine;
iatrogenic.

Depending on the characteristics of the clinical picture, acute and chronic constipation in children is distinguished.

Source: bolit.info

Causes of constipation in children and risk factors

Common causes of constipation in children in the first years of life include feeding errors, as well as impaired absorption of nutrients.

A child can receive less breast milk than required in case of hypogalactia in the mother, as well as with sluggish sucking, regurgitation, clefts of the hard palate and upper lip. In the case of insufficient nutrition, the volume of feces in the child is accordingly insufficient to induce the urge to defecate. Such cases of delayed bowel movements are referred to as pseudo-constipation.

The occurrence of constipation in children who are breastfed is facilitated by a lack of fiber-rich foods in the mother's diet. At the same time, excessive consumption of fatty foods leads to an even greater hardening of feces in the child and aggravates constipation.

For constipation in children who are bottle-fed, it is recommended to use mixtures containing lactulose or dietary fiber.

A temporary delay in defecation (transient constipation) is observed in children during periods of acute fever due to dehydration of the body against the background of an increase in body temperature, increased sweating, and vomiting.

Alimentary constipation in children occurs with nutritional disorders, which include malnutrition, insufficient drinking regimen, lack of vitamins in the body, dysfunction of the digestive glands, early transfer of the child to artificial feeding.

Constipation in a child can be a manifestation of diseases that are not directly related to pathological processes in the gastrointestinal tract. Such diseases include hypothyroidism, rickets and other metabolic diseases. However, in most patients, constipation is still due to disorders of the digestive tract.

The organic form of constipation in children develops with ectopia of the anus, Hirschsprung's disease, rectal atresia, dolichosigma, intestinal neoplasms, anorectal scars, adhesive disease, helminthic invasions.

In most patients of this age group, constipation is of a functional nature. Dyskinetic constipation in children is caused by traumatic or hypoxic-ischemic lesions of the central nervous system. A conditioned reflex form of constipation in children occurs with painful bowel movements (with anal fissures, rectal fistulas, paraproctitis, diaper dermatitis). Hypotonic constipation in children develops against the background of insufficient physical activity, prolonged bed rest, chronic gastroduodenitis, peptic ulcer, rickets. Spastic constipation can occur in children with neuro-arthritic diathesis, infantile cerebral palsy, lactase deficiency.

When treating constipation in children, first of all, it is necessary to eliminate the causative factor. In some cases, normalization of the child's nutrition is sufficient, including an increase in the amount of fluid consumed.

Other reasons for the development of constipation in children include intestinal dysbiosis, diabetes mellitus, gigantism, pheochromocytoma, adrenal insufficiency.

Risk factors include:

hereditary predisposition;
uncontrolled use of a number of drugs (enzymes, diuretics, enterosorbents, antibacterial agents, antispasmodics, iron preparations);
abuse of enemas;
muscle hypotension;
unbalanced diet;
underweight;
a sharp change in climatic conditions;
improper potty training;
psychological problems;
prolonged (up to 3-4 years of age) wearing diapers.

Source: sitemedical.ru

Stages of constipation in children

During constipation in children, the following stages are distinguished:

compensated- defecation occurs 1 time in 2-3 days;
subcompensated- defecation occurs 1 time in 3-5 days;
decompensated- defecation delay can reach 10 or more days.

Symptoms

The clinical manifestations of constipation in children include local (intestinal) and general (extraintestinal) symptoms. Local include: a rare rhythm or prolonged absence of defecation, a change in the consistency of feces, pain in the abdomen, bloating, a feeling of incomplete emptying of the intestines after a bowel movement, an admixture of blood in the stool, pain during bowel movements, flatulence, a feeling of pressure in the anus.

In children up to six months, the consistency of feces is normally pasty, from six months to one and a half to two years, the feces have a pasty or shaped consistency, later - formalized.

Overstretching of the intestinal wall with dense feces, which, moreover, can injure the mucous membrane of the anal canal, causes pain and anxiety in the child during bowel movements. In children with constipation, encopresis (calorification) is often observed, usually after a long delay in defecation.

