If the child has frequent constipation. Video about the treatment of constipation in a child: how to treat constipation in a child up to a year, what causes constipation in children. Other hazards

What causes such a problem with stool in children 4-6 years old? There may be many. Doctors name several common causes of trouble. This is:

1. Eating disorder. This is the main cause of constipation in children and adults. Monitor your child's diet carefully. Perhaps he eats a lot of flour, sweet. Hardening of stool causes rice, fatty meat, biscuits. If there are few vegetables and fruits in his menu, the main sources of fiber and vitamin, then constipation will not take long.
2. Lack of water. Parents, taking care of the child's nutrition, sometimes forget to control the amount of liquid he drinks. This is easily determined by the amount of urination and urine concentration.
3. Taking medication. If the child is undergoing treatment that requires medication, then constipation may be a side effect or the result of an overdose.
4. Psychological problem. Often the cause of constipation is nervous overexcitation, stress. Perhaps this was facilitated by moving, attending a kindergarten or problems in the family.
5. Congenital or acquired bowel disease. Sometimes the cause of constipation is a malfunction of the intestines. In this case, you can not do without an examination by a specialist and prescribed treatment.

How to identify symptoms?

Determining the presence of constipation in children is very simple.

Pay attention to such factors:

• hard feces, sometimes in the form of lumps;
• groaning of the child;
• sitting on the potty or toilet for a long time;
• redness of the skin of the face during and after defecation;
• encopresis - the presence of fecal traces on the underwear, not associated with incontinence;
• blood in the stool or on the toilet paper is bright scarlet, indicating the presence of an anal fissure.

What to do and how to help children at home?

There are several ways to solve the problem of constipation. Many of them can be performed by parents at home without the involvement of drugs, for example, with an enema or folk remedies. However, the parent should be aware that in some cases laxative suppositories cannot be dispensed with.

Massage

Many children are well helped by massage for constipation, which has a beneficial effect on digestion. To make the intestines work properly, you do not need to complete special massage courses.

You can ease the condition of a small tummy as follows:

1. Wash and warm your hands.
2. Make stroking movements on the stomach from top to bottom.
3. Draw a few circles clockwise around the belly button.
4. Attach a warm diaper to your stomach and give your child a glass of kefir.

Enema

If you need to get rid of constipation urgently, then a regular enema will help in this case.

It is done as follows:

1. Step 1. Prepare a “pear” for an enema, rinse it thoroughly from the inside and sterilize its spout with boiling water.
2. Step 2 Take half a glass of boiled water, add one tablespoon of any vegetable oil to it.
3. Step 3 Type in the "pear" water with oil.
4. Step 4 Put the child upside down and gently insert the nose of the "pear" into the anus, previously lubricated with baby cream.
5. Step 5 Inject water with oil into the rectum and ask the child to lie down for 10-15 minutes.

This time will be enough for the enema to work and the child can safely go to the toilet for the most part.

Candles

With severe constipation, it is better to use laxative suppositories. This tool will quickly help you solve the problem. What kind of candles to choose? Pediatricians recommend the use of safe drugs, such as glycerin suppositories. This drug has many advantages:

• Safe, do not have adverse reactions, it can be used even for infants.
• Fast acting- in half an hour the result will appear.
• Inexpensive and affordable. It can be bought at every pharmacy without a prescription.
• Universal- can be used by adults.

If constipation in a child of 4-6 years old is accompanied by anal fissures, then in this case it is better to use Sea Buckthorn Suppositories. They have a disinfecting effect, quickly relieve inflammation, heal.

Folk remedies

Prolonged constipation can be treated with folk remedies. Of course, children will not drink many decoctions that are useful in this case, however some of the tools they will like:

1. Kefir with oil. Before going to bed, let your child drink a glass of kefir with the addition of one teaspoon of vegetable oil. You will see the result in a few days.
2. Delicious pumpkin dessert. Grate pumpkin and mix with honey. Grease a muffin tin with vegetable oil and pour the mixture into it. Bake for 20 minutes. This dessert is only for those children who are not allergic to pumpkin and honey.
3. Rosehip drink. Rose hips have a laxative effect. Prepare tea and compote from this plant for your child. To do this, grind dry fruits in a coffee grinder, pour one tablespoon of the powder with a glass of boiling water and let it brew for half an hour. Then strain and sweeten.

Prevention

Constipation in children can and should be prevented. To do this, it is necessary first of all to monitor the child's nutrition and observe his drinking regimen.

Add foods that have a laxative effect to the menu. These include:

• kefir;
• yogurt;
• cabbage;
• zucchini;
• cucumbers;
• pumpkin;
• plums;
• apples;
• pears.

Do not forget that the child needs to drink plenty of water and eat liquid meals for the fluid balance of the body. The menu every day must be present first courses.

If constipation is accompanied by other symptoms, such as pain in the intestines, fever or vomiting, you need to call an ambulance or show the child to the pediatrician. In this case, it is impossible to give him any drugs or carry out procedures without the permission of the doctor. Such self-medication can be hazardous to health.

- difficulty in the process of emptying the intestines, the absence of an independent stool for a day or more. Manifestations of constipation in children can be a decrease in the frequency of defecation, hard stool consistency, tension or anxiety of the child during defecation. To find out the causes of constipation, children can undergo a rectal finger examination, ultrasound, endoscopy, X-ray contrast examination of the intestine, and stool tests. The main principles for the treatment of constipation in children are: the development of a reflex to defecate, diet therapy, physical activity, massage, drug therapy, physiotherapy, and, if necessary, setting enemas.

In most cases, constipation in children is functional. In the formation of dyskinetic constipation in children, a special role is played by hypoxic-ischemic and traumatic lesions of the central nervous system, which is most often clinically manifested by hypertensive-hydrocephalic syndrome. Hypotonic constipation occurs in children against the background of rickets, malnutrition, chronic gastroduodenitis, peptic ulcer, myasthenia gravis, sedentary lifestyle, prolonged bed rest. Spastic constipation can develop in children with lactase deficiency, cerebral palsy, neuro-arthritic diathesis. With dysbacteriosis in children, constipation occurs due to a violation of the composition of the normal intestinal flora that produces lactic acid and stimulates intestinal motility.

Conditioned reflex constipation in children can occur with diaper dermatitis, anal fissures, paraproctitis, rectal fistulas. Psychogenic constipation in children can occur with forced weaning, forced potty training, the inconvenience of visiting a public toilet in a kindergarten or school. If the act of defecation was accompanied by pain, or going to the toilet was psychologically uncomfortable, the child may ignore the urge to defecate. In this case, the feces accumulate in the rectum, due to the absorption of water, it becomes even harder, which causes even more painful bowel movements and aggravates constipation in children.

Intoxication constipation in children develop with acute or chronic intoxication with toxic substances, infectious-toxic - with dysentery, ulcerative colitis. Constipation of endocrine origin in children may be associated with hypothyroidism, myxedema, diabetes mellitus, gigantism, pheochromocytoma, adrenal insufficiency. Constipation in children can be caused by the uncontrolled use of certain drugs - enterosorbents, enzymes, diuretics, iron preparations, etc. Frequent enemas and laxatives lead to inhibition of their own reflex to empty the intestines.

Symptoms of constipation in children

Constipation in children can present with intestinal (local) and extraintestinal (general) symptoms. Local manifestations include: a rare rhythm of defecation or lack of stool, a change in the consistency of feces, a feeling of incomplete emptying of the intestine after going to the toilet, pain and bloating, the presence of blood in the feces, pain during defecation, paradoxical fecal incontinence.

Normal stool frequency in children changes with age. So, in newborns who are breastfed, the frequency of bowel movements coincides with the number of feedings (6-7 times a day). With age, there is a decrease in the frequency of stools, and by 4–6 months (the time of introduction of complementary foods), the rhythm of defecation decreases to 2 times a day. In children receiving artificial feeding, stools usually occur no more than 1 time per day. From the age of 1 year and older, the frequency of stools in a child should be 1-2 times a day. A more rare rhythm of bowel movement in children is regarded as constipation.

Up to 6 months, the normal consistency of feces is mushy; from 6 months to 1.5-2 years mushy or decorated. The presence of very hard feces in the form of “balls” or “dense sausages”, frequent stools in small portions in a child also indicate constipation.

Due to coprostasis, the child develops intestinal colic, flatulence, a feeling of pressure in the anus. The anxiety of the child and pain during defecation are caused by overstretching of the intestinal wall with dense fecal masses of large diameter, which often injures the anal canal mucosa. In these cases, there is often a small amount of red blood in the form of streaks in the stool. Encopresis (calomania, paradoxical fecal incontinence) usually develops after a previous long retention of feces.

In addition to local manifestations, in children suffering from constipation, extraintestinal manifestations are noted, indicating fecal intoxication. These include general weakness, fatigue, headache, irritability, anorexia, nausea, anemia, pallor of the skin, a tendency to develop pustular rashes and acne.

Accumulation of stool in the intestinal lumen, malnutrition of its mucous membrane, violation of the intestinal microflora can contribute to the development of colitis, which causes an even greater increase in constipation in children. In addition, persistent constipation in children can lead to rectal prolapse.

