What it is?
Constipation is a difficult or systematically insufficient emptying of the intestine. Each child born has its own individual characteristics that parents need to take into account in order not to panic and not to resort to various means of stimulating the act of defecation. Parents should remember: in infants who are breastfed, normal absence of stool for up to 3 days is considered normal, for children on artificial feeding - up to 2 days - in the event that the behavior and condition of the child is not violated. Such a child behaves as usual: he has a normal appetite, he is active, he has gases, there is no temperature or any other signs of illness. Mom of such a child should not cling to an enema or use other methods to achieve the inevitable evacuation of the intestine every day. However, any violation of the general condition of the baby, when, together with a delay in the stool, vomiting, lethargy, drowsiness, absence or decrease in appetite, temperature, and delay in the escape of gases, require immediate medical attention and assistance.
Norm and pathology
A feature of infancy is that the nature of the stool and the number of acts of defecation are determined by the nature of the feeding. With artificial feeding of baby calf from light yellow to light brown, its consistency is thicker, the smell can be unpleasant. The number of feces up to half a year 2-4 times a day, after 6 months - 1-2 times a day. It should be noted that artificial feeding is a risk in terms of constipation in the baby. According to a number of physiologists, this is due to the fact that the transfer of the baby to feed with milk formula leads to premature ripening of the secretory apparatus of the gastrointestinal tract, and then to the depletion of its ability to digest and assimilate food, which, in turn, predisposes to constipation. If the mother feeds the baby with her milk, the baby's feces have a golden yellow color, a kind of liquid sour cream and an acidic smell. The number of feces in children, as a rule (but not always), is up to 5-7 times a day in the first half of the year, after half a year - up to 2-3 times. But it should not be forgotten that constipation is not uncommon in infancy: according to pediatricians, they suffer from 10 to 25% of children. When should parents be alerted and assume that the baby really has problems with the stool?
Indirect signs of constipation in infants is not so much a rare emptying of the intestine, but primarily a change in behavior associated with the passage of stool: increased anxiety before and during defecation, severe straining, strong crying. The nature of the chair also has significance: in children up to 6 months, a dense, decorated stool should be considered a sign of constipation, sometimes blood streaks can occur in such a stool. Along with this for the chronic constipation is characterized by the development of other manifestations in the form of anemia (reducing the number of red blood cells and hemoglobin in the blood), reduced weight gain, allergic skin and mucous membrane damage, dry skin and mucous membranes. Risk factors in the occurrence of constipation are artificial feeding, prematurity, CNS (central nervous system) damage and dysbacteriosis (a condition in which the normal composition of bacteria that colonize the intestine changes).
Types of constipation
Doctors distinguish between acute and chronic constipation. An acute constipation is the absence of defecation for several days. It develops when the colon is obstructed due to various causes (in infants most often it is an intussusception - the implantation of one part of the intestine into another, which causes blockage of the intestinal lumen and a violation of the circulation of the intestine itself). The causes of intussusception are intrauterine anomalies in the development of the intestine in the child, overfeeding the baby, early introduction of complementary foods (due to the immaturity of the enzymatic system that breaks down the food), intestinal infections. This condition develops more often in children from 3 months to 1 year, they often suffer from plump children. Such a child among full well-being suddenly becomes suddenly restless, cries, refuses to eat. The bout of anxiety ends as suddenly as it begins, but after a short time (3-5 minutes) it repeats again. There is a one- or two-time vomiting with an admixture of bile green, feces can be isolated once or twice with an admixture of blood. Later, the chair stops, and bright bloody discharge is released from the rectum (they occur more often after 5-6 hours after the onset of the first bouts of pain).
In this case, the baby's belly is soft. The temperature is usually normal. The child can lose consciousness. Naturally, when such symptoms occur, parents will be concerned not so much with the presence of a chair, as with severe attacks of pain, vomiting and spotting in a child, and they will not slow to cause an "ambulance". Chronic constipation develops gradually. Such a diagnosis is made when it is observed in a child more than 3 months. It should be remembered that constipation in itself is not a disease. In most cases, this is just a manifestation of any condition or illness in the child, so it is necessary to treat not the constipation itself, but its cause. And this will require effort and attention, both from the physician and from the parents.
Causes of constipation
Constipation in infants may be caused by the following reasons:
• Alimentary - improper diet, insufficient amount of food or water in the baby's diet, as well as constant overheating of the baby. Such causes lead to a decrease in the volume of fecal masses in the intestine, loss of water (and the composition of the stool includes water), and to disruption of the composition of the intestinal microflora. In children of the first year of life who are on mixed or artificial feeding, similar constipation occurs much more often than in children receiving only breast milk.
• Bowel anomalies. For newborns, Hirschsprung's disease is especially relevant. At the heart of this disease is a violation of innervation of the colon, its peristalsis (motor function of the intestine) is broken, the colon becomes "off" from work. As a result, intestinal contents accumulate in the overlying parts of the intestine, which, in neglected cases, causes an expansion of the intestine. If a child suffers only a short part of the intestine, the constipation is formed gradually and may not require surgical intervention for a long time. If the longer section of the large intestine is affected, the absence of a chair is accompanied by a severe condition of the child and immediate surgical intervention is required.
Infectious diseases. The intestinal infections transferred in the first months of life can cause the death of nerve cells in the large intestine, which, in turn, leads to a violation of the motor (motor) function of the intestine. And this is the reason for the delay in the act of defecation, the accumulation of stool in the intestines and the development of constipation.
• Various inflammatory processes in the intestine or vascular disease (vasculitis). Such constipation also develops due to the damage to the nerve plexuses and sensitive cells in the intestinal wall.
