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How to deal with constipation in a child?

08/15/17

Manual for parents on a problem that is very common in children with autism

Source: Autism Speaks

To the symptoms of chronic constipation includes:

- Very very hard and dense stool.

- Pain and difficulty in emptying the bowels.

- The child has a bowel movement three times a week or less.

Talk to your child's doctor to find out if your child is constipated.

What causes constipation in children with autism?

1. Holding a stool

Some children try to hold a stool and ignore the urge to have a bowel movement. This can happen for various reasons, for example:

- Fear of the toilet.

- Reluctance to use the toilet outside the home.

- Unwillingness to interrupt the game.

- Fear of pain during bowel movements.

2. Toilet training

Children may resist and hold stool when toilet training is attempted. This can become a habit that is difficult to break later on.

3. Nutrition problems

- Lack of fiber found in fruits, vegetables and whole grains.

- Dairy products, if the child is allergic to cow's milk or consumes too much dairy products.

- Insufficient intake of water and other beverages, especially when ill.

- Changes in appetite or diet due to illness of the child.

4. Stress and changes in daily routine.

Travel, weather changes, and stress can affect bowel function.

5. Medications

Some medications, such as antacids, antidepressants, and some attention-deficit/hyperactivity disorder medications, can cause stools that are too hard.

6. Associated medical problems.

Constipation is common in children who have movement problems, including decreased muscle tone and cerebral palsy. Also, constipation is possible in case of hypersensitivity to gluten or casein.

Acute constipation and encopresis

Acute constipation

Some (but not all) children with chronic constipation may have this problem. Acute constipation can be caused by too much hard stool in the colon. As a result, the child cannot have a bowel movement for several days. Acute constipation is diagnosed by a doctor by palpation of the abdomen or by X-ray. Acute constipation is often accompanied by loss of appetite and lethargy. After a bowel movement, the child feels better and the symptoms decrease.

Encoprese

This problem occurs in some (but not all) constipated children. Encopresis means that during constipation, the child has loose stools. This is a common problem.
Encopresis can develop if a child holds a stool for so long that it becomes difficult for him to have a bowel movement. The stool becomes larger and drier. Due to the retention of large stools, the intestinal muscles get tired and relax. After the muscles relax, loose stools can seep into the underwear.

The child does not feel that this is happening and cannot control loose stools. This usually happens several times a day, causing the underwear to become dirty. Sometimes encopresis is confused with diarrhea, but the child does not actually have diarrhea because most of the stool in the intestines remains solid.

Many children with encopresis experience loss of appetite and decreased interest in daily activities. After a bowel movement, the child feels better and these symptoms decrease.

Treatment of constipation

There are three main approaches to the treatment of constipation.

Talk to your child's doctor about which type of treatment is best for you:

1. Dietary changes

- Increasing the amount of fiber in your diet will make bowel movements easier.

- Increasing fluid intake , especially water and juice, helps soften stools and reduces the chance of constipation.

2. Behavioral changes

- Regular exercise . Physical activity improves the functioning of the abdominal muscles, which facilitates bowel movements. Regular exercise, including walking, jumping rope, ball games, cycling and swimming, can help with constipation.

- Bowel training in the toilet . It is important that the child knows how to use the toilet at the first urge. The best way to teach this is through planned and extended "sit-downs" where the child is rewarded for simply sitting on the toilet for extended periods of time.

3. Medications

Children often need medication to have regular bowel movements. These can be:

- Preparations for daily use.

- Single-dose preparations that "cleanse" the intestines in case of severe difficulty with emptying.

Increasing fiber in the child's diet

A diet high in fiber promotes regular bowel movements and prevents constipation. Fiber is a substance that the body cannot digest. There are two types of fiber - soluble and insoluble. Soluble fiber promotes the entry of water into the intestines. Insoluble fiber facilitates the passage of stool through the intestines. Both types of fiber are needed to prevent constipation.