Diagnosis of constipation in children

Examination of children suffering from constipation should be carried out with the participation of a pediatrician, pediatric gastroenterologist or proctologist. From the anamnesis, the time of onset and dynamics of the disease, the frequency and consistency of the stool are specified. On examination, abdominal distension is detected, fecal stones are determined on palpation along the sigmoid colon. In the process of digital examination of the rectum, the standing of the ampoule, the strength of the sphincter are assessed, and organic malformations are excluded.

Laboratory diagnostic methods for constipation in children include the study of feces for dysbacteriosis, coprology, helminth eggs; general and biochemical analysis of blood. As part of a comprehensive assessment of the state of the gastrointestinal tract, children can be shown ultrasound of the pancreas, liver, stomach with a water-siphon test, endoscopy. In order to examine the condition of the distal large intestine, ultrasonography of the large intestine is performed.

The final assessment of the structural and functional state of the intestine is possible after an x-ray examination: plain radiography of the abdominal cavity, EEG.

Treatment of constipation in children

Due to the fact that constipation in children is always secondary to the leading cause, within the framework of this review it is possible to speak only about the main directions of medical work. In some cases, in order to normalize physiological functions, it is sufficient to change the nature of the child's diet, activate physical activity, and increase the drinking regimen. In the diet of infants suffering from constipation, fruit and vegetable purees should be present; in older children - sour-milk products, dietary fiber, fiber. An extremely important aspect of the treatment of constipation in children is the development of a conditioned reflex to defecate.

In order to eliminate intestinal hypotension, massage courses with elements of exercise therapy are prescribed. Physiotherapeutic treatment of constipation in children includes galvanization (with hypotension), pulsed currents, electrophoresis, paraffin applications on the abdomen (with hypertonicity). A positive result in functional constipation in children gives acupuncture. With psychogenic constipation, children may need the help of a child psychologist.

Drug therapy for constipation in children may include the appointment of laxatives (lactulose, sennosides, suppositories with glycerin), antispasmodics (papaverine, drotaverine), prokinetics (dommperidone), probiotics. In some cases, short courses of enemas (cleansing, hypertonic, oil) are prescribed.

Forecast and prevention and constipation in children

With the elimination of predisposing causes and the implementation of individual recommendations, the defecation regimen and the nature of the stool are normalized. Otherwise, constipation in children can take a chronic course and accompany them already in adulthood. If children are prone to constipation, a medical examination is mandatory; self-medication is unacceptable, especially with the use of laxatives and enemas. Acute constipation in children can be a sign of intestinal obstruction and other life-threatening conditions.

Measures to prevent constipation in children should include breastfeeding, daily gymnastics, massage courses, a balanced diet, teaching the child to defecate at a certain time, and creating a favorable psychological atmosphere. It is imperative to identify and eliminate the cause that led to constipation.

The problem of constipation in children in pediatric practice is one of the most common. Parents are often worried about the absence of a chair in a child for several days, difficulty in defecation and related complaints of children about pain, refusal of children from the pot.

What is constipation?

Constipation is the slow movement of feces through the intestines. This is a problem that can appear at any age, including a newborn baby and a preschooler. It is believed that constipation is the most common pathology of the gastrointestinal tract in children. Some parents do not pay due attention to this side of the child's life, others have the wrong idea of ​​​​what a child's chair should be and its frequency. Not all parents come to the doctor with this problem in children or do not go immediately, because they do not attach due importance to it or do not know whether such a stool in a child is a norm or a pathology.

What stool is considered normal?

The frequency of stool in children of different ages is different. A breastfed newborn baby may have a bowel movement as many times as he is fed. This is an ideal option, stools are allowed from 10-12 times a day, but little by little, about a teaspoon, up to 1 time per week in large volume. You can talk about constipation when the child has a hard stool. For children who are bottle-fed, up to a year, constipation is the absence of an independent stool during the day. At the same time, the consistency of the stool should be mushy, and the appearance of shaped feces (“sausage”) is regarded as a tendency to constipation. From 4-6 months, the frequency of bowel movements usually decreases to 2 times a day. From a year and older - it should be 1-2 times a day. From 6 months to 1.5-2 years old, feces can be both formalized and mushy, from two years old it should be formalized.

Constipation is a violation of bowel function, manifested in an increase in the intervals between bowel movements. Constipation is also considered those cases when a child has painful defecation with feces that are dense in consistency, even if the stool frequency corresponds to the age norm. Defecation in a child can be daily, but accompanied by straining, a change in the nature of the stool (“large” diameter of the fecal cylinder, “sheep” feces - dense, divided into small fragments). This situation is also characteristic of dysfunction of the large intestine and can be characterized as chronic constipation, the presence of defecation less than 6 times a week for children under 3 years of age and less than 3 times a week for children over 3 years of age. Constipation in children is often accompanied by abdominal pain, to which they often react with crying and anxiety. The movement of feces is carried out due to the contraction of the muscles of the intestine under the influence of nerve endings. The movement of feces from top to bottom through the intestines is carried out due to its wave-like contractions - peristalsis. The urge to defecate occurs when stool enters the rectum, stretching it and irritating the nerve endings that are there. In older children, defecation is carried out consciously under the control of the central nervous system. The general immaturity of the neuromuscular apparatus of children in the first months of life can contribute to the retention of feces.

Constipation can be divided into organic and functional.

Organic constipation is associated with malformations (anatomical defects) of any part of the large intestine. Most often, organic constipation manifests itself from birth in the form of a lack of independent stool. The most common organic causes of constipation are Hirschsprung's disease and dolichosigma. Acquired anatomical changes (tumors, polyps, adhesive disease after operations) can also be the cause of organic constipation. Fortunately, these diseases in children are extremely rare and developmental anomalies often appear already in the first year of a child's life. This type of constipation is treated by pediatric surgeons and usually requires surgery.

In the vast majority of cases, children have functional constipation, that is, dysregulation of the gastrointestinal tract. The causes of functional constipation in young children are:

1. Wrong diet of a nursing mother.
2. Insufficient drinking regime of a child with artificial feeding.
3. Insufficient drinking regimen of a child who is breastfed with the introduction of complementary foods (introduced "thick" complementary foods, but did not give the baby water).
4. Early transfer of the child to artificial feeding.
5. Fast transfer of the baby from one mixture to another (less than 7 days).
6. Irrational diet of the child (the child receives for a long time a high content of proteins, fats, which are poorly digested).
7. The presence of rickets in an infant, in which there is a reduced muscle tone, including the muscles of the intestinal wall. In some cases, 2-3 weeks after the appointment of vitamin D, constipation in a child disappears.
8. Consequences of damage to the central nervous system, which developed during the wrong course of pregnancy and childbirth.
9. Dysfunction of the thyroid gland (hypothyroidism). One of the clinical manifestations of hypothyroidism is constipation.
10. Iron deficiency anemia - with iron deficiency, there is an insufficient supply of oxygen to the muscles of the intestine, and therefore, its muscle weakness is noted.
11. Intestinal dysbiosis - a violation of the intestinal microflora, which leads to an increase in the processes of decay, a decrease in the motor activity of the intestine.
12. Food allergy (to the protein of cow's milk, eggs, fish, soybeans, cereals containing gluten (gliadin)), leading to inflammatory changes of an allergic nature in the intestinal wall.
13. A significant role in the development of functional constipation in children is played by violations of the act of defecation due to inhibition or lack of development of a reflex to defecate (conditioned reflex, psychogenic constipation). This type of constipation is often observed in shy children during the period of adaptation to new conditions (nursery, kindergarten). Suppression of the reflex to defecate leads to compaction of feces, trauma to the mucous membrane of the rectum, the development of its inflammation, pain during defecation, there is a "fear of the pot", neurotic disorders are aggravated.
14. Uncontrolled use of certain drugs (smecta, imodium, bifidumbacterin, enzyme preparations). Frequent use of enemas and laxatives inhibits one's own bowel reflex. Constipation can develop against the background of long-term use of drugs: antispasmodics - drugs that eliminate spasm of smooth muscles, for example, intestines, anticonvulsants, diuretics (diuretics), psychotropic drugs, antibiotics, etc.
15. Worm infestation is often accompanied by constipation.
As a result of the impact of various, the above reasons, the muscle tone of the intestine changes. With an increase in the tone of any part of the intestine, a spasm occurs, feces cannot quickly pass this place. This is the mechanism of development of spastic constipation, the external manifestations of which are the presence of dense, fragmented, "sheep" feces. Another type of functional constipation is hypotonic constipation, which is characterized by stool retention, with its release in the form of a fecal cylinder.

Children may experience temporary delays in stool - "transient constipation". This may be due to errors in diet, dehydration of feces during acute febrile conditions (if the child has a high temperature, severe sweating, loss of fluid with vomit, etc.). Babies who are breastfed may develop a so-called "false constipation". It occurs due to the fact that babies receive a small amount of breast milk, as well as the presence of congenital defects in the oral cavity (for example, cleft hard and soft palate), sluggish sucking, regurgitation. In these cases, it is still not worth talking about constipation and taking emergency measures. With the elimination of the cause that caused the stool retention, its normalization occurs independently. Sometimes, to solve this problem, it is enough to adjust the diet and drinking regimen.

