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Constipation in children. Prevention. Diet therapy

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Health

Sabitova Vasily Ilyasovna Gastroenterologist

06/21/2019

Constipation is widespread among both adults and children (5-30% depending on the diagnostic criteria). Symptoms become chronic in more than 30% of patients, not only cause discomfort and pain to the child himself, but also disrupt the quality of life of his family.

CONSTIPATION - a condition manifested by an increase in the intervals between bowel movements (compared to the individual norm) or systematically slow, difficult and / or insufficient bowel movements. Constipation also includes stools with “gruel”, but after defecation was absent for up to 3 days.

Constipation can be related to functional or organic causes (abnormalities, inflammation). In children, 90-95% of constipation is functional. The peak incidence of functional constipation falls on 2-4 years, when they begin to accustom the child to the potty / toilet.

Main causes of functional constipation

• Pain
• Fever
• Dehydration
• Wrong diet of a nursing mother
• Insufficient drinking regime of a child with artificial feeding
• Insufficient drinking regimen of a breast-fed child with the introduction of complementary foods
• Early transition of the child to artificial feeding
• Fast transition of the baby from one mixture to another (less than 7 days)
• Irrational nutrition of the child (for a long time the child receives food with a large amount of proteins, fats and insufficient dietary fiber, abuse of drinks containing a large amount of astringents - tea, coffee, cocoa)
• Excessive use of baby hygiene products or the development of an allergic reaction of the skin of the perianal area
• Consequences of perinatal injuries of the nervous system
• Rickets, vitamin D deficiency
• Anemia
• Impaired thyroid function (deficiency - hypothyroidism)
• Food allergy, especially cow's milk protein allergy
• Forced potty training, period of adaptation to new conditions (nursery, kindergarten)
• Physical inactivity - a sedentary lifestyle
• Mental trauma or stress
• Systematic suppression of the urge to empty the bowels, associated, for example, with the beginning of attending a kindergarten, school, etc.
• Taking certain drugs
• Constipation in family members

Frequency of defecation in children of different ages

In addition to the frequency of the chair, you should pay attention to its nature. For a more objective assessment, the “Bristol fecal shape scale” is convenient, since it is the shape of the feces, and not the frequency of the stool, that is more consistent with the time of intestinal transit.

Bristol stool chart

In accordance with this scale, 3 and 4 form of feces is regarded as normal, and 1 and 2 indicate delayed transit (constipation). Quite often, in practice, there are situations when a child has a bowel movement frequency within the normal range, but the stool is dense, fragmented, in a meager amount. These signs indicate incomplete emptying of the bowels and are considered as manifestations of constipation.

The consistency of the stool in newborns and infants should be mushy. From 6 months to 1.5 - 2 years, feces can be both formalized and mushy. From the age of two, the chair must be decorated.

Signs and symptoms of constipation

• abdominal pain, often bursting, aching, sometimes colicky
• bloating
• change in the shape and consistency of the stool
• excessive flatulence
• unpleasant smell of flatus and stool
• may have pain during bowel movements
• straining during bowel movements
• there may be blood in the stool - on the surface of the feces or in the form of traces on a napkin (indicates an anal fissure)

If you do not eliminate constipation and do not establish bowel movements, then there is a risk of coprostasis (formation of fecal stones) and fecal intoxication:

• loss of appetite
• lack of energy
• general malaise
• depression, irritability
• nausea, vomiting
• skin symptoms - dryness, rash, peeling
• fecal incontinence, stool spotting
• urinary retention and incontinence due to pressure from a crowded bowel on the bladder
• bleeding from fissures, hemorrhoids

The treatment of constipation involves the following goals:

1. Normalization of stool consistency (soft, painless stools)

2. Regularity of bowel movements (prevention of re-accumulation of feces)

The treatment of constipation is a sequential, complex, individual process and consists of several stages:

• child and parent education
• correction of nutrition and drinking regimen
• elimination of existing coprostasis with the help of medications
• maintenance therapy

It is necessary to exclude factors that provoke and contribute to constipation (normalization of motor and nutritional regimen, discontinuation of medications that can cause constipation, identification of a food allergen, exclusion or confirmation of neuromuscular disease, celiac disease, etc.).

Lifestyle normalization includes:

• development of a conditioned reflex
• active lifestyle
• gymnastics
• light abdominal massage training
• for small children - laying out on the stomach, bending the legs to the stomach.

Education is the first step in the treatment of functional constipation. It must be remembered that episodes of fecal smearing and encopresis (fecal incontinence) are not arbitrary and should not be blamed on the child, who may already be frightened and disoriented. In some cases, when the intra-family situation is difficult, the help of a family psychologist may be needed.

It is important to understand that the treatment of functional constipation can be lengthy, based on trust, partnership and requires patience. Modern laxatives that are legal in children will not make the intestines “lazy”, will not cause “addiction”, they enter the bloodstream in minimal amounts or are not absorbed at all and are safe for long-term use.