Persistent constipation in children can lead to rectal prolapse.

The extraintestinal manifestations of constipation in children include general weakness, fatigue, irritability, headaches, pallor of the skin, anorexia, anemia, a tendency to develop pustular rashes on the skin, loss of appetite.

With chronic constipation in children, an increase in the volume of feces occurs. This form of pathology is characterized by a persistent long-term (3 months or longer) decrease in bowel movements, which is accompanied by difficulty in emptying the intestines and an increase in the density of feces.

Diagnostics

To diagnose constipation in children, you may need to consult not only a pediatrician, but also a pediatric gastroenterologist or proctologist. When collecting complaints and anamnesis, the time of onset and dynamics of the pathological process, the frequency of bowel movements and the consistency of feces are specified. When conducting an objective examination, the color of the skin, the state of the tongue, tissue turgor, bloating and soreness of the abdomen are determined; palpation can determine the presence of fecal stones along the sigmoid colon. During the digital rectal examination, the state of the ampoule, the sphincter is assessed, organic malformations can be detected.

From the methods of laboratory diagnostics, a general and biochemical blood test, a coprogram, a study of feces for helminth eggs, for dysbiosis are usually carried out.

In order to exclude somatic pathology, an ultrasound examination of the liver, pancreas, stomach, large intestine, esophagogastroduodenoscopy, plain X-ray of the abdominal cavity, irrigography, enterocolonoscintigraphy may be required. To examine the mucous membranes of different parts of the intestine, they resort to sigmoidoscopy, colonoscopy.

Constipation is registered in 15-30% of children, while children of preschool age are more susceptible to it.

In some cases, a consultation with a pediatric neurologist with electroencephalography, echoencephalography is required.

Treatment of constipation in children

When treating constipation in children, first of all, it is necessary to eliminate the causative factor. In some cases, normalization of the child's nutrition is sufficient, including an increase in the amount of fluid consumed. Of no small importance for constipation in children is the development of a conditioned reflex to defecate.

Medical treatment of constipation in children is carried out if necessary and consists in the appointment of laxatives, antispasmodic drugs, prokinetics. In some cases, short courses of cleansing, hypertensive or oil enemas are indicated.

In some cases, physical therapy is effective. Electrophoresis, pulse currents, galvanization (with hypotension) and paraffin applications (with hypertonicity) can be used. With functional constipation in children, exercise therapy provides a good therapeutic effect. Massage for constipation in a child is used in case of intestinal hypotension after each meal. In the absence of contraindications, herbal medicine can be used (tea with fennel, dill water).

If there are signs of perinatal lesions of the central nervous system, treatment is carried out with the participation of a pediatric neurologist. In this case, neurometabolic stimulants, B vitamins, drugs to improve cerebral circulation are prescribed. With the development of conditioned reflex constipation in children, it may be necessary to consult a child psychologist.

Follow-up and supportive therapy is usually carried out over a period of 6-24 months.

Regular constipation in children negatively affects the growth and development of the child, can lead to intoxication, hypovitaminosis, the development of other complications, and worsen the quality of life.

Diet for constipation in children

With the development of constipation in a breastfed baby, first of all, it is necessary to analyze and correct the nature of the feeding of the nursing mother. It is recommended to limit the use of foods that contribute to increased gas production (black bread, onions, tomatoes, cabbage, rice, legumes, mushrooms, grapes, pears, spicy, smoked foods, spices).

For constipation in children who are bottle-fed, it is recommended to use mixtures containing lactulose or dietary fiber. Young children need up to 5 g of dietary fiber per day (excess content of dietary fiber in the diet can cause impaired digestion and poor absorption of calcium, zinc, iron).

Forecast

When the cause of constipation is eliminated and the recommendations of the attending physician are followed, the prognosis is favorable. In the absence of timely adequate treatment, the prognosis worsens, constipation can become chronic and persist into adulthood.