The effect of constipation on the body.

Constipation is accompanied by the development of chronic lethargy, weakness, decreased appetite in a child against the background of a violation of the processes of digestion and increased absorption of harmful substances from feces. With the accumulation of fecal masses in the lumen of the intestine, the nutrition of its mucous membrane is disturbed. Chronic stool retention leads to a violation of the intestinal microflora, an increase in the number of pathogenic microflora and a decrease in the level of normal microflora. There is a violation of the absorption of vitamins and microelements, leading to other metabolic disorders in the cells and tissues of the whole organism; gradually developing iron deficiency. An inflammatory process in the intestines (colitis) may develop, intestinal motility will increase, which is accompanied by the appearance of abdominal pain, the diameter of the intestine will expand, which will lead to an even greater increase in constipation. Long-term constipation can cause various complications. Most often, in children, there are violations of the intestinal microflora, which entails a violation of the processes of digestion and absorption in its departments. In the future, intoxication increases, due to an increase in the processes of decay in the intestines, the accumulation of harmful substances. Perhaps a violation of blood circulation in the intestinal wall, the development of an inflammatory process in the large intestine and the expansion of the intestinal lumen. Most often, with constipation in children of different ages, rectal fissures are observed, accompanied by the appearance of scarlet blood on the surface of the feces. Persistent constipation can cause prolapse of the rectal mucosa. If these symptoms appear, you can not self-medicate, you must immediately consult a doctor. In young children, painful defecation leads to fear of this process.

"Ambulance.

At home, if constipation occurs in a child older than a year, a cleansing enema can be used as a first aid before a doctor's examination. For a cleansing enema, boiled water at room temperature is used. To increase the laxative effect of the enema, glycerin is added to the water - 1-2 teaspoons per glass of water.

In no case should you call a chair with soap (it causes a strong chemical burn of the mucosa), cotton swabs or a thermometer. This leads to additional traumatization of the rectal mucosa and further suppresses the natural reflex to defecate. You can use glycerin suppositories as an emergency (can be used from birth), but you should not get carried away with them.

If a baby who is breastfeeding has a dense stool, with streaks of blood, you should definitely consult a doctor!

If the child is older, you should consult a doctor in the following cases:
- constipation is accompanied by complaints of abdominal pain, bloating, loss of appetite;
- there is blood in the child's stool;
- the child holds the chair for emotional reasons, especially when planting on the potty;
- the child periodically has fecal smearing (encopresis), in which solid feces accumulate in the rectum, and liquid feces are involuntarily excreted due to the loss of control by the child over the muscular apparatus of the rectum.

First of all, you need to visit a pediatrician, it is he who must determine the need for consultations of other specialists (pediatric neurologist, endocrinologist, surgeon).

Treatment.

The main condition for the successful treatment of constipation in children is to achieve such consistency of intestinal contents and the speed of its transit through the large intestine, which would allow to have a regular, preferably daily (or at least once every two days) stool at the same time of day.

This treatment requires an individual approach from the doctor in each specific case and depends on many factors: the causes of constipation, the age of the child, the severity and duration of the disease, the independence and frequency of defecation, the presence of dyspepsia and pain, as well as concomitant diseases of the gastrointestinal tract and other organs. and systems.

In the treatment of constipation, five main areas can be distinguished:

1. General guidance. The doctor needs to explain the physiology of bowel movements and the consequences of constipation. Explain to parents how to treat and how to resolve problems, especially in cases with a long course and for patients who previously had other treating physicians. We must promise children that the stool will be soft and will not cause pain later on. At the same time, you need to ask the child not to retain feces. Reassure him that if he adheres to the treatment, then the faecal stains will disappear. The main task in relation to the child is to eliminate pain. When addressing parents, we ask them not to allow unnecessary and degrading comments. It's not their fault and it shouldn't create a psychological problem. However, ideas of anatomical causes must be eliminated from their minds. It takes from 3 months to 2 years before the situation returns to normal. The time required for this depends on the previous duration of the constipation, the correct adherence to the treatment, the calmness and patience invested. It is important that parents develop a positive reaction when children begin to control bowel movements and avoid punishing children in cases of relapse.

Toilet exercises. We agree with children and parents that after each large meal, children should sit in the toilet (with a footrest) for at least 10 minutes. We explain to parents that children do not have to defecate every time, but if they try, reassure them that it does not hurt.

2. Medical nutrition. This is the most important measure (depending, however, on family habits), although the most difficult to implement. We must convince parents that children with constipation, especially if the family history has such problems, should have a nutritious diet high in plant fibers. Sometimes it is necessary to change the habits of the whole family. If you want to increase the intake of food that contributes to the formation of fecal matter, vegetables, fruits and cereals are recommended. The amount of fiber intake should be "age + 5-10 grams per day" for children over 2 years of age. It is useful to add wheat bran to enrich a nutritious diet poor in plant fibers. First of all, it is necessary to watch and avoid the consumption of foods that contribute to constipation, such as cow's milk, vermicelli, rice, bananas, and unpeeled apples. Supplement calcium (1 g/day) and calories by consuming non-constipating foods such as meat, eggs, butter, and vegetable oil.

It is important to ensure fluid intake and avoid caffeinated drinks.

When treating children of the first year of life who are breastfed, it is very important to analyze the nature of the drinking regimen and nutrition of a nursing mother, especially if she has stool retention. It is necessary to exclude the following products from her diet: those that contribute to increased gas formation (legumes, white cabbage, tomatoes, mushrooms, black bread); reducing the motor function of the colon (containing tannin - blueberries, strong tea, cocoa; rich in fatty oils - turnips, radishes, onions and garlic; semolina and rice porridge, mucous soups and kissels). In addition, milk is poorly tolerated, as it contributes to flatulence, especially against the background of intestinal dysbacteriosis.

Similar restrictions are necessary for children suffering from constipation at an older age.

Formula-fed infants are recommended to use adapted milk formulas. They can be divided into 4 types:

with gluten from carob beans ("Fried" - 0.6%);
containing lactulose ("Semper Bifidus");
enriched with oligosaccharides ("Nutrilon Omneo", "Nutrilon plus");
containing prebiotics ("Lactofidus, NAN-fermented milk, "Agusha-1" and "Agusha-1" - fermented milk).
The optimal daily volume of these mixtures for both mixed and artificial feeding is selected individually, starting with replacing half of one feeding on the first day, one full feeding on the 2nd day, followed by a daily increase by one feeding per day until stool regularity is achieved. If constipation persists, then the child is completely transferred to one of the above mixtures. With the normalization of the stool, the volume of the mixture is reduced, as a rule, to a maintenance dose (usually 2-3 feedings per day).

A worthy place in their diet should be occupied by fermented milk products (kefir, curdled milk), starter cultures (Narine, Evita, Vitaflor), as well as functional foods based on fermented milk (Bifidok, Activia yogurt, etc.). .).
With constipation, accompanied by signs of inflammation (colitis), depending on the activity of the inflammatory process in the intestine, diet No. 3 or No. 4 (B or C) according to Pevzner is prescribed.
2. Pharmacotherapy of intestinal motility disorders is based on modern ideas about the physiology of its motor activity. The combined nature of various disorders (hypotension and spasm) of the intestine, often observed in the clinical picture of the disease, creates certain difficulties in the medical correction of these disorders.

Traditionally, the first group of drug therapy for constipation are laxatives. According to the mechanism of action, they are divided into drugs:

Increasing the volume of intestinal contents (vegetable fibers, hydrophilic colloids, saline laxatives, synthetic disaccharides);
- stimulating intestinal receptors (rhubarb, senna, buckthorn - containing anthraglycosides and synthetic agents - bisacodyl, sodium picosulfite);

Emollients (synthetic disaccharides, vaseline and almond oil). All laxatives differ in the localization of action: mainly on the small intestine (saline laxatives, liquid paraffin), colon (synthetic disaccharides, bisacodyl) and the entire intestine (hydrophilic colloids, saline laxatives).

Despite their diversity, most of them cause a number of side effects (allergic reactions, drug-induced diarrhea with the development of dehydration and electrolyte disorders, intestinal obstruction, melanosis of the colon, endocrine disorders, dysbacteriosis, etc.), which is why the use of laxatives in children should be short (no more than 10-14 days).

Can you give your child a laxative?

Sometimes parents try to treat the child themselves, giving him various laxatives, which are now widely available in pharmacies. Pediatric doctors do not recommend doing this, since most laxatives are intended for adults and their effect is short-lived. Also, they can give numerous side effects, such as allergic reactions, loss of potassium, protein through the intestines, dysbacteriosis, inhibition of one's own reflex to empty the intestines.

Medicines for the treatment of constipation can only be prescribed by a doctor.

