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Preventive measures against regurgitation in children

08.03.2017

Regurgitation is the spontaneous reflux of gastric contents into the esophagus and mouth. This condition is not uncommon in infants and is often a cause for concern for parents. The frequency of regurgitation syndrome in children of the first year of life is 18-50%: up to 4 months - 67%, up to 6 months 24%, up to 1 year 5%. In most cases, regurgitation is "benign" and disappears on its own after 12-18 months. At the same time, “benign” or physiological regurgitation characterizes: nine0003

• the age of the child is up to 12 months;

• spitting up 2 or more times a day for 3 or more weeks;

• sufficient weight gain;

The child has no signs of metabolic disorders, diseases of the gastrointestinal tract or the central nervous system. The child does not experience difficulty in swallowing or feeding, there is no forced position of the body. nine0003

Do not confuse regurgitation with vomiting. When a child burps, the abdominal muscles do not tense up. With vomiting, on the contrary, muscle tension occurs and food is ejected by pressure not only through the mouth, but also through the nose. In some cases, there may be general anxiety, pallor, cold extremities. Often with vomiting, the temperature rises, loose stools appear, which is a sign of an infectious disease. Vomit may contain unchanged milk, mucus, blood or bile. nine0003

What explains physiological regurgitation

What is the tendency of babies to spit up? This phenomenon is explained by the peculiarity of the structure of the gastrointestinal tract of young children. At the age of one year, the esophagus is shorter and wider, physiological narrowing is weakly expressed. The stomach is located horizontally, its capacity is small, and the muscles that close the entrance to the stomach and prevent the contents from being thrown back into the esophagus are poorly developed. As the child begins to walk, the axis of the stomach becomes more vertical. The capacity of the stomach increases by the year from 30-35 ml to 250-300 ml. The secretory apparatus matures, the work of the closing muscles (sphincters) improves, which leads to a gradual decrease in the frequency and disappearance of regurgitation. These features explain the predisposition of young children to regurgitation and even the inevitability of this condition. However, there are measures to help reduce the frequency of regurgitation. nine0003

Factors contributing to physiological regurgitation include:

1. Overfeeding. As a rule, actively sucking babies begin to suffer from overfeeding, with abundant milk secretion, as well as when switching to artificial or mixed feeding with an incorrect calculation of the required amount of milk formula. Regurgitation appears immediately or some time after feeding in the amount of 5-10 ml. Milk can flow out unchanged or curdled. nine0003

2. Swallowing air during feeding (aerophagia). A similar situation arises if the child suckles greedily at the breast, and the mother's milk is not very plentiful; due to the retracted, flat nipple of the mother's breast, since the child fails to fully capture the nipple and areola; with artificial feeding, if the hole at the nipple of the bottle is large enough or the nipple is not completely filled with milk. Babies with aerophagia often experience anxiety after feeding, bulging of the abdominal wall (belly inflates). After 10-15 minutes, the swallowed milk flows out unchanged, which is accompanied by a loud sound of air eructation. nine0003

3. Intestinal colic or constipation. These conditions lead to an increase in pressure in the abdominal cavity and a violation of the movement of food through the gastrointestinal tract, causing regurgitation.

Until the child is four months old, spitting up up to two teaspoons of milk after feeding, or one spitting up of more than three spoons during the day, is considered the norm. You can check the amount of spitting up in the following way: take a diaper, pour one teaspoon of water on its surface, and then compare this spot with the spot formed after the next spitting up. nine0003

Pathological regurgitation may be due to:

• surgical diseases and malformations of the digestive system;

• diaphragmatic hernia;

• pathology of the central nervous system, trauma of the cervical spine during childbirth;

• food intolerance, lactase deficiency;

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• increased intracranial pressure.

Such regurgitation is characterized by intensity, systematicity, the child spits up a large amount of milk. At the same time, there is a violation of the general condition of the baby - the child is whiny, loses or does not gain weight, cannot eat the amount of food necessary for his age. In such a situation, a pediatrician, gastroenterologist, surgeon, allergist, neurologist should be examined. It also requires examination and exclusion of anomalies in the structure of the upper gastrointestinal tract, the preservation of regurgitation for more than 1 year. nine0003

Scale for assessing the intensity of regurgitation:

1. Less than 5 regurgitations per day with a volume of not more than 3 ml - 1 point.

2. More than 5 regurgitations per day with a volume of more than 3 ml - 2 points.

3. More than 5 regurgitations per day up to half the amount of formula or breast milk, not more often than in half of the feedings - 3 points.

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4. Spitting up a small amount of milk for 30 minutes or more after each feeding - 4 points.

5. Regurgitation from half to full volume of formula or breast milk in at least half of the feedings - 5 points.

Regurgitation with an intensity of 3 or more points requires a visit to a doctor.

Preventive measures against regurgitation in children

If regurgitation is physiological in nature, then it is not worth treating or correcting in this case. It is necessary to deal with the elimination of the cause, if possible, and carry out prevention.