Prophylaxis

In order to prevent the development of constipation in children, it is recommended:

timely treatment of diseases that can lead to constipation;
avoidance of irrational use of medicines;
sufficient physical activity;
correct potty training.

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Constipation is a functional failure in the digestive process during which bowel movements are difficult, irregular, and painful.

There are many reasons for this state, and it can appear at any age.

In children, this is the most popular gastrointestinal disease, although many parents do not pay special attention to this difficulty and refuse to show the child to a specialist.

Constipation in children under 3 years old occurs regardless of age, however, in infants under 3 years old, they can provoke psychological difficulties, since the child has only recently begun to go to the potty, because discomfort often causes him fear.

Causes and treatment of constipation in children

Starting from 1 year and older, the child goes to the toilet up to 2 times a day, and the stool becomes not mushy, but decorated.

If there is a predisposition to the disease, the intervals between evacuations will become longer, and the bowel movement itself can often provoke difficulties.

Constipation is stool with a normal frequency when it is associated with pain and compaction of stool.

Parents should focus on such signals that are harbingers of malfunctions in the functioning of the gastrointestinal tract in a child:

an infant under 3 years of age is emptied less than 6 times in 7 days;
at the age of more than 3 years, the child has less than 3 evacuations during the week;
the child complains of pain in the abdomen, crying and anxiety can be observed;
defecation can be associated with pain, straining;
there is a feeling of incomplete defecation.

The systematic occurrence of such symptoms will be the reason for going to the pediatrician. The duration of signs of constipation for more than 3 months indicates a chronic form of the disease.

Symptoms

Normal indicators of the frequency of bowel movements varies in different periods of a child's life and reaches from several times a day to 2-3 times a week.

This is due to the degree of maturity of his digestion, metabolism, diet, and other circumstances. It is possible to identify constipation by the following symptoms:

no bowel movements for 3 days or more;
hard, dry feces;
too soft feces (after emptying, there is a feeling of incomplete defecation);
straining;
a small amount of feces;
heterogeneous stools that contain hard and soft elements;
pain after emptying;
an admixture of a small amount of blood in the feces;
the occurrence of cracks in the anus.

The state of constipation is mainly associated with increased gas formation, flatulence (frequent gas discharge), swelling and seething in the abdominal cavity, painful sensations of a cutting nature near the navel.

In children under 3 years old who suffer from constipation, there is a dry hyperkeratotic skin, the presence of inflammation and acne on the surface of the face (in particular, near the forehead and on the cheekbones).

An imbalance in the digestive process is usually associated with a predisposition to atopic dermatitis.

Causes and classification

If the cause of delayed bowel movements is not identified and eliminated in a timely manner, constipation will become chronic, and in such a situation it will be difficult to eliminate them.

Many adults suffer from this disease for a long time, which originates in childhood.

It is impossible to achieve regular bowel movements through enemas and laxatives if the factors that provoke the disease are not eliminated.

Based on the root cause and nature of the course, constipation is classified into the following types.

Transient

This type of poor emptying is thought to be the result of an inappropriate diet.

It occurs as a result of excessive consumption of flour products, which increase the formation of gases in fruits and vegetables, sweets, carbonated water, and legumes.

Constipation is such when it forms rarely, and the cause of its occurrence will be obvious.

Such malaise predominantly goes away on its own in the process of bringing the food back to normal or after a small drug correction.

Functional

The reasons that lead to this type of disease in children are organic. In such a situation, voiding disorder is the result of intestinal abnormalities, either inherited or acquired.

Hereditary pathological processes (lengthening of the sigmoid colon and lack of innervation), at 2-3 years old, are already detected and cured, since they can manifest themselves acutely and in fact from the first month of a child's life.

It is possible to exclude functional constipation in children in preschool age when the absent self-emptying manifested itself with a normal diet and lifestyle, and is also associated with symptoms of a disorder of the digestive processes.