However, chronic constipation requires very painstaking and long-term treatment, and this determines the choice of drugs of this spectrum of action in pediatric practice. In the first place among them is Lactulose, which, according to the mechanism of action, is related to prebiotics, as well as food bran and seaweed.

Lactulose is the active substance of Dufalac (Solvay Pharma, Germany), which is a source of carbohydrates preferred by lactate-producing bacteria (especially various types of Bifidobacterium and Lactobacterium), and due to it, they significantly increase their mass, which causes a laxative effect. Lactulose, a synthetic disaccharide not found in nature, is not broken down or absorbed in the small intestine, so when it reaches the colon, it is bacterially degraded and broken down into short chain fatty acids (lactic, acetic, propionic, and butyric), lowering the pH of the colon contents and stimulating peristalsis. The decomposition of lactulose to short-chain fatty acids also increases the osmotic pressure in the intestinal lumen. Duphalac is a physiological and safe regulator of intestinal motility and is widely used in both children and adults, including pregnant women, which allows us to recommend it as a basic drug in the constipation treatment regimen. The dose of Dufalac is recommended to be selected individually, depending on the age and degree of stool retention, starting with 5 ml of syrup, followed by an increase to the most effective (but not more than 50 ml per day). The duration of its administration can be quite long, and the withdrawal of the drug is carried out gradually. Of the means that increase the volume of intestinal contents, wheat bran and seaweed are often used. When taking bran, it is recommended to drink plenty of fluids to avoid hardening of the feces (1 g of bran binds 18 g of water). It is recommended to take from 15 to 50 g of dietary fiber per day. However, a large number of them leads to a decrease in the absorption of fats by 5–7%, proteins by 8–15%. Sea kale (kelp) refers to mucous substances and consists of the same amounts of fiber and polysaccharides that are unable to be absorbed in the intestines. These are insoluble substances of plant origin, having a resinous consistency. In water, they swell and turn into a slimy mass, which does not allow feces to thicken, and at the same time increase its volume. Seaweed is a brown algae rich in iodide, bromide and calcium salts, polysaccharides, vitamin C. It is prescribed 1-2 teaspoons once a day (production form - powder). The drug is contraindicated in patients with idiosyncrasy to iodine and with prolonged use can cause iodism.

The second group of drugs are prokinetics, which have a primary stimulating effect on the propulsive activity of the colon and antispasmodics. Until recently, prokinetics have been rarely used for constipation in children. Previously, methaclopramide (synonyms: Raglan, Cerucal, etc.) was used more often than others, which coordinates the disturbed ratio of the tone and kinetics of the stomach, normalizing the evacuation from it and the passage of chyme through the duodenum. Side effects of this drug include drowsiness, fatigue, headaches, dystonic phenomena, spasm of the esophagus, galactorrhea, fears, coming bulbar disorders.
In recent years, a new generation of prokinetics has appeared - domperidone. Given the fact that this drug does not give such pronounced side effects as methaclopramide, it has become widespread in gastroenterology, including constipation in children. Domperidone is a dopamine antagonist. By blocking dopamine receptors, it affects the motor function of the gastrointestinal tract - it increases the peristalsis of the stomach and normalizes its emptying, and also increases the tone of the lower esophageal sphincter. The drug to a certain extent increases the tone and enhances the peristalsis of the entire intestine, which is manifested in the elimination of flatulence and pain along the colon, the normalization of stool in some patients. Since domperidone does not cross the blood-brain barrier, it is much less likely to cause extrapyramidal disorders. The drug is prescribed 5-10 mg 3 times a day (10 mg tablets) 10-30 minutes before meals, for 4 weeks. In young children, it is successfully used in liquid form.

Another representative of this group is Meteospasmil, which includes alverin and simethicone. Some authors refer it to prokinetics of peripheral action. It is produced in capsules and is prescribed 1 capsule 2-3 times a day for children over 12 years old.

In addition to hypo- and atonic states, intestinal motor disorders such as increased colonic motility can be observed, especially in IBS with constipation syndrome. In this case, it becomes necessary to prescribe drugs in order to reduce this function, in particular, antispasmodics. In practice, isoquinoline derivatives (Papaverine, No-shpa) are often used. These drugs have a number of side effects, and with severe intestinal hypermotility, they often turn out to be ineffective. M-cholinolytics (tincture of belladonna, Platifillin, Metacin) as antispasmodic drugs have been used in gastroenterology for a long time. The negative effect of the use of M-cholinolytics is the systemic nature of their action. Therefore, it is advisable to prescribe selective anticholinergics, one of the representatives of which is N-butylscopalamin, a blocker of M-cholinergic receptors. Interacting with cholinergic receptors in the walls of internal organs, it has an antispasmodic effect on the smooth muscles of the gastrointestinal tract, urinary and biliary tract, etc. The drug is prescribed in the form of a solution or tablets inside, as well as in the form of suppositories in an age dosage. For children under 6 years of age, the drug is prescribed more often in a solution of 1-2 teaspoons 2-3 times a day or in candles 1-3 times a day, and for schoolchildren - 1-2 tablets 1-3 times a day before meals. The duration of the drug is 7-10 days.
In recent years, effective drugs have appeared that purposefully act on intestinal spasm. These are pinaverine bromide, a calcium channel blocker, used in children over 12 years old at a dose of 50–100 mg (1–2 tablets) 3 times a day for 1–3 months, and mebeverine, a myotropic antispasmodic with direct action on smooth muscles. The latter is prescribed for older children at 100–200 mg (1 capsule) 2 times a day 20 minutes before meals for a period of 7–10 days, followed by a dose reduction. There is still little experience with the use of these drugs, but it is hoped that their clinical study will give them the opportunity to take their rightful place in the treatment of constipation in children.

The third group includes choleretic preparations of plant origin (Flamin, Hofitol, Gepabene, etc.), which have been used for many years as components of laxatives.
Bile acids are known to be natural detergents. Our observations have shown that in children with chronic constipation, in 100% of cases, cholestasis of varying severity is noted, which leads to the mandatory prescription of choleretic drugs.
The rhythmic flow of bile into the duodenum allows bile acids to:
participate in the hydrolysis of neutral fat and stimulation of pancreatic secretions, contributing to the processes of abdominal digestion;
due to the osmotic action of salts, increase the flow of fluid into the intestinal lumen and increase pressure in it, which activates the motor function of the intestine;
alkalize the contents of the proximal duodenum, ensuring the optimal effect of pancreatic enzymes;
direct bactericidal action in the lumen of the small intestine, preventing excessive bacterial growth and intestinal stasis, normalizing the processes of digestion and preventing.
The three groups of drugs listed above are basic in the treatment of constipation in children. With recent constipation, in order to achieve a positive effect, it is enough to change the nature of nutrition, the quality of food, increase the amount of fluid consumed and physical activity in order to obtain a stable positive effect against the background of short-term basic therapy. Children who have suffered from constipation for a long time need longer and more systematic treatment.

If the child does not have an independent stool against the background of basic therapy, cleansing (0.9% sodium chloride solution) or hypertonic (10% sodium chloride solution) enemas are prescribed for 5–7 days, followed by transfer to laxative suppositories, and as regular stools are obtained - for basic therapy.
3. In the complex treatment of constipation, a large place is given to the normalization of the intestinal microflora. The addition of biological preparations to therapy, primarily containing lactobacilli, allows you to get a faster and more lasting effect.
4. In the treatment of constipation, use agents that normalize the state of the central and autonomic nervous system, as well as herbal medicine. The choice of drug depends on the affective disorders identified in the patient (asthenic, depressive, hysterical, phobic syndromes). Optimal treatment results can be obtained if the child is observed together with a neuropsychiatrist, especially when it comes to IBS.
5. Drug therapy should be supplemented by physiotherapy, massage, physiotherapy exercises.

Folk laxatives for constipation

Herbs and preparations for the treatment of constipation Health portal www.site

Pour 3 g of lemon balm leaf with 1 cup of boiled water. Make an enema by injecting 30-40 ml of infusion. Apply for constipation.

Brew as tea 1 teaspoon of anise fruits in 1 cup of boiling water. Insist 20 minutes, strain. Drink 0.25 cup 3-4 times a day half an hour before meals for constipation.

Pour 1 tablespoon of crushed senna leaves with 1 glass of water, insist overnight, strain in the morning. Take 1 tablespoon 1-3 times daily as a laxative. Unlike other laxatives such as rhubarb, senna does not cause abdominal pain.

Pour 1 teaspoon of crushed dandelion roots into 1 cup of water. Boil 20 minutes. Drink 0.25 cup 3-4 times a day before meals for constipation.

Pour 1-2 tablespoons of large psyllium seeds with 1 glass of water, bring to a boil, boil for 10 minutes, strain the broth warm. Take 1 tablespoon once a day on an empty stomach for constipation.

Pour 2 tablespoons of horse sorrel root with 0.5 liters of boiling water and cook in a water bath for 30 minutes. In small doses, this remedy has an astringent effect, and in large doses it has a laxative effect, acting 10-12 hours after ingestion. For constipation, drink 1 glass at night. A lower dose will not work.