Correction of the behavior of a child with constipation is based on the development of a routine of visiting the toilet, in order to achieve regular defecation. Defecation should be every time at the same time. The urge to defecate is based on the gastrocecal reflex, which manifests itself in the morning 1 hour after eating. A child with constipation needs to spend 3-10 minutes in the toilet (depending on age). It is necessary to plant the child on a potty or offer to visit the toilet after each meal.

A prerequisite for effective defecation is to provide a good support for the legs (a low bench on which the child can put his feet), which helps to increase intra-abdominal pressure.

If the defecation is not successful, the child should never be punished and vice versa. The daily frequency of bowel movements can be noted in a diary, which can be analyzed at a scheduled visit to the doctor.

Treatment of constipation should begin with lifestyle changes, which include dietary modification, drinking regimen and physical activity.

Calculation of fluid volume for healthy children

Children under the age of 1 year should drink at least 100 ml of water per day.

For healthy children weighing 10 to 20 kg the water requirement is calculated using the formula:

100 ml (volume of water for children under 1 year old) + 50 ml per kg for body weight over 10 kg.

For example, with a mass of 12 kg: 100 ml + 2 x 50 ml = 200 ml.

A child weighing 20 kg should drink water: 100 ml + 50 x 10 = 600 ml

For children weighing over 20 kg the following formula is suggested for calculation:

600 ml (volume of water for a child weighing 20 kg) + 20 ml for each kg over 20 kg.

For children over 3-5 years old you can use the calculation of the amount of water: 30ml / kg of weight

Principles of diet therapy for constipation:

• satisfaction of physical needs for nutrients and energy
• exclusion of excessive consumption of proteins and fats, which can inhibit intestinal motility
• enrichment of the diet with dietary fiber
• normalization of intestinal microflora with pro- and prebiotics

If the child is breastfed, then the mother's nutrition is corrected (restriction of products that promote gas formation). With artificial feeding, special mixtures are shown. For constipation associated with an allergy to cow's milk protein, therapeutic mixtures are prescribed if the child is bottle-fed. If the child is breastfed, cow's milk and products based on it are completely excluded from the mother's diet.

After the introduction of “thick” complementary foods, boiled water is necessary for all children, regardless of the type of feeding.

For older children, it is recommended to eat foods rich in vegetable fibers. It is not recommended to “smear food”, puree, “snacks”, “eating on the go”. Food should be crumbly, meat / poultry / fish - “piece”. A “bulk” breakfast is required to stimulate the “gastrocecal reflex”.

The main source of coarse-fiber vegetable fiber, containing a large amount of dietary fiber, is cereal bran, rye bread, as well as a number of vegetables and fruits. According to the principles of evidence-based medicine, a statistically significant increase in stool frequency and improvement in its consistency was demonstrated with the use of fiber compared with placebo.

Bran, as the main source of vegetable fiber, is recommended to be added to the second and third courses, after pouring boiling water over it and settling for 20 minutes. Bran can also be used in between meals, drinking plenty of fluids. For school-age children, the total amount of fluid when taking bran should be at least 1.5-2 liters per day, otherwise they mainly act as sorbents, absorbing fluid from the intestines, thereby increasing constipation. The dose is selected individually, it is recommended to start with 1 teaspoon 2-3 times a day, with a gradual increase to 40 g per day. When the effect is achieved, the dose is reduced and limited to one dose.

The American Academy of Pediatrics (2009) recommends a fiber intake of 0.5 g/kg/day (maximum 35 g/day) for all children. Fiber intake below the minimum recommended value has been shown to be a risk factor for chronic constipation in children.

However, long-term intake of a large amount of plant fibers due to fermentation by intestinal microflora is naturally accompanied by bloating and flatulence.

Children with constipation are shown to take cool liquids on an empty stomach (drinking and mineral water, juice, compotes, kvass), to enhance the laxative effect, it is possible to add honey, xylitol or sorbitol. It is very beneficial for bowel function to increase the intake of juices containing sorbitol/sorbitol, such as juice from plums, pears, apricots, peaches and apples,

With “sluggish” bowel function (hypomotor constipation), cool mineral water of medium and high mineralization is used, such as Essentuki 17, Batalinskaya, Arzni, Donat Magnesium, etc.; with spastic constipation (hypermotor constipation, stool form more often type 1) - warm and low mineralization (Essentuki 4). Calculation of mineral water - 3-5 ml / kg per day.

It is necessary to limit milk in its pure form and in dishes, as flatulence may occur with the appearance or intensification of abdominal pain. It is better to replace whole milk with sour-milk products - kefir, acidophilus, yogurt, yogurt, etc.

The diet of children with constipation includes dishes rich in vegetable fiber - salads from fresh vegetables, greens 2-3 times a day, baked apples, stewed vegetables, diluted vegetable and fruit juices with pulp. Food is cooked mostly unground, steamed or boiled in water.

It is preferable to take raw vegetables and fruits (in the absence of contraindications). Especially recommended are tomatoes, zucchini, pumpkin, carrots, beets, lettuce, cauliflower, apples. Dried fruits (prunes, dried apricots, figs) are given in soaked form and as part of cooked dishes. White cabbage, young green beans, green peas are allowed with good tolerance. Parsley, dill, celery are good to add to various dishes and salads.