Prevention of regurgitation in children includes the following measures:

1. Postural therapy: when feeding, it is necessary to hold the baby at an angle of 45 °, make sure that he completely grasps the nipple with the areola; after feeding, hold the baby in an upright position ("column") for 20 minutes - to drain the swallowed air. Due to this, the air that has entered the stomach will be able to go out. If nothing happened, then put the baby down and after a minute or two, lift him upright again. nine0003

2. Make sure that the opening in the bottle is not too large and that the nipple is filled with milk. Experiment with nipples - perhaps the other will be better. Milk should come out in drops, not a trickle.

3. Before you start feeding your baby, lay him belly down on a solid base.

4. After feeding, try to minimize the baby's physical activity, do not disturb him unnecessarily, and change clothes only if there is an emergency. nine0003

5. Avoid squeezing diapers or clothes on the abdomen of the child.

6. If the baby's appetite is good, then it is better to feed him often, but in small portions, otherwise, due to the large amount of food, the stomach may overflow, and this, as a result, leads to regurgitation of excess food.

7. The surface in the bed on which the baby lies should rise 10 cm at the head. nine0003

8. In addition, it is possible to use special "thickeners" of milk or anti-reflux mixtures, which the doctor will help you choose.

In the event that regurgitation begins to become more frequent or becomes abundant, or first began after six months of the baby's life, or does not subside by one and a half to two years of life, the child should be consulted by a pediatrician. With a high probability, additional help from a gastroenterologist will be needed. nine0003

In our Family Medical Center you can always find highly professional help.

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Regurgitation and vomiting in children

Regurgitation syndrome is one of the most common reasons for parents of young children to visit a pediatrician and a surgeon. The causes of regurgitation in children under 1 year old are different: anatomical and functional features, neurological disorders, infectious processes, malformations or other problems. The mechanism that prevents regurgitation and vomiting in children is very complex and depends on the anatomical structure and physiological processes of the child. The formation of this mechanism occurs in the last trimester of pregnancy and continues in the first months of a child's life. Although regurgitation and vomiting can be a symptom of various diseases, in themselves these processes are physiological, i.e. normal. The pathological reflux of stomach contents into the esophagus is called gastroesophageal reflux, and the mechanism that prevents vomiting is called the antireflux mechanism. nine0003

Anti-reflux mechanism in children

In children, the nervous regulation of the antireflux mechanism is very complex and easily disturbed under the influence of external and internal factors. Regurgitation and vomiting easily occur in children with an immature antireflux mechanism, if the mode or volume of feeding is incorrectly selected, as a reaction to artificial mixtures, at the slightest sign of infectious processes. This is especially often observed in children with intrauterine growth retardation and premature babies, as well as in severe pregnancy and toxicosis, caesarean section, complicated childbirth, etc. nine0003

When to see a doctor

Despite the fact that moderate spitting up in a child under 6 months is considered a variant of the norm, parents should definitely tell the pediatrician about this during a routine examination. The reason for serious concern and immediate examination of the child is an increase in the frequency or increase in the volume of regurgitation, the appearance of streaks of blood or bile impurities, a lag in recruitment or weight loss, and high temperature. In this case, it is urgent to consult a surgeon to rule out surgical causes. nine0003

Diagnostics

In most cases, an ultrasound examination (ultrasound) is necessary to establish an accurate diagnosis and select the correct treatment. An experienced doctor of ultrasound diagnostics helps to establish the correct diagnosis in more than half of the cases. Sometimes, for a more accurate diagnosis, a flexible gastroscopy, X-ray examination, or computed tomography of the abdominal organs is performed.

When surgery is required

Pyloric stenosis, or impaired patency of the gastric outlet, is the cause of the most severe regurgitation syndrome (vomiting "fountain") in children under 2 months, accompanied by severe weight loss and progressive deterioration of the child's condition. This disease requires urgent surgical care. In leading clinics, such operations are performed using a minimally invasive laparoscopic method. The current level of development of surgery and pediatric anesthesiology allows the use of endoscopic surgery techniques even in children in the first weeks of life. nine0003

There are also other causes of regurgitation that require surgical intervention, such as hiatal hernia, chalazia (gaping) of the esophagus, and others. These malformations are characterized by a violation of the formation of the antireflux mechanism and lead to constant regurgitation in a child, impaired weight gain, decreased appetite, chronic cough, bronchial asthma, and anemia. If drug therapy is ineffective, then a gastrofundoplication operation is indicated, in which an artificial antireflux valve is surgically formed. Like many other interventions, in modern children's clinics this operation is performed laparoscopically - with less trauma, minimal blood loss, minimal cosmetic defect and a quick recovery of the child after the operation. nine0003

Of course, vomiting and regurgitation can be symptoms of many other diseases and occur at any age in a child. Thus, vomiting is often observed in acute appendicitis and intestinal obstruction, it can be a symptom of an intestinal infection, intoxication, etc. In addition to the disease itself, vomiting and profuse regurgitation are dangerous because the child loses a large amount of water and salts necessary for life, which can lead to dehydration - exsicosis. The younger the child, the faster the disruption of compensatory mechanisms and the worsening of his condition. Therefore, the appearance in a child of symptoms of vomiting or severe regurgitation in young children requires immediate medical attention to identify the causes, establish the correct diagnosis and select the optimal treatment, and, if necessary, surgical.

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