Pour 1 tablespoon of crushed buckthorn bark with 1 glass of water, simmer for 20 minutes, add water to the original volume. Drink 0.5 cups in the morning and at night for constipation.

Pour 5 g of crushed cumin fruits with 2 cups of boiling water, boil for 5 minutes, strain. Take 0.5 cup 3 times a day before meals for constipation.

An infusion of seeds (burdocks) of burdock is an ancient laxative. Take mature seeds (a lump of half a fist) and pour 1 cup of boiling water. Soar for 2 hours and drink at a time (the decoction after straining the burdocks will turn out to be about 0.5 cups) with constipation.

Pour 1 teaspoon of flaxseed with 1 cup of boiling water, insist, wrapped, 4-5 hours. Drink with constipation the entire infusion at a time, along with the seeds at night. You can add jam to taste.

As a mild laxative, an aqueous decoction of blueberry twigs along with leaves is used: pour 15 g of raw materials with 200 ml of water, boil for 10 minutes, leave for 1 hour, strain and take 1 tablespoon 4-6 times a day.

Take crushed fresh rosehip leaves mixed with sugar for constipation or drink the juice of rosehip flowers diluted with spring water.

Food should contain black bread, vegetables, sour milk.

A laxative effect has the use of well-cooked beets with vegetable oil.

Home remedies for constipation

With constipation, it is necessary to drink water every 30 minutes, 1 tablespoon in the interval between breakfast and lunch. After lunch, you can continue to drink water in the same way.

Take carrot seed powder 1 g 3 times a day 1 hour before meals for constipation.

Take 1 teaspoon 3-4 times a day before meals freshly prepared onion juice. The course of treatment for constipation is 3 weeks, then a 3-week break, after which the treatment is repeated.

Drink freshly prepared potato juice: 0.5 cup 2-3 times a day 30 minutes before meals. Treatment should be carried out within 2 weeks for constipation.

For constipation, you should eat 1 teaspoon of powdered peas daily - this regulates digestion.

With chronic constipation, you need to drink water 3-4 times a day, in which oats or plums have been boiled for a long time.

Drink radish juice, sauerkraut brine for constipation.

Drink tea from dried cherries or apples for constipation.

For constipation, eat a few plums in the morning on an empty stomach or several times a day.

Insist for 3 hours a mixture of 100 g of honey and 100 ml of aloe juice (only thick leaves are taken, thin ones have little healing properties). Take 1 teaspoon 3 times a day for chronic constipation, gastritis and excessive gas formation.

With a tendency to constipation, grind 150 g of aloe leaves, pour 300 g of heated natural honey, leave for 1 day, then heat, strain. Take 1 dessert spoon in the morning 1 hour before meals.

Ground wheat bran is useful for constipation and irritable bowel syndrome. Before adding bran to food, pour boiling water for 30 minutes, then drain the water. Put the resulting gruel in any dish, first 1 teaspoon, after 7-10 days - 2 teaspoons, after another 7-10 days - 1-2 tablespoons 2-3 times a day.

Children under 3 years of age laxatives are contraindicated!

Reminder for constipation in children

The treatment of constipation is a long, strenuous and not always rewarding task, only a purely medical approach to this problem does not solve most of the problems.

Colon dysfunction or constipation is a fairly common disease in childhood. In the medical literature in recent years it has received the name "Irritable Bowel Syndrome". Constipation occurs in children of all ages, but is especially common in younger students and children attending preschool institutions. In most cases, this disease does not always bring pain to the child, therefore, this pathology is clearly not given enough attention. Parents find out about this disease in a child quite late, especially if the child is shy and secretive.

The treatment of constipation is a long, strenuous and not always rewarding task, only a purely medical approach to this problem does not solve most of the problems. Children with chronic constipation become lethargic, irritable, shy, and their school performance declines rapidly. Many children, out of fear of painful sensations during the act of defecation, become isolated, independently suppress natural urges, thereby aggravating the course of the disease, a so-called "vicious circle" is formed.

Thus, chronic functional constipation in children attending preschool institutions and school acquire social significance; Therefore, pediatricians almost always rely on the help and support of parents in the rehabilitation of children. Only parental care and a friendly environment help to get lasting results.

Constipation is called abnormal work of the colon, which is manifested by rare bowel movements in a child (less than once every two days) or their complete absence for a long time (which is very common), difficult and painful defecation, a small amount of stool (dry and hard). ), the lack of a physiological feeling of complete emptying of the intestine.

The human large intestine is the site of the formation of feces, it has an approximately U-shaped shape. The length of the entire colon in a child older than 3 years is on average 1-1.5 meters. Fecal masses are formed from undigested and unused food residues. This happens through their partial dehydration and various types of peristaltic movements of the intestine, which form and promote fecal masses to the exit. A significant part of the feces is a huge amount of microbial bodies. According to microbiologists, 30 to 40 billion microorganisms are found in 1 gram of a healthy person's feces.

The causes of constipation are varied. We, pediatricians, believe that constipation is primarily associated with poor nutrition or the so-called alimentary factor. The cause of chronic constipation is a deficiency in the diet of coarse fiber plant fiber as one of the main stimulants of intestinal motility (vegetables, fruits, coarse breads, gray cereals, etc.), as well as eating high-calorie, refined foods. As a result of such nutrition, a small amount of dehydrated fecal masses is formed in the large intestine, their movement through the intestines is disturbed. It has been observed that the lack of water in the feces leads to a significant delay in the movement of feces through the intestines. This is especially evident in the winter-spring season, when the consumption of both fresh and prepared vegetables and fruits is noticeably reduced.

The state of the child's nervous system plays an important role in regulating the motor function of the large intestine. Various stressful situations, mental, emotional and physical overload, unfavorable family and school relationships between children and adults negatively affect the general condition of the child's nervous system, which in turn leads to disorders of the colon's motor function. The elimination of stressful situations, the normalization of the psychological situation in the family and at school, and in some cases the help of a psychoneurologist, have a beneficial effect on the treatment of the disease.

Long-term retention of the child's feces leads to the absorption of decay and fermentation products from the intestines into the blood, which has a negative effect on the entire body of the child (toxic effect). Children complain of headaches, increased fatigue, their appetite decreases, sleep is disturbed. Children become irritable, whiny and sometimes "uncontrollable". If there is no stool for several days, he may experience sharp pains in the abdomen, vomiting, fever.

Very often, dense fecal masses, accumulating for a long time in the final section of the colon, when trying to empty, stretch the anus. This may lead to the formation of cracks. Cracks are always accompanied by acute pain in the anus during and after emptying. The child is afraid of these painful sensations and tries to avoid attempts to empty the intestines, which leads to an even greater compaction of the feces.

In advanced cases, with a prolonged absence of stool, as a result of increasing intra-intestinal pressure, such an unpleasant condition as stool smearing, that is, spontaneous leakage of feces through the anus, may appear. The implications of this state of affairs are clear. The child becomes the object of jokes, and in some cases even more aggressive actions on the part of peers. The mental state of the patient is on the verge of collapse, the children refuse to go to kindergarten or school, the feeling of fear exceeds all reasonable limits.
Chronic constipation in a child can also occur when the child loses the habit of emptying the bowels at the same time (usually in the morning). Parents are often to blame here, who pay little attention to the life of their child, do not teach from early childhood to defecate at a certain time.
By the way, it has been noticed that some teachers in a kindergarten or school, for strange, sometimes indescribable reasons, do not allow young children to go to the toilet during classes. Such illiterate behavior of the teacher leads to the fact that children deliberately suppress the urge to defecate during school hours. This harmful reflex is easily fixed and causes chronic constipation.
A similar phenomenon is facilitated by the environment, unusual for a child, who first began attending a kindergarten or school: a public toilet with the presence of a large number of strangers of different ages. This is especially unfavorable for shy, shy children, especially boys brought up in the strictest puritanical principles.

What should parents do if their child has chronic constipation?

The main thing is not to self-medicate, but immediately seek advice from a specialist - a gastroenterologist. Children should definitely undergo the necessary examination.

The organization of rational nutrition is the basis of treatment. Parents in most cases consider nutritional recommendations of little value, demanding the appointment of the latest drugs that can eliminate constipation within a few days. It should be said right away: there are no such drugs! Since disorders of the motor function of the colon in the overwhelming majority of cases are associated with malnutrition in the family, the organization of the digestive ration is the main task of treatment.

The child's diet should be changed in such a way that it contains more vegetables containing coarse vegetable fiber and pectins, i.e. components that stimulate intestinal motility. These are fresh carrots, beets, cauliflower and Brussels sprouts, pumpkin, zucchini, squash, plums, gourds. There is not enough fiber in cucumbers, tomatoes, apples.

Vegetables and fruits should make up at least 50-60% of the daily diet and be consumed in any form (fresh or after heat treatment). During lunch, sick children should be offered vegetables in the form of salads, vinaigrettes, mashed potatoes, seasoning them with vegetable oil to improve their palatability. It is better not to use fatty varieties of mayonnaise and sour cream, as fats inhibit the work of the intestines. Sour cream can be added to vegetable or cereal soup.