Fiber is an important part of a healthy diet. A lot of fiber is found in foods such as fruits, vegetables, whole grains, legumes, nuts, and seeds. They also contain a lot of protein, vitamins and minerals. A diet high in these foods is the best way to get enough fiber.

Where to find fiber

When shopping for food, you can check the nutritional information of the product, including the fiber level. Good choices are foods that contain at least 2 grams of fiber per serving.

When shopping, look for products that contain whole grains, whole grain flour, and oatmeal. Perhaps there are options for your child's favorite foods with whole grains, that is, higher fiber content. For example, whole-grain cheese crackers, whole-grain wheat flour bread, and high-fiber cereals may be suitable for you.

Recommended Fiber Values ​​

— Ages 1 to 3: 19 grams per day (for boys and girls).

- Ages 4 to 8: 25 grams per day (for boys and girls).

- Ages 9 to 13: 31 grams per day for boys and 26 grams per day for girls.

Examples of high fiber foods

- White beans: 9. 5 grams per 1/2 cup.

- Oatmeal: 8.8 grams per 1/2 cup.

- Red beans: 8.2 grams per 1/2 cup.

- Beans: 7.5 grams per 1/2 cup.

- Pear (with skin): 4.3 grams per small pear.

- Raspberries: 4.0 grams per 1/2 cup.

- Baked potatoes (with skin): 3.8 grams per piece.

- Almonds: 3.3 grams per 30 grams.

- Apple (with skin): 3.3 grams per piece.

- Banana: 3.1 grams for one medium-sized piece.

- Orange: 3.1 grams per medium sized piece.

- Peanut butter: 3.0 grams per 2 tablespoons.

- Broccoli: 2.8 grams per 1/2 cup.

- Green peas: 2.5 grams per 1/2 cup.

- Avocado: 2.3 grams per 1/2 cup.

- Corn: 1.6 grams per 1/2 cup.

- Strawberries: 1.5 grams per 1/2 cup.

- Wild rice: 1.5 grams per 1/2 cup.

- Raisins: 1.4 grams per 1/2 cup.

- Popcorn: 1.2 grams per 1 cup.

Increasing fiber and fluid in the child's diet

It is advisable to offer children foods rich in fiber from an early age so that their use becomes a lifelong habit.

If your child is currently constipated, it is important to increase fiber levels very gradually over 2-3 weeks. Too much fiber in the diet can worsen constipation or cause gas, abdominal pain and diarrhea.

Increasing fiber will only be effective if the child also starts drinking more fluids. Make sure your child doesn't just start eating more fiber, but also starts drinking more water and juice.

How to Increase Fiber Without Child Resistance

Children with autism often resist change, especially dietary changes. Parents need to be patient and try different approaches, for example:

- Switch to crackers and whole grain pasta.

- Try whole grain bread and pizza. Many types of whole-grain bread do not differ in appearance from ordinary white bread.

- Offer your child whole grain muesli or popcorn as a snack.

— Offer the child dried fruit as a sweet treat (prunes, dried apricots, raisins).

- Try to make cocktails from frozen fruits or berries based on juice or milk.

- Offer your child carrot, bell pepper, or celery sticks that can be dipped in peanut butter, hummus, or salad dressing.

— Add shredded vegetables or mashed vegetables to your child's favorite foods, such as pasta or pizza.

- Make funny faces or figures out of slices of fruits and vegetables.

- Invite the child to dip fruit slices in nut butter or his favorite kind of yogurt.

- Bake cookies, muffins or pies with whole wheat flour.

Increasing fluid intake

Sufficient water is essential to maintain a healthy body. It is found in both foods and drinks. As you increase the amount of fiber in your diet, you also need to increase your fluid intake.

How much fluid do you need?

- Follow your thirst. The amount of water a child needs varies depending on physical activity and what the child eats. Therefore, it is very important to monitor the signs of thirst in a child.