If after reading the article you still have questions or you do not understand how to apply the recommendations in your particular case, we invite you and your child to be examined by a pediatric gastroenterologist at the DDC. For the convenience of parents, you can make an appointment with a pediatric gastroenterologist at the Children's Diagnostic Center on a weekday and on Saturdays.
We will be happy to help!

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Constipation in a child: what to do?

Constipation disrupts the functioning of the gastrointestinal tract. The main manifestation of constipation is a rare stool, difficulty in emptying the intestinal tract. If emptying occurs every three days, but there is no swelling and discomfort, and the feces have a normal consistency, this is not considered constipation.

If your child is constipated, a specialist should be consulted. Initially, you should seek help from a gastroenterologist. The First Children's Medical Center employs the best pediatric gastroenterologists in Saratov: here you can get qualified medical care!

Symptoms of constipation

The main symptoms of constipation include:

• infrequent bowel movements;
• if the child pushes hard trying to go to the toilet;
• if there is pain during bowel movements;
• stools look like balls.

When the baby is breastfed, he can empty himself up to seven times a day, after each meal. During the first week, the frequency of emptying is three times a day.

When the baby is one month old, the stool will be daily. At two months of age and when complementary foods begin, stools can be once every two days. If the baby has a soft stool, he feels good, but at the same time he defecates once every few days, this is the norm.

Signs of constipation include: discomfort during bowel movements, moodiness, very hard stools. If this situation persists, you should contact your pediatrician.

It is important to adjust the feeding regimen. Do not overfeed the child, do not transfer to artificial feeding if the mother has little milk. The first step is to try to fix the situation. A nursing mother should drink more fluids, stop eating foods that cause flatulence, reduce intestinal motility. Only in extreme cases should be transferred to artificial mixtures.

If the baby is formula-fed, he should empty himself once a day. The main mistake in this case is that parents often change mixtures, try others. Mixtures should be adapted, sour-milk, which contain probiotics and prebiotics. It is also necessary to strictly follow the instructions, properly dilute the mixture, taking into account all proportions. The introduction of complementary foods should be on time. The diet should contain foods that contain a large amount of fiber.

After the introduction of complementary foods, the stool becomes formed, hard, less frequent. Until the age of three, bowel movements should be daily. After three years, the frequency of defecation should be at least three times a week.

Why constipation occurs

There are two types of constipation - organic and functional. The causes of organic constipation are:

• Hirschsprung's disease;
• anomalies in the development of the gastrointestinal tract;
• pathology of the endocrine system;
• violations of metabolic processes.

In a newborn child, this symptom may indicate a narrowing, lengthening or expansion of the intestinal tract.

The causes of functional constipation include:

• psychological problems, for example, being in an unfamiliar environment;
• lactose deficiency;
• lack of fluid in the body;
• errors in the diet;
• negative reaction of the body to taking antibacterial drugs, drugs for the treatment of anemia, anticonvulsants;
• congestion of bile in the gallbladder and its ducts;
• Intestinal worms.

In newborns, the nervous system is immature, it is just being formed. Therefore, children are unable to control the movements of their muscles during bowel movements. You can help them by gently bending the legs, pressing them to the tummy. With these movements, the pelvic muscles relax, the bowel is released much faster.

How the therapy works

The treatment of constipation requires a holistic approach. Treatment is prescribed in each case individually, depending on the cause of constipation.

To ensure the normal functioning of all organs, it is necessary to adjust the stool in children. You will need to adjust your diet and lifestyle, do not abuse laxatives, as they help only temporarily.

The main principles of therapy include:

• Diet correction. Requires elimination of foods that can cause constipation. Among them are fermented milk products, rice, muffins, bakery products, pasta. The menu is recommended to include vegetable fiber, which is found in fresh fruits and vegetables. You should also abandon fast carbohydrates - flour products, sweets. You need to add to the menu more foods that contain potassium, for example, figs, dried apricots, prunes.
• Observe the drinking regimen. It is important to drink clean drinking water. During the day, the child should drink at least 40 milliliters of water per kilogram of his weight.
• According to the doctor's prescription, medicines, homeopathic remedies should be given to the baby. These include drugs for the outflow of bile, drugs that restore the intestinal microflora. You can use antihelminthics, laxatives, drugs with lactulose in the composition. Your doctor may also prescribe medications that contain polyethylene glycol. They retain moisture in the intestines, thin the stool.
• In case of prolonged constipation, the child can be given a glycerine suppository, a microclyster as a stimulant.
• Undergo physiotherapeutic procedures prescribed by the doctor, massage, do therapeutic exercises.
• Provide a calm environment, help the baby psychologically so that he is not afraid to empty his intestines. You can read fairy tales, play with your child.
• Train the intestines, after eating, put the child on the potty for a few minutes.

First you need to get rid of constipation and only then potty training. If constipation is not treated in a timely manner, this will entail unpleasant consequences for the health of the child.

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