Pediatricians attach particular importance to the systematic intake of wheat bran. This is a valuable natural remedy obtained by grinding grain and has a number of useful properties. This is a valuable natural remedy obtained by grinding grain and has a number of useful properties:
- bran is one of the powerful stimulants of intestinal peristalsis;
- they contain a significant amount of B vitamins, which have a beneficial effect on all organs and systems of the human body, and especially the central nervous system;
- bran contributes to the elimination of toxins, allergens from the body, their use is advisable in the complex treatment of numerous allergic diseases;
- bran removes excess cholesterol from the body and thereby helps to prevent atherosclerosis.
Wheat bran can be used in any form. More often than not, we recommend using wheat bran in this way.

The purchased product (usually sold at flour mills and pharmacies) spread in a thin layer (1-1.5 cm) on a metal tray and bake in an oven at a temperature of 100-150 C for 10-15 minutes. After cooling, transfer the bran to a hermetically sealed jar, as the product is hygroscopic. Three to five tablespoons of bran, i.e. the amount that is required per day, pour 1/2 cup of boiling water and soak for 15-20 minutes. In this case, a thickish light gray or light brown mass is formed.
The taste of bran is a completely tasteless product, and children in most cases strongly refuse to take it in its natural form. To improve the palatability, add a single dose of bran (usually starting with 1 teaspoon 3 times a day, gradually increasing to 3-10 tablespoons per day, depending on the degree of stool retention) add to 1/2 cup of fruit or vegetable juice, to a glass of fermented milk product, to porridge, soup, garnish. The duration of taking bran is not limited and can be calculated for years without any harm to the body.
Dairy products (curdled milk, fermented baked milk, varenets, one- or two-day kefir, etc.) should be included in the daily diet, it is better to use them in the morning on an empty stomach and at night. Fermented milk products can be enriched with bifidum flora.

The first courses in the diet are obligatory, soups are mainly vegetable or from gray cereals (buckwheat). Meat is best eaten cooked. Bread of gray and black varieties, with bran, yesterday's baking. Fresh buns and cakes are contraindicated for constipation.
In the presence of constipation, it is necessary to exclude products that increase gas formation in the intestines: whole milk, sweet dishes, legumes.

For the normal functioning of all muscles and intestinal, in particular, it is necessary to consume foods containing potassium. These are baked potatoes, dried fruits, dried apricots, prunes, figs, compote from them. Parents can do the following: pour 10-20 prunes or dried apricots (or all together) the night before with boiling water, divide the portion into 3 parts in the morning and give the child to school, where he will eat these berries with pleasure. And in the evening at home, the child will drink the resulting infusion from the berries.
As a dessert, we recommend giving children with chronic constipation a mixture of well-washed, steamed with boiling water and well-dispersed dried fruits:
prunes - 1 weight part,
figs - 1 weight part,
dried apricots - 1 weight part,
walnuts (core) - 1 part by weight.

The products are mixed in equal amounts, cut finely with a stainless steel knife, 1-1.5 weight parts of honey are added, the whole mixture is mixed again, laid out in a jar and sterilized at 80 C for 15 minutes. The dose is usually 1-2 teaspoons. l. 3 times a day after meals. It should be remembered that such a mixture can cause allergic reactions in children with a predisposition to such reactions.
It is important that during the day the child consumes more liquid: at least 4-5 glasses a day in the form of tea, compotes, broth, juices, water, etc., as well as taking cool drinks in the morning on an empty stomach (100-200 ml) . Carbonated drinks are excluded.

Daily regimen for constipation

Despite the significant role of diet, it may not work if the child has not developed the habit of emptying the intestines at a certain time, preferably in the morning (6-9 hours). This habit should be developed and reinforced. To do this, immediately after getting up in the morning, the child on an empty stomach drinks 0.5-1 glass of cold water or vegetable juice.

If there is an urge to stool, then the patient empties the intestines as much as possible. If there is no urge to defecate, you should first resort to physical exercises, breakfast and after a while go to the toilet. A squatting position is taken, with legs tucked to the stomach. The act of defecation is helped by self-massage of the abdomen with hands, rhythmic retraction of the anus, pressure between the coccyx and anus. The appropriate conditions must be created for the child. If the child is small, then it is better to plant him not on the toilet, but on the pot (previously washed clean and warmed slightly above body temperature). Restoration of the act of defecation is a long task, and it must be solved by parents and adults in direct contact with the child, persistently, without emotional outbursts.

Physical activity for constipation in a child

With chronic constipation, daily dosed physical activity is necessary - walking, morning exercises, outdoor games, skiing, skating, swimming. During classes at school, in the classroom, physical education breaks should certainly be carried out. Most of the exercises should be aimed at stimulating the muscles of the anterior abdominal wall. We offer a set of special exercises.

1. Free ventilation of the room. Walking in place 30 sec
2. I. p. (starting position): sitting on a chair, hands to shoulders. Raise your arms up, tilt your body back - inhale. Hands to the shoulders, torso slightly tilt forward - exhale 2 - 8 times
3. I. p.: sitting on a chair. Raising the arms to the sides - inhale. Raise the right leg, bent at the knee, press it to the stomach - exhale. Also with the left leg 2 - 8 times
4. I. p.: sitting on a chair. Alternately pulling up and moving to the side of the straight leg 2 - 8 times
5. I. p.: standing. Deep breathing 2-4 times
6. I. p .: sitting on a chair, emphasis with hands behind, legs bent. Breeding legs to the sides 4 - 8 times
7. I. p .: standing, arms to the sides. Leading the leg forward, to the side, back, alternately with the right, then with the left 2 - 8 times
8. I. p .: standing, hands on the belt. Half squat with arms laid back 2 - 6 times

For young children, physical exercise should be carried out in the form of a game. For example, we recommend this exercise. Scatter 20-30 pieces of small toys on the floor and ask the child to collect all the toys, bending down for each of the standing positions. This "exercise" should be repeated during the day 2-3 times.

In addition to the procedures described, the doctor will prescribe some medicines to the child. They should be taken strictly in the amount recommended by the specialist. Do not self-medicate or use laxatives without a doctor's prescription. Only the correct and consistent implementation of our recommendations will help children get rid of chronic diseases. And the children will delight you with cheerful laughter, excellent success at school, excellent appetite and excellent health.

Chronic constipation in children

The progress achieved by modern society has led to the fact that nature, oppressed in many areas, began to "avenge" humanity for its lost positions, which manifested itself in an increase in the prevalence of the so-called "diseases of civilization". Undoubtedly, chronic constipation belongs to this group of diseases, the cause of which can be a lot of factors, both endogenous and exogenous.

Long-term constipation was defined as prolonged retention of contents in the intestine for more than 32 hours or delayed bowel emptying from hardened stools. However, observations have shown that the frequency of bowel movements cannot serve as a criterion for diagnosing constipation, especially in children. So for a healthy child of the first year of life, the frequency of stools is from 2 to 7-8 times a day, and from the age of 2, the frequency varies from 3 times a day to 1 time in 2 days. This indicates the need for some other criteria, and such criteria were developed in 1992 by the International Research Group.
According to the recommendations of this group, the diagnosis of "constipation" can be made if:
- defecation requires tension;
- hard or lumpy stools;
- there is a feeling of incomplete emptying of the intestine after the act of defecation
- the act of defecation takes place 2 or less than twice a week.

According to a number of pediatricians for children, the last criterion requires correction, and the criterion for constipation should be the frequency of stools less than 3-4 times a week for children older than 1 year and less than 6 times a week for children of the first year of life.

At the same time, one can speak of chronic constipation if the above criteria occur for at least a 3-month period without the use of laxatives. With daily stools, but the presence of the above symptoms, chronic constipation can be called "hidden". A special group is the so-called functional constipation, and their variant is situational constipation, most often having a psychogenic or alimentary factor.
Constipation is not a disease, but only a symptom of a disease. And the task of the doctor in the first place is to identify the cause of this symptom.

There is no generally accepted classification of constipation. Constipation is conditionally divided into:
- primary,
- secondary,
- idiopathic.

The cause of primary constipation is the presence of congenital anomalies in the development of the colon (megarectum, megadolichosigma, dolichocolon, Hirschsprung's disease, anorectal stenosis) or acquired structural disorders (intestinal polyps or tumors, adhesive disease, etc.).

The most common causes of secondary constipation in infants are: genetic predisposition, pathological course of pregnancy and childbirth, early and / or rapid transition to artificial feeding, improper daily regimen and nutrition of the mother, non-compliance with the drinking regimen, the presence of constipation in the mother herself, protein intolerance cow's milk, iron deficiency, prematurity, hypothyroidism, as well as diseases accompanied by muscular hypotension (rickets, dysembryogenesis, etc.).
The formation of constipation in children of the first year of life is greatly influenced by all kinds of feeding disorders (underfeeding, improper introduction of complementary foods, monotonous nutrition, eating disorders, frequent change of formula, feeding with milk formulas with a high iron content, etc.).

Secondary constipation in children older than a year is more often formed against the background of alimentary, neurogenic, endocrine, psychogenic, metabolic and other causes.