Bloating, rumbling, painful sensations inside the abdomen are triggered by the accumulation of feces and gases in the intestine due to the obstacles formed inside it.

They are tumors, polyps, which lead to acute or chronic obstruction. Treatment in such a case is usually prompt.

Psychological

It develops in a child who has experienced pain during the emptying process at least once.

The provoking factor is often pressure from parents who are fixated on everyday bowel movements and force the baby to be on the potty for a long time.

Other psychoemotional stresses are also capable of causing a similar ailment: a sudden change of place of residence, a children's team, adaptation in it, a lack of understanding of peers.

Such psychological constipation often occurs in children at school age. Being conscious individuals, they may be embarrassed to go to the toilet in a public place, endure for a long time, as a result of which emptying will become unstable.

The basis of the relationship between the functioning of the intestines and the psychological state of the child will be the work of the digestive sphincters.

Atonic

Formed during hypodynamia. It affects children with low levels of physical activity, who do not like to spend time actively. Such a lifestyle affects the deterioration of tone in general, as well as muscle relaxation in the intestines.

Metabolism is subject to this. Due to the digestion of food, the movement of feces will become slower, bowel movements will be irregular and painful.

In case of constipation in children, which is caused by physical inactivity, it is necessary to saturate the menu with products that have a beneficial effect on improving motor skills.

Spastic constipation

This type is a consequence of hypertonicity of the intestinal musculature, which clamps the digestive waste and does not allow free movement to the anus.

It is associated with colic, frequent gas emission, a feeling of heaviness inside the abdomen and bloating.

By the nature of the course, constipation in children is acute and chronic. Acute is the absence of emptying for 3 or more days (the duration varies depending on the age of the child).

In addition to disruptions in the diet, they can be provoked by infections in the intestines, obstruction, mechanical injuries, the use of medications that disrupt the motility of the gastrointestinal tract.

Chronic course is characterized by the absence of full and constant bowel movements for 3 months or more. In such a situation, the specialist prescribes special means and dietary food.

The difference is that the child has chronic constipation. Difficulty emptying, long intervals between emptyings, the formation of dry, dehydrated feces, etc.

Persistent constipation in a child is considered a popular problem and, according to statistics, is mainly characteristic of babies.

Why is constipation therapy in children needed?

Constipation in a child is not only difficult to empty. Constant untimely bowel movements can adversely affect the gastrointestinal tract and the entire body.

Chronic constipation can provoke such complications:

Failure to digest food during constipation leads to poor absorption of useful minerals, vitamins, microparticles, which is fraught with the appearance of anemia, malaise, and deterioration of the immune system.
The decay products from the accumulated feces through the intestinal walls are absorbed into the bloodstream and begin to poison the body. Signs of poisoning are manifested by lethargy, drowsiness, decreased activity, loss of appetite, etc.
Stagnation in the intestines provokes an imbalance of beneficial and harmful microorganisms, which affects the body's resistance to disease and digestion.
The feces stretch the intestinal walls, significantly aggravating constipation in children, provoking inflammation in the mucous membrane, spastic pain, increased gas formation, and disruptions in the local blood circulation.
A similar ailment can lead to cracks in the anus, bleeding from the rectum, and discomfort. The child will begin to be afraid to go to the toilet, difficulties of a neurological nature may form.

First aid

Many parents are wondering how to treat constipation in a child, and why it occurs. When all sorts of attempts to empty themselves do not work, the task of the parents will be to alleviate the child's condition.

They should help him get rid of constipation.

Although laxatives are allowed in preschool children, parents should not resort to using them without first consulting a specialist.

As first aid for a child, glycerin suppositories and a cleansing enema may be suitable. They are also used for newborns, they are safe and effective.

When there are no candles, you can do an enema using a glass of boiled, non-hot water.

The pear should be disinfected and the tip lubricated with oil or baby cream. Water is used only cold, not higher than room temperature.

Otherwise, it is absorbed into the intestines, pulling with it toxins that are secreted by stagnant feces.