- When a child drinks enough water, his urine becomes clear, light yellow in color. Dark, tea-colored urine usually means your child needs to drink more.

Fluid types

1. Water: the best source of fluid.

2. 100% juice: good for health, but should be limited.

- 120-180 ml per day for children under 6 years old

- 240-360 ml per day for children over 6 years old

- Some juices (pear, apple, plum) contain sugars that act as a natural laxative and may help with constipation.

3. Milk:

- An important part of a child's nutrition.

— Excessive consumption of milk can lead to constipation.

- Desirable rate for milk: 480-720 ml per day (2-3 cups).

4. Sports drinks and drinks with electrolytes:

- They often have added sugar.

- Not the best choice for children.

- Check with your doctor before giving these drinks to your child.

5. Fruit drinks, soft drinks:

- They usually have added sugar.

- Not the best choice for children.

- It is better to save them for special occasions, such as holidays, you should not give them to the child regularly.

Fluids and constipation

It is very important to increase fluid intake at the same time as increasing fiber. Fluid helps soften stools and make bowel movements easier.

- Some juices (pear, apple, plum) are natural laxatives.

— It is advisable to give the child a lot to drink between meals, this contributes to regular bowel movements.

- Drinks with a lot of sugar, caffeine or "fortified with vitamins" can increase constipation.

Tips for increasing fluid intake

— Encourage your child to drink water between meals, on a full stomach the child may drink too little.

- Offer your child fruits with a high water content, such as grapes, oranges, or watermelon, as snacks and treats.

— Keep a bottle or cup of water handy so your child can always have a drink. Add some citrus juice to your water to make it taste better. Or try adding some other drink to the water.

- Lead by example. Children are more likely to drink water when they see their parents or siblings drinking water.

Toilet training

In case of constipation, it is very important to teach the child to use the toilet as soon as he feels the first urge. The easiest way to teach this is with a daily period of time when the child sits on the toilet for a long time. When a child gets used to sitting on the toilet for a long time, it will be easier for him to relax the muscles that hold the stool. With daily toilet seating time, your child will become less likely to hold a stool. When the child stops holding the stool, the intestines return to normal size and become more sensitive.

How to teach your child to sit on the toilet for a long time every day

1. Be patient with yourself and with your child. Learning a new skill, especially this skill, is never easy.

2. Start by teaching your child to sit on the toilet, even if he does not defecate:

- Start with 1-2 minutes. Very slowly increase the time to 10-12 minutes.

- Use a visual timer to let your child know how long to sit.

- Offer the child some quiet activity while he sits on the toilet. For example, reading a book, drawing, playing a handheld computer game, listening to music or audio books.

- Try to save the child's favorite pastime for sitting on the toilet and do not offer it at other times.

- Praise your child even for small progress.

- Never force a child to sit on the toilet and never force him to sit on it unless you are working with a behavior specialist to help you do it safely.

3. Choose a time for your child to use the toilet.

- Making toilet use a regular part of a child's daily routine will help develop a normal bowel habit.

— Children with autism often like routine. Making toilet seating a part of the daily routine will reduce the risk of child resistance.

- Try using a visual timetable with pictures, one of the items being toilet time.

— If your child is most likely to have a bowel movement at some time of the day, try to schedule toilet seating for that time.

— Morning is the best time for most people, but it may not be suitable for a child who will be rushed to kindergarten or school in the morning.

- For some children, the best time is after coming home from school or kindergarten.

4. Make sure your child is comfortable.

- Choose the toilet seat or potty that is most comfortable for your child.

— Use a child seat for the toilet if the normal seat is too big for the child.

- Use the footrest if the child's feet do not touch the floor.