It should be noted the frequent presence of cholestasis in a child with constipation, so according to various authors, 70-80% of children have certain violations of the function of bile secretion.

At an early age, neuroreflex connections are immature, the formation of the mechanism of the act of defecation occurs gradually under the influence of environmental factors and the individual characteristics of the child's body. In addition, by the time of birth, the intramural nervous system of the large intestine is also immature. "Maturation" occurs gradually during the first months of life, and complete formation ends at 2-3 years of age. The immaturity of regulatory mechanisms determines the exceptional vulnerability of the vital function of bowel movement under the influence of various adverse factors (toxins, drugs, stress, violation of microbiocenosis, and even more so infection), a violation of the reflex relationship of the rectum with its sphincter apparatus can easily occur.
The period of the most frequent manifestation of constipation is 7-10 years of age. This is due to a gradual increase in the symptoms of constipation that occurred in the first year of life, the development of secondary changes in the distal colon and the addition of new risk factors for the development of diseases of the digestive system at the age of 6-7 years (the moment of entering school) (changes in the regimen and nature of nutrition , psycho-emotional overload).

In 1994, a working classification of constipation in children was proposed:
1. Downstream: Acute, chronic.
2. By etiology: Alimentary, hypodynamic, organic: (congenital anomalies of the colon and rectum; acquired anorectal), metabolic, toxic, secondary or symptomatic in diseases: (endocrine; digestive organs; urinary system; gynecological sphere; infectious; accompanied by muscular hypotension chronic hypoxia).
3. By topography: Cologenic, proctogenic, mixed.
4. By the nature of movement disorders: Hypomotor, hypermotor, mixed.
5. By stage: Compensated, subcompensated, decompensated.

The clinical picture of constipation is varied. In some cases, the child does not make any complaints. In the presence of pain, their localization can be both throughout the abdomen, and with predominant localization in the right or more often in the left half of the abdomen. In addition, there are swelling, a feeling of pressure, fullness, disappearing after defecation or gas discharge. Of the dyspeptic disorders, a decrease in appetite, belching, an unpleasant taste in the mouth, rumbling in the abdomen, and persistent flatulence are more often noted. When characterizing the stool, it should be noted that its consistency can be different: from normal, shaped to hard dry balls and lumps ("sheep" feces); in some patients, only the initial part of the feces is compacted, and the final part is a mushy mass. With a pronounced inflammatory process in the intestines with hypersecretion of mucus, "constipation diarrhea" is noted, which is caused by impregnation and liquefaction of feces with mucus. The clinical picture is largely determined by the topography of the lesion. In some cases, reflex pains in the sacrum, buttocks, hips, and heart area join, palpitations, shortness of breath, headache, which disappear after defecation, may develop.

With prolonged constipation, there are signs of fecal intoxication associated with the accumulation of metabolic products (cresol, indole, skatol), which are absorbed from the intestine and cause weakness, nausea, subfebrile temperature, and a decrease in the rate of physical and mental development. It can also be noted: increased autonomic dysfunctions, development of depressive conditions, aggravation of dysbiotic disorders, development of cholelithiasis, hepatosis, hypovitaminosis, immune dysfunctions, persistence of allergic diseases and pustular skin lesions. Anal fissures, proctitis, proctosigmoiditis, secondary dolichosigma and megadolichosigma can join, prerequisites are created for the development and persistence of fecal incontinence - encopresis.

It is especially important to timely detect constipation, determine and correct the causes of its development. Without this, it is impossible to choose the right tactics for examining patients and prescribing adequate therapy.

First of all, a thorough history taking by the district pediatrician is necessary to identify children at risk for the development of constipation (children of parents with constipation, intestinal dysfunction and intestinal infections in history, dysbiosis in the first year of life, malnutrition). Of the laboratory methods, a coprological study should be performed, a stool test for helminth eggs and dysbacteriosis, a general and biochemical blood test should be performed.

According to indications, instrumental research methods are carried out - sigmoidoscopy, irrigoscopy (graphy), colonoscopy, if possible, with targeted biopsy, manometry, sphincterometry, balloonography, myography and others.

In recent years, ultrasound examination with filling of the intestine to assess its function has become widespread. This method allowed us to develop a classification of functional disorders of the distal colon depending on the echographic picture and criteria for anomalies in the development of the distal intestine, which in turn allows a more differentiated approach to the appointment of radiological methods and reduce radiation exposure. The accuracy and sensitivity of ultrasound diagnostics reach 90%.

Treatment of chronic constipation should be comprehensive and include, first of all, the treatment of conditions that caused stool retention. The following areas of therapy are distinguished:
1. Alimentary correction. It includes the selection of special milk formulas (Bifidus, Samper Baby-1 and Baby-2, Frisovoy) or one-day fermented milk products for children of the first year of life, the inclusion of foods containing vegetable fiber in the diet.
2. Pharmacotherapy of motor function disorders. Includes the appointment of prokinetics, antispasmodics, choleretic and laxatives.
3. Appointment of drugs with anthelmintic action and drugs for the correction of dysbiotic disorders (probiotics, prebiotics).
4. Correction of metabolic disorders (vitamin therapy, calcium and magnesium preparations, lemontar, etc.).
5. Phytotherapy.
6. Physiotherapeutic procedures and physiotherapy exercises, massage.

With prolonged stool retention, laxatives are most often used, which differ from each other in the mechanism of action.

However, most laxatives are more or less addictive, with side effects such as allergic reactions, drug-induced diarrhea with metabolic disorders, colonic melanosis, and sometimes intestinal obstruction, which limits their use in children.
In the emergency treatment of constipation and in preparation for diagnostic studies, as a rule, water cleansing or hypertonic enemas are used. The introduction of large volumes of water into the intestines, which are necessary to obtain the effect and adequate preparation for research, is accompanied by discomfort, and in the case of hypertonic enemas and pain, and in some cases it is contraindicated. In addition, there is a high risk of developing water intoxication due to the absorption of water containing fecal components, the occurrence of edema and even convulsions. It has also been established that enema waters wash out not only feces, but also bacterial flora, which can lead to aggravation of dysbiotic disorders of the intestine, colonization of the distal intestines by pathogenic microorganisms. Enema waters can cause inflammation of the intestinal mucosa.

For many parents, there is no worse disease than constipation in a child. This violation gives the baby suffering and pain, about which he constantly complains to his parents with the help of screams and crying.

What should young parents do in this case? How to prevent the problem?

In pediatric practice, constipation in children is common. Not having a stool for several days, and not using the potty, is a concern for many parents. Constipation is the slow movement of feces through the intestines.

This problem can occur in both infants and preschoolers, and is also the most common gastrointestinal disease. Many parents do not attach importance to this and do not go to doctors, which harms the health of the child.

The main provocateur

Frequent constipation in a child is not uncommon, the main cause of the violation is considered to be malnutrition. Eating adult food leads to a kind of "blockage" of the intestine.

Parents should think about unacceptable foods in the diet of children, which include salty, smoked, sweet, fatty, sour. It also provokes constipation and the lack of food rich in fiber in the child's diet.

Features of the problem depending on age

The causes of constipation in children depend on the age of the small patient. There are indicators of normal stool frequency in children:

If bowel movements are difficult and the child is pushing hard, there are frequent complaints of abdominal pain, the stool has become small and dry, then the child has constipation. This is an occasion to consult a specialist, otherwise constipation will turn into a chronic form and will be difficult to treat.

Symptoms of the violation

Constipation in children is:

1. organic(5%) occur in a child from birth and are the result of an anatomical defect in the segments of the intestine. The underdevelopment of the nerve endings of the intestinal walls leads to the fact that its lower sections narrow and the upper ones expand. This slows down the movement of feces. This pathology is rare. More often there is an elongation of one of the sections of the colon, which begins to move uncontrollably and strongly, disrupting the progress of feces to the exit. This disease occurs in children 3-4 years of age. Symptoms of organic constipation in infants are a decrease in the number of bowel movements and their short duration. The child has seething, bloating and pain in the abdomen due to the accumulation of feces in the intestines, when the obstruction described above prevents its exit.
2. Functional constipation (95%) in children is very common and depends on many factors. On breastfeeding, the quality of the stool depends on the nutrition of the mother and the composition of the baby's complementary foods, an important role is played by the lack of water intake. On artificial feeding - from frequent changes in the mixture, diet, lack of fluid. An excess of proteins and fats in the baby's diet disrupts the regularity of the stool. Constipation occurs if the child has such diseases: iron deficiency anemia, rickets, CNS damage during childbirth, intestinal dysbiosis, food allergies. Frequent use of drugs that stimulate digestion leads to disruption of the intestines and constipation. Symptoms of functional constipation are: hard, bean-like stools, straining during bowel movements, taking up a quarter of the time of a bowel movement, in one case in four there is a feeling of not emptying the intestines, a feeling of obstruction of feces during bowel movements, and stools less than 2-3 times a week.

Children between the ages of 2 and 6 are often embarrassed to go to the toilet and deliberately hold back their bowel movements.