It is forbidden to pour a large amount of liquid into the anus, since there is a risk of injury or stretching. Sharp pain and sudden cramping can be provoked.

Such measures should be enough to get a laxative effect in a domestic environment, after which the baby must be called for help or taken to a doctor to a medical institution.

Such remedies should not be used often, since this is not a treatment, but a short-term elimination of the symptoms of difficult emptying.

You should immediately contact a specialist without trying to give an enema when the child has:

intense pain near the abdomen, seething, symptoms of poisoning;
blood from the rectum;
unauthorized calorification, if, against the background of persistent constipation, liquid stool seeps to the surface.

Treatment of constipation in children

When a child is worried about constipation, parents should not ignore this fact and correct such a problem on their own.

Therapy measures should be aimed at achieving constant and natural defecation (every day or every other day, at least), optimally, in the same period of time.

The baby should be emptied without straining, the feces should be loose in consistency.

Treatment of constipation in children should be done by a specialist. He prescribes the necessary tests (blood, urine, coprogram, feces for helminths) and directs the child to the necessary specialized doctors.

Constipation in a child should be treated on an individual basis, taking into account all sorts of provoking factors: the severity of the disease, its causes, the presence of pain, age and psychological characteristics of the baby, related diseases.

Parents should be prepared that the treatment will continue for more than a month. The final restoration of the functioning of the gastrointestinal tract and the elimination of associated psychological difficulties takes up to 2 years.

Therapeutic diet

Usually, the initial measure for constipation is a laxative diet. She is an important link, without which it is not possible to counteract the disease.

It is difficult to organize such a diet for children. Often, experts ask parents to change the diet of all family members. Thus, it will become easier for the baby to endure "hardships" and get used to new products.

Necessary:

Eliminate food that provokes thickening of feces. Flour, rice porridge, pasta, milk, some fruits.
Seize products that form gases: cabbage, beans, mushrooms.
Do not eat foods that reduce intestinal motility. Caffeine-containing products (tea, coffee, chocolate), jelly.
For the speedy movement of feces through the intestines, they must be formed in the right amount. For these purposes, you need to add meals that contain coarse fibers (vegetables, fruits) to the diet. The amount of fiber recommended for consumption by children over 2 years old is determined by the age of the child: it is equal to the number of full years of the infant + 10 g on top.
The rest of the menu should be supplemented with "neutral" products: lean meats, eggs, butter.
The child should drink the correct amount of liquid (clean filtered water without gas or additives).
It is imperative to introduce the required amount of fermented milk products into the diet. Kefir, yogurt, etc.
When a child has an inflammatory process inside the gastrointestinal tract, he is transferred to strict adherence to dietary nutrition (table No. 3 or No. 4 for children).

Daily regime

A good daily routine plays an important role in the treatment of childhood constipation. It is necessary that food, toilet, etc. take place within a certain period of time.

Thus, the child will develop the habit of emptying the intestines at approximately the same time every day (optimally in the morning). At the same time, it will be psychologically and physiologically ready for emptying.

Parents need to instill in the baby the habit of starting the day by drinking 1 glass of warm water and gymnastics.

When after that the urge to go to the toilet is not observed, the baby needs to warm up, take breakfast and try to empty himself again.

Motor activity should be throughout the day. Gymnastic exercises contribute to the activation of peristalsis in the intestines and the advancement of food residues along the gastrointestinal tract.

The following exercises should be done:

squats;
slopes;
swings with straight and bent legs;
pressing the knees to the stomach;
Press.

For children from 3 years old and above, ice skating, cycling, jogging, active games are useful. Any movement contributes to the activity of the anterior abdominal wall and contributes to the functioning of the intestinal muscles.

Recovery of defecation

If you have constipation, children should be taught to empty properly.

It is necessary to tell the baby that a specialist will help cure him. And if at the moment there is discomfort, you should try to empty yourself at the same time.

It is necessary to create optimal conditions for the baby. The most effective posture for defecation is squatting with your legs pressed against your stomach.