How to teach a bowel movement in the toilet

1. Make sure your child sits on the toilet for long periods of time 1-2 times each day.

2. Teach your child that "poop goes down the toilet" by emptying dirty diapers or underwear.

3. Try to time your child to sit on the toilet when you think your child is most likely to have a stool.

4. Try to stimulate the gastrocolic reflex before sitting on the toilet. This reflex occurs after eating or drinking and allows the bowel muscles to expel stool after eating. To stimulate this reflex, try to get your child to eat or snack, and drink a warm drink before sitting on the toilet.

5. Watch for possible signs in the child's behavior. If you notice that he wants to use the toilet, then take him there. Signs may include:

- Changes in facial expressions.

- Attempts to go to a quiet part of the house.

- Muscular tension.

Positive reinforcement

- Start with rewards for your child just sitting on the toilet.

- When the child begins to empty his bowels on the toilet, start rewarding him for it.

- Small rewards that the child receives immediately after the desired behavior work best.

- Give rewards less frequently over time.

Try not to use food as a reward. Instead, you can reward your child with:

- Sing your favorite song with your child.

- Hugs, tickling, verbal praise.

- Favorite game with a child.

- Stickers that will allow the child to track their progress.

- Time for your favorite pastime.

- Tokens (in the form of stickers, stars or other items) that can then be exchanged for very large rewards, such as a trip to the cinema or to the park.

Many children with autism have special interests. They can be used when planning rewards. For example, if a child is interested in cars, then as a reward, he can look at car magazines. If a child loves trains, then he can receive stickers with trains as a reward.

Positive rewards lead to the desired changes in behavior much faster than any punishment or criticism.

If the child is dirty

- Say something like "I noticed that you are dirty" or "Please change. "

- Help the child to do this as needed.

— Do not scold the child or draw attention to what has happened.

If the child does not want to sit on the toilet

- Try to get the child as close to the toilet as possible when he begins to have a bowel movement. If the child does it in diapers while standing, then try to have him do it while standing in the toilet.

- When the child has defecated in the diaper, throw the contents of the diaper down the toilet in front of the child.

- Teach your child to sit on the toilet with their clothes down. Give your child a toy that can keep him busy for a while.

- Over time, move on to having the child sit on the toilet with the lid up but wearing a diaper.

- When the baby is comfortable sitting on the toilet with the lid up, cut a hole in the diaper and enlarge it over time. Try to have the child sit on the toilet in a diaper while having a bowel movement.

Specialist help

Very often it is difficult for a family to change what happens at home. Toilet training can be a very complex behavioral problem. Some families need additional specialist support. Signs that the family needs more help include:

- The child becomes very upset when taken to the toilet.

- Child holds stool longer and longer.

— Constipation progresses in the child.

— Everything connected with the toilet causes tantrums or aggression in the child.

Specialists may include child psychologist, behavioral analyst, pediatrician. Sometimes staff at the child care facility that the child attends can help find the right specialist.

Daily preparations

— May be started immediately if the child does not have acute constipation.

- Taken orally.

- Most effective when taken daily.

Purpose of taking the drug:

- Soft stools and bowel movements every day.

- All stool comes out of the bowels.

Dosage of the drug:

- The initial dose of the drug must be prescribed by a doctor. Sometimes the dosage needs to be varied. Talk to your doctor about this, he will help you change the dosage.

When it is necessary to increase the dosage of the drug:

- Small and hard stools.

- The child does not have a bowel movement every day.

- The child has difficulty emptying the bowels or is in pain.

When to reduce the dosage of the drug:

- Loose stools.

— The child has abdominal pain or cramps.

Duration of drug treatment

— As a rule, the course of treatment lasts at least 6 months.

— After 6 months of daily bowel movements, the doctor may decide to gradually reduce the dosage of the drug.

- If you stop taking the drug before the intestines return to normal, then constipation will begin again.

— It is important to make sure that the child has soft stools every day.

How do drugs to treat constipation work?

There are three types of laxatives. They act differently.

1. Osmotic laxatives. They carry water into the stool to keep it soft. Safe and often given to children. Usually taken every day. Suitable for long term use.