• CNS lesion. Constipation often occurs in children with infantile cerebral palsy syndrome, as well as in children whose birth was associated with various complications in childbirth. In addition to constipation, such children may have various violations of the act of swallowing, regurgitation, vomiting.
• Endocrine disorders (hypothyroidism - deficiency of thyroid function, diabetes mellitus, etc.). With such diseases, constipation is not uncommon. For example, hypothyroidism slows the progress of the content through the intestines. With dysfunction of the parathyroid glands, constipation occurs due to a violation of the mineral metabolism. Constipation in diabetes mellitus can be a consequence of damage to the intestinal nerve plexus or dehydration of the child's body.
• Some medications. Before giving the child any drug prescribed by a doctor, carefully read the instructions. For example, iron preparations that are prescribed for anemia can cause constipation. Strict adherence to the rules of taking the drug will help to avoid it. Drug constipation is a consequence of taking other drugs, among which the most important are nonsteroidal anti-inflammatory drugs, neuroleptics, sorbents. Particular attention deserves constipation, which develops due to uncontrolled and / or prolonged use of antibiotics. In this case, stool retention is a consequence of intestinal dysbiosis. Thus, there are many reasons that can cause stool disorders in the baby. Therefore, only dealing with the treatment of constipation, you can skip the cause that caused it. That is why the occurrence of constipation in the child is an indication for a doctor.
How to help the baby?
If the child is pushing, blushing, crying, when you touch his stomach, it's a request for help. What can help a child with constipation? Offer the child bottled water (unboiled, still). It is convenient to give the baby from a normal sterile syringe (without needles), you can give him water from a teaspoon. Even a small amount of liquid that enters the intestine will help to soften the stool, and stimulate the output of stool.
Tummy massage
Massage begins to do immediately after drinking. Wash and rub your hands to make them warm. In the fight against constipation, stomach massage should be done regularly: immediately after awakening, and then several times during the day before feeding or not earlier than an hour after feeding. Massage is performed in the position of the baby lying on the back. Any movements are made without strong pressure. Each exercise is performed within 1-2 minutes, in children after six months, the time of massage can be extended. During the massage, talk to the baby, smile to him. Watch the baby's condition: massage should not cause discomfort or pain.
• With the palm of your right hand, make a circular motion clockwise. We start from the navel and gradually expand the circle from the right lower corner upwards and the right hypochondrium, we pass across the abdomen to the left hypochondrium and fall down to the lower left corner. We try the least to press on the right hypochondrium (where the liver is located) and the left hypochondrium (the location of the spleen). Grabbing the waist of the child with his hands on both sides, we move them towards each other through the side surfaces of the abdomen, converging our hands over the navel. We make the stroking 1-2 minutes.
• Right palm begins to stroke the area from the navel to the pubis. We mass down 1-2 minutes.
• Massage the sigmoid colon (the lower part of the colon, passing into the rectum). Mentally divide the child's belly into four squares. The lower left square is the location of the sigmoid colon, which diagonally crosses this square from top to bottom. The sigmoid colon, especially when it is in a filled state, is easy to feel in the form of a roller. With two fingers lightly press on the area of the sigmoid colon. Massage in circular movements, without moving your fingers, 2 minutes. Already after 1-2 minutes of massage usually there is a desire for defecation. Gymnastics. In the supine position, alternately bend and unbend the legs of the child, pressing them to the stomach, 6-8 times. You can diversify the gym, imitating cycling. Then press both legs to the baby's belly, holding for a few seconds. Straighten the legs. Exercise is repeated up to 8 times. To carry out the exercises a large gymnastic ball with horns is useful. Putting the baby tummy on the ball and letting him grab for the horns, roll it on the ball for 1-2 minutes. Accompany exercises with conversation and songs: the kid should receive from them pleasure. Massage of the abdomen and gymnastics often help the child to empty the intestines and make the passage of gases less painful.
Bath
If the massage does not help, the baby can be immersed in warm water, then remove it from the bath and wrap it. After that, we spread the child to ourselves on the naked abdomen with a bare tummy or we hold it over the basin or diaper, pressing the baby's legs to the tummy. It should be remembered that the most disadvantageous position for a baby suffering from colic or constipation is the position on the back, since in the prone position the self-massage of the baby's bowels occurs and thus the progress of gases and intestinal contents improves.
Introduction of a candle
If this does not help and the baby continues to cry, he can put a candle with glycerin into the rectum. Use candles regularly, as a cure for constipation, is not worth it: this is an ambulance. Candles are inserted in the position of the baby lying on the back, with legs bent to the stomach.
Using a gas outlet tube
To alleviate the condition of the baby, who suffers from bloating and gas, one can use a gas pipe. Enter it in the rectum should be no more than 3 cm in length (in the pharmacy you can buy a rectal catheter, the injected part of which does not exceed 2.5 cm). The catheter or vent tube is inserted into the position of the baby lying on its back or on its side with legs bent to the abdomen. The tip of the inserted catheter or tube should be abundantly lubricated with baby cream or petroleum jelly. As for the enema, it is not so harmless for the baby event, as it is commonly believed. Concerning the expediency and the method of its application, it is necessary to consult a pediatrician. If the above measures do not help, you should consult a pediatrician who can prescribe medicines to your child. The drug of choice in the treatment of constipation is lactulose syrup (eg Dufalac), which you will be recommended by a doctor. Remember that any medications are good only if they affect the cause of constipation. With bloating and intestinal colic, the baby is additionally given an espumizan, a simplex sapex, a planktex before each feeding. Remember that constipation in the baby is not a disease. It only serves as a signal that something is wrong in the body. And the doctor must search for the cause, and also fight with symptoms (in this case in the form of constipation). Now we know what to do if the child has constipation.