If sitting, put a bench under your feet. You can massage the abdomen with your hands. The child is able to help emptying when he quickly draws in and relaxes the anus.

Drug therapy

When necessary, a specialist prescribes laxative therapy.

Since they are addictive and have side effects in the form of an allergic reaction, drug-induced diarrhea and other adverse effects, their treatment in children should not last more than 14 days.

Children under 3 years of age with constipation are allowed laxatives, including lactulose, for example, Duphalac. It is a safe remedy that is prescribed even during pregnancy in order to increase the amount of stool.

Also, children from constipation are prescribed choleretic agents of plant origin (Hofitol).

Their goal is to fill the lack of digestive juices, stimulate the production of bile and pancreatic secretions. This enables the baby to absorb food more efficiently and quickly remove its remnants outside.

Preparations that contain bifidobacteria and lactobacilli are recommended for all children with constipation in order to treat dysbiosis, restore a healthy intestinal microflora.

These include Linex, Bifidumbacterin, Hilak Forte and others.

Traditional medicine

Plants that improve digestive processes can also help eliminate discomfort. These include medicinal herbs, fruits, vegetables, dried fruits:

Mix equal amounts of fennel, oregano and elderberry. Add half a serving of anise to it. 1 tbsp. l. the finished mass is steamed with a glass of boiling water, infused. Then she needs to water the children 100 g 2 times a day.
Oregano bark, birch leaf, fennel flowers, 3-color violet and licorice are mixed in the same amount. 1 tbsp. l. the mixture is poured with water, brought to a boil, kept on fire for about 10 minutes. It is given to the infant chilled in the dose that he can drink.
Hay grass. It is a laxative. To get a pleasant-tasting medicine for constipation for children, you need to take 200 g of dried fruits, 100 g of rose hips, 50 g of hay, grind the resulting mass with a blender or meat grinder. Then honey is added in order to obtain a soft consistency. Children over 1 year old are allowed to give 1 tsp. 2 times a day, at 3 years, the dosage may be increased. This mixture helps to regulate the frequency of bowel movements, as well as to strengthen the immune system.
Freshly squeezed aloe juice is mixed with honey until a pleasant taste is achieved, given to a child over 3 years old, 1 tsp. on an empty stomach.
Dry dandelion roots are poured with boiled water in a proportion of 1 tbsp. l. herbs for 1 glass of boiling water, infused, 1 tsp is given. 3 times a day.

All traditional medicines are based on natural ingredients with an increased level of allergenicity. It is forbidden to accept prescriptions for children less than 1 year old without consulting a specialist.

When a baby has a predisposition to an allergic reaction and is less than 1 year old, it is advisable to give him an ordinary medication for constipation in children.

All children should be informed that constipation caused by various provoking factors is not their fault. But it is forbidden to use laxatives without parental consent during illness.

It takes a long time to fix such a dangerous problem. In some situations, traditional medicine will help for constipation, but they should be used optimally after the recommendation of a doctor.

When a similar difficulty arose, such as chronic constipation, then a baby at 3 years old must be taught to spend more time in the pot after eating.

Useful video

Disorders of the defecation process are observed in people at any age, but constipation in a 2-year-old child is a serious problem, since it can negatively affect psychological, emotional and physical development.

For young children, constipation is not only an increase in the intervals between bowel movements, but also a change in the density and consistency of stool.

If the visit to the toilet remains regular, but the baby has to make efforts to evacuate the feces, he experiences severe pain, and the feces resemble sheep, parents need to consult a pediatrician and gastroenterologist.

Causes of constipation in children

For infants under one year old who are breastfed, the main reasons are insufficient mother's milk, food allergies and possible damage to the central nervous system at birth.

Constipation in a child 2 years of age and older is classified depending on physiological and neuropsychogenic causes.

Pediatricians pay great attention to psychological constipation in children, which occurs as a result of a tense situation in the family, changes in the daily routine associated with the first visits to kindergarten, and pain syndrome that occurs during bowel movements.