Examples: polyethylene glycol without electrolytes, magnesium hydroxide, magnesium citrate, lactulose, sorbitol.

2. Stimulant laxatives. They promote contractions of the intestinal muscles and promote stool in the intestines. As a rule, they are prescribed for a single dose.

Examples: senna, bisacodyl.

3. Lubricating laxatives. Facilitate the passage of stool through the intestines with an oil base.

Examples: liquid paraffin, glycerin suppositories.

Acute constipation medicines

Acute constipation occurs when large masses of hard stool block the intestines. If the doctor thinks that there is a blockage in the intestines, then as a first treatment option, he may prescribe a drug that will "cleanse" the intestines.

Your doctor will work with you to determine the best type of drug. Sometimes drugs that are taken by mouth are best. Sometimes drugs that are injected into the intestines are better suited. This "clearing" usually takes 2-3 days. It is best to spend it on the weekend or on vacation. The child will need to spend 2-3 days near the toilet and use it often.

These drugs can only be prescribed by a doctor. He will tell you how long and how often to take the drug.

Enema procedure

Most cases of constipation in children are treated with oral medications. In some cases, children need a drug that is injected into the rectum. Talk to your doctor about what treatment is best for your child. Do not give your child an enema without talking to the doctor first. Below is information about giving an enema, if needed.

How to prepare a child for an enema

- Explain the procedure to the child in a way that he can understand, perhaps with illustrations.

- Let the child look at and touch the enema bottle.

- Touch the tip of the enema to his hand so he knows what it's like.

- Help your child practice beforehand how to lie down properly during an enema.

Enema Preparation

— Read the enema instructions very carefully. Check out the pictures and instructions in the instructions.

- Make sure the enema is at room temperature.

- Prepare everything you need: an enema bottle; towel on which the child will lie; pillows; music, a favorite toy, or other items to help your child stay calm; wet cleansing wipes.

Decide where you will give the enema. Sometimes it's best to put the baby on a blanket or large towel on the bathroom floor next to the toilet.

- Place towels and/or pillows for your child to lie down comfortably.

- Have another person stand at eye level with the child during the procedure - read to him, sing, talk, play music or otherwise distract him and help him lie still.

How to give an enema

1. Wash your hands.

2. Remove the protective cap from the enema tip. The tip should have a lubricant that makes it easier to administer the enema.

3. Help the child lie on his left side with his knees pressed against his chest.

4. Have your helper talk or sing to your child in an effort to soothe and encourage.

5. Hold the enema in one hand. With your other hand, spread your buttocks until you see the anus.

5. Insert the end of the bottle very carefully into the anus. Don't force it in.

6. Position the end of the enema towards the child's back. The contents of the enema should fall on the intestinal wall, and not on the stool.

7. Squeeze the enema until nearly the entire volume has been delivered.

8. If possible, try to have the child lie down for 15-20 minutes. You can hold on to his buttocks to prevent him from pushing out the contents of the enema too soon.

9. If your child wears diapers, put on a diaper.

10. If the child uses the toilet, then put him on the toilet after 15-20 minutes. The liquid should go down the toilet along with the stool.

If at any stage the child becomes very upset, starts crying, screaming, kicking, then it is normal to stop the procedure. Talk to your doctor about other treatments for constipation.

We hope that the information on our website will be useful or interesting for you. You can support people with autism in Russia and contribute to the work of the Foundation by clicking on the "Help" button.

Parenting children with autism, Nutrition and digestion, Comorbidities

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
• Incorrect 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 start of attending 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 scale

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 stool
• excessive flatulence
• unpleasant smell of flatus and stool
• may have pain during bowel movements
• straining to defecate
• there may be blood in the stool - on the surface of the stool 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 medication
• 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
• gentle 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 1 year of age 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:

• meeting physical needs for nutrients and energy
• exclusion of excess 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.

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