Moving, getting used to the garden or divorce of parents, as well as potty training is a psychological obstacle to bowel movements. Parental support is important here: it is necessary to talk to the child in time and explain how to go to the toilet correctly.

The opinion of Dr. Komarovsky on the causes and treatment of constipation in children:

First aid

What can parents do before a doctor's examination to alleviate the suffering of a child who has constipation? In this case, it is necessary to clean the intestines of your child with an enema. For this, boiled water at room temperature is used, to which 1-2 teaspoons of glycerin can be added to enhance the laxative effect.

To help soften the feces, the use of vaseline oil, which is not absorbed by the intestines, can help.

It is important to observe the dosage of water for enemas and the amount of vaseline oil (it increases with the age of the child).

An enema is an emergency remedy for constipation, so it is not recommended to use it constantly, because the intestines should not get used to such a bowel movement. In such cases, it is better to use a candle with glycerin.

An effective way to help a child is a tummy massage. To do this, it is necessary to massage the baby's tummy in a clockwise circular motion starting from the navel and gradually increasing the circle of rotation.

It is enough to massage for two minutes, but several times a day.

Follow-up therapy

When a child is constipated, parents should not ignore visiting a doctor. The pediatrician should prescribe blood, urine, feces tests for helminths, a coprogram, and, based on their results, refer them to the right specialist: an endocrinologist, surgeon, gastroenterologist, neurologist and other specialists.

Treatment involves achieving regular bowel movements every day or every other day, at about the same time. The stool should become soft, and defecation should be quick and painless.

Treatment for each baby is individual and long-term. So the psychological problem can be eliminated within two years.

Nutrition Features

The first step in treatment is the appointment of a laxative diet. Changing the diet is punitive in nature, so for the effectiveness of treatment it is recommended to change the eating habits of all family members.

In such cases it is necessary:

It is important to observe the diet and bowel movements - they must always take place at a certain time. Then the body will be ready for defecation physiologically and psychologically - it is best to do this in the morning.

The child should move a lot, play outdoor games, walk, ride a bike, skate. You can do therapeutic exercises, in a playful way, offer various exercises aimed at improving intestinal motility.

Medical treatment

In some cases, the doctor prescribes the use of laxatives. Treatment with such drugs should be no more than 2 weeks, otherwise addiction may occur or side effects may occur in the form of allergies or diarrhea.

Up to 3 years of age, drugs based on lactulose (Duphalac) are recommended. It has no side effects and is safe for little children.

Prokinetics help to improve the functioning of the stomach and intestines, promote the promotion of feces. One of these drugs is Domperidone, which eliminates pain and gases, normalizes bowel movements.

Herbal choleretic preparations are also shown to children to improve the functioning of the pancreas and gallbladder. To improve the intestinal microflora, Bifidumbacterin, Linex and others are recommended.

ethnoscience

Of the popular recipes, the most suitable for children are eating wheat bran and seaweed. They must be washed down with plenty of water after consumption. They swell with water in the intestines and thin the feces, which contributes to rapid emptying.

Effective and tincture of senna leaves - 1 tbsp. a spoon in a glass of water - it is capable of relaxing without the appearance of spasms. The child should be given an infusion of one spoon 3 times a day.

For babies with constipation, it is better to give vegetable oil a few drops before feeding, and also drink dill water.

It's better not to know than to treat

The best prevention of childhood constipation is drinking enough fluids, eating foods rich in fiber, maintaining an active lifestyle, constant walks.

Parents should promptly identify and treat diseases of the gastrointestinal tract, endocrine and cardiovascular systems that cause the disorder.

Is it dangerous?

The consequences of untreated constipation in crumbs can be unpleasant and even dangerous. Constipation can lead to dysbacteriosis, intoxication of the body, which is manifested by lethargy, pale skin, and headache.

Once in the blood, toxic substances cause pustular diseases, peeling of the skin and yellowness. Frequent constipation can lead to a weakened immune system.

Constipation in babies responds well to treatment if the therapy is competent and timely. To treat the disorder, there are enough effective and safe methods, means and preparations.

It is important to follow all the doctor's prescriptions, according to which you can achieve daily stool in a child without pain and discomfort.

The frequency of stool, as well as urination, is one of the signs of the normal functioning of the body of both the child and the adult. And if adults sometimes do not pay attention to themselves, then the baby's stool and its quality are vigilantly monitored by the parents. Anything causes mom anxiety. And the delay in the process is sometimes even more disturbing than diarrhea.

Constipation occurs due to the slow transport of feces in the intestines. How to deal with constipation in babies? When can the situation be resolved by home methods? And when is going to the doctor a prerequisite for maintaining the health of a child?

Young children may have frequent bowel movements.

The quantity and quality of feces depends on the age of the baby. And sometimes what seems like an adult or diarrhea can turn out to be a personal physiological norm for a toddler. Normal frequency of bowel movements in babies of different ages:

1. The first six months of life before the introduction of complementary foods - 1-2 times a day. The stool is unformed, soft, mushy.
2. After 6 months to a year, subject to the introduction of complementary foods - 1-2 times a day. Feces are formed, dense, but soft. Already resemble the feces of adults.
3. From 1 to 3 years - the frequency of defecation at least 6 times a week. Fecal masses are soft, formed. The process itself takes place without a pronounced.
4. From 3 years and older - at least 3 trips to the toilet for the most part per week.

If, with such a frequency of bowel movements, the baby develops normally and enjoys life, then you should not worry about his bowel movements.

When rare bowel movements are a pathology

If you suspect that constipation is a consequence of pathological processes, you should observe the general condition of the baby. Signs of pathology:

• incomprehensible anxiety and tearfulness of babies;
• the process of defecation proceeds with difficulty, with straining, pain;
• the consistency of feces is excessively dense, dry.

If this symptomatology lasts more than 3 months, then we can talk about the chronic course of the disease. In addition, a vicious circle often forms - the child begins to be afraid of the defecation process and restrains the urge to. Thus, provoking overstretching of the rectum and new constipation.

Psychological aspects

In children under one year, defecation occurs uncontrollably.

After a year of life, babies begin to control the process of defecation. For some, this happens earlier, for others later, but gradually the functions of controlling the anal sphincter pass into the conscious plane.

With a confluence of adverse factors, the baby begins to restrain the urge. This may be a new environment, potty training, solving the problems of delaying defecation with the help, a period of adaptation in kindergarten, any psychological attitudes introduced by adults.

Regular suppression of urges leads to the fact that the feces become more dense and hard. And even sitting on his favorite potty at home, the baby begins to feel soreness when trying to go big. As a result, the child begins to be afraid to defecate even in the usual comfortable conditions.

A vicious circle is formed, which is difficult to break even for experienced pediatricians. Over time, without proper treatment, there is already an imbalance of cause-and-effect relationships in the central nervous system. The process takes a chronic course.

Non-compliance with the drinking regimen can cause functional constipation.

This type of constipation is organic in nature. Its causes may depend on the behavior of the child and his environment, but also be a sign of serious pathological processes in the baby's body. Why functional constipation develops:

• Poor nutrition for a long period. This may be vegetarianism, an excess of meat products in the diet with a lack of vegetable fiber.
• Non-compliance with the drinking regime.
• Sedentary lifestyle.
• Babies must move. Pediatricians recommend walking in any weather for several hours. Older children should attend sports sections, dances. Sitting at a computer or in front of a TV with cartoons has a bad effect on intestinal motility and constipation develops.
• Dysbacteriosis caused by illness or the use of aggressive drugs, an unbalanced diet.
• The shape of an organism on a product. In this case, damage to the intestinal villi occurs, the processes of assimilation of food are disrupted.
• Insufficient production of enzymes due to pathology or immaturity of the gastrointestinal tract.
• Rickets is a pathology accompanied by a decrease in the activity of the intestinal muscles. The result is constipation.
• Thyroid dysfunction.
• Violation of causal relationships in the brain due to the impact of various psychological factors - psychological constipation.
• The effect of certain drugs taken on an ongoing basis.
• Abuse of medications.
• Irrational use of laxatives, enemas. This leads to an imbalance of cause-and-effect relationships in the brain.

According to medical statistics, parents are most often to blame for constipation in a baby.

When to seek immediate medical attention:

1. sharp pains in the abdomen;
2. bleeding from;
3. the appearance of liquid uncontrolled feces with persistent constipation.

Medical tactics

Bacterial starter cultures are useful for constipation.

Hoping that the problem will be solved on its own is not worth it. Chronic constipation in a baby leads to developmental delay due to lack of nutrients, intoxication with decay products, and development.

Where to start treatment? Initially, the child's diet should be reviewed. Introduce fiber-rich foods - raw vegetables and fruits, limit fatty meat products. It copes well with constipation of the drain in any form - raw, compotes, prunes. Observe the drinking regime.

Be sure to include fermented milk products in the diet - kefirs, fermented baked milk. It is advisable to make homemade drinks using bacterial starters. Physical activity shown. Walk more with your child.

To overcome the psychological discomfort of the baby on trips, on vacation, take your favorite familiar potty from home. This will make the child feel at ease.