Experts call other reasons associated with children's constipation:

Changing your diet. For children over two years old, a selective attitude towards food is characteristic, at this age the child has taste preferences, as a result of which the baby can refuse certain healthy dishes.
Violation of the drinking regime or lack of fluid in the body caused by diarrhea, vomiting, intoxication, high fever.
In babies under one year old, constipation may occur due to the transition to artificial feeding.
Development disorders of various parts of the large intestine can be both congenital (lengthening of the sigmoid colon, Hirschsprung's disease, etc.) and acquired (adhesions, neoplasms, polyps, diverticula, accumulation of worms).
Damage to the mucous membrane such as anal fissures, paraproctitis, fistula formation, cause severe pain, as a result of which the baby deliberately retains feces.
Taking medications without the consent of the pediatrician. Situations often arise when parents independently treat children with drugs, such as antispasmodics, probiotics, laxatives, antibiotics, etc.

Enemas designed to facilitate the passage of stool can inhibit the natural reflex of the bowel.

Therefore, any stool disorders in a 2-year-old child should be performed only under the supervision of the attending physician.

It is important to remember that enemas and laxatives should be given to children only in extreme cases after consultation with a pediatrician or gastroenterologist.

Local and general symptoms of constipation in children

The number of bowel movements per day is individual for each child. The indicator depends not only on the age of the baby, but also on the diet, concomitant pathologies, and psychological state.

For children under one year old who are breastfed, the number of bowel movements corresponds to the number of meals. If the baby uses artificial mixtures, he can poop 1 - 2 times a day.

Children over a year old use the toilet on average once every 24 hours. If the baby has a stool less often, we can say that the baby has constipation.

The consistency of feces is also of great importance. In young children, it is mushy.

If the stool resembles a hard sausage or looks like dry hard balls, after emptying the intestines at 2 years old, it does not feel relief, this also indicates that the baby is constipated.

Before doing anything, parents need to pay attention to the following signs that have constipation in children:

lower abdominal pain, bloating;
intestinal colic;
nausea, vomiting;
a feeling of pressure on the anus;
streaks of blood can be seen in the feces.

Common (extraintestinal) symptoms of fecal retention are weakness, tearfulness, fatigue of the baby, unexplained weight loss, pallor of the skin, pustular eruptions.

Untimely treatment can lead to the development of chronic constipation and prolapse of the rectum, therefore, if characteristic symptoms are found, you should immediately consult a doctor.

Prompt help with delayed feces

For children over a year old, periodic violations of the administration regime are characteristic. Experts attribute this to a violation of the drinking regime or diet.

But in the case when the baby wants to empty the intestines, but cannot do it for more than two days and at the same time complains of pain in the tummy, parents should suspect constipation and consult a doctor.

If at the moment it is not possible to do this, you can use one of the following methods of providing ambulance for children:

A baby at the age of two, who is tormented by constipation, can be given a rectal glycerin suppository. The product is recognized as safe even for newborn babies. The child must be placed on the left side, bend the legs at the knees and enter the suppository. Then you need to gently squeeze the buttocks and hold until the glycerin dissolves in the rectum.
To quickly relieve the condition in children over two years old, you can do cleansing enemas with cool boiled water and a small spoonful of glycerin. It is important to remember that warm liquid is absorbed by the intestinal walls, so you can only do an enema with cool water.
After consultation with the attending physician, constipation in the baby can be relieved with the help of Mikrolax micro enema. It should be remembered that for a child under 2 years old, the tip of the tube can be inserted no deeper than 2 centimeters.

In order not to damage the intestinal mucosa in a child and not harm his health, the following rules should be observed when providing prompt assistance:

every time before using the syringe, it should be disinfected;
the tip of the pear is lubricated with baby oil or petroleum jelly, which greatly facilitates its introduction into the anus;
too much fluid should not be injected into the child's intestines, this can lead to stretching of the walls;
with intestinal obstruction in a child, it is forbidden to treat constipation with an enema!

If a two-year-old child regularly has constipation, it is necessary to consult a doctor, since improperly selected treatment can lead to the development of serious complications.

Constipation Nutrition Basics

Since the main reason why a child over two years old regularly has constipation, experts call improper nutrition, the diet should be analyzed and the necessary changes made to it.

Drinking regimen plays an important role in softening feces. You can eliminate constipation in a child with half a glass of purified water in the morning on an empty stomach.

During the day, a 2-year-old baby can be offered herbal tea, a decoction of raspberry leaves, figs or prunes, natural juices from apples or peaches.

A child's balanced diet should contain:

soups, broths and other first courses;
if the baby has constipation, fermented milk products should be introduced into the menu, and whole milk should be excluded;
rich in vitamins and useful dietary fiber, carrots, beets, cabbage, plums, etc.;
as a side dish instead of pasta, the baby should be offered whole grain porridge;
use olive or sunflower oil as a dressing for vegetable salads.

In the case when the child periodically suffers from constipation, carbonated drinks, fast food, fatty, fried foods, boiled rice, potatoes, and confectionery are completely excluded from the diet.

Treatment with folk methods

With such a problem as constipation in a small child, you need to consult a pediatrician or gastroenterologist. Perhaps they will send the baby for a consultation with specialized specialists.

Based on the data obtained after a complete examination, the doctor will prescribe treatment, the purpose of which is not only to relieve symptoms, but also to eliminate the cause of the change in the bowel regime.

Complex therapy includes the use of medications, adjusting the diet, drinking regimen, and gymnastic exercises. Traditional medicine methods should also be agreed with your doctor.

An important condition for using "grandmother's" recipes is the absence of allergic reactions to the components.

If blood is found in the feces, nausea and vomiting, self-medication is prohibited, you must call an ambulance.

The following are recognized as effective traditional medicine:

Hand-squeezed vegetable and fruit juices. Beets, carrots, cabbage, apples and peaches can be used as raw materials.
For children over a year old, the process of passing feces can be accelerated by giving the child a teaspoon of petroleum jelly before bedtime. In the morning, the baby will be able to go to the toilet on his own.
A small spoonful of flax seeds is poured with a glass of boiling water and left to infuse for 15 minutes. The resulting drink resembles a jelly in consistency, which is given in a small amount to the baby to drink before eating.
Dill water is known to relieve gas in both newborns and adults. In addition, it is widely used as a laxative. To prepare the broth, 1 - 2 small tablespoons of dill seeds are placed in 250 ml of boiling water and left on fire for 5 minutes. If there are no seeds at home, you can use the greens of the plant, but the effect of the remedy will be much weaker.
Chamomile is known for its antiseptic properties, therefore it is used for inflammatory processes in the intestines. The flowers of the plant are poured with boiling water and placed in a water bath, where they simmer for 5 - 10 minutes. Then the broth is passed through a clean cloth and cooled. Children over three years old can take half a glass before each meal.
To treat constipation in a child over two years old, you can use oatmeal infusion. To prepare it, 150 g of grains are placed in a thermos, poured with boiling water and left overnight. The resulting liquid is given to the child in the morning, immediately after sleep.
For older children, you can introduce prunes or dried fruit compotes into the diet, the main components of which will be dried plums and figs.
To facilitate bowel movements, you can prepare a kefir drink, which contains 200 ml of a healthy fermented milk product, 30 ml of chamomile decoction and 5 g of vegetable oil.

The resulting composition is poured into two glasses, one of which the child drinks after a night's sleep, and the second in the evening.

Constipation in a 2-year-old child is a common occurrence with alimentary, physiological and psychological causes.

Complications of a delay in the act of defecation can be pathologies such as prolapse of the rectum, fissures of the anus, paraproctitis, and even the development of tumor processes.

Therefore, if you find the characteristic symptoms of the baby, you should immediately show a specialist to determine the cause and purpose of complex treatment of the problem.