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Constipation in a child - causes, symptoms, diagnosis and treatment of constipation

Constipation in a child - the absence of stool for a day or more, as well as a change in the nature of the feces when they become hard and dry with a normal frequency of defecation.

Children often experience constipation due to malnutrition, stress, problems with the digestive system. To accurately determine the cause of a malfunction in the intestines, the child needs to be examined.

Causes of constipation in a child

The specific cause is determined by the doctor on the basis of the collected history, clinical symptoms and examination data. There are several factors that can cause constipation in a child.

Non-compliance with nutrition rules

Most often, young parents face such a problem for the first time immediately after the introduction of the first complementary foods to a child at 6 months of age. Cereals and solid foods begin to dominate the baby's diet, while the usual breast milk fades into the background. All this affects both intestinal motility and the consistency of stool. They become hard and take the form of small balls (the so-called "sheep feces"). Because of this, every act of defecation in the baby is difficult and painful, so he often cries during a bowel movement.

The cause of constipation in children 3-4 years old is a lack of fiber in the diet. But it is she who stimulates intestinal motility. The child consumes few vegetables and fruits, which are the main sources of fiber, since cottage cheese, cereals, and meat begin to predominate in his menu.

In this case, it is enough to change the baby's diet by adding more vegetables, fruits, "soft" foods and liquid foods to the diet, as well as adjust the drinking regimen.

Psychological state of the child

"Psychological constipation" occurs in children who are taught to use the potty. Parents need to be patient, because if the baby feels irritation, each act of defecation will become a source of stress for him.

Preschoolers and younger children may have difficulty going to the toilet when they first start kindergarten or school. Then they begin to restrain natural needs, which is fraught with constipation. In this case, calm conversations with the child can help.

Dysbacteriosis

Reproduction of pathogenic microflora and suppression of vital activity of beneficial bacteria also cause constipation. Due to indigestion, bowel movements begin to occur with a delay. The feces become greenish-gray and acquire an unpleasant odor. In this case, the child complains of rumbling and pain in the abdomen.

Infectious process

Quite often, constipation develops after an infectious disease that occurs with a high temperature. Because of the fever, fluid from the body is lost during increased sweating and during evaporation with rapid breathing. Therefore, due to lack of fluid, stools acquire a dense texture and move poorly through the intestines.

Pathologies of the rectum and chronic diseases of the digestive system

Constipation can be a symptom of many diseases of the gastrointestinal tract. Inflammation of the mucosa or ulcerative defects on it disrupt the normal process of digestion. This is reflected in the frequency of trips to the toilet.

As for the pathologies of the rectum, they are all characterized by painful defecation. Therefore, the child tries his best to restrain himself so as not to experience discomfort during a bowel movement.

Helminthiases

Worm infestations can be diagnosed at any age. However, in young children, they often provoke constipation. Infection occurs with errors in personal hygiene. As a result, digestion is disturbed, beriberi and anemia develop, and due to the deterioration in the movement of feces through the intestines, problems with defecation appear.

Other causes

Constipation in a child can also be caused by irritation of the skin around the anus or an allergic reaction in this area. In this case, the act of defecation provokes pain and discomfort, so the child deliberately avoids it.

Constipation can also be one of the symptoms of pathologies such as hypothyroidism, vitamin D deficiency, anemia, food allergies. Sometimes the cause of constipation in a child may be a hereditary predisposition or a side effect of taking certain medications. In any case, only a doctor can determine the cause of the problem.

Symptoms of a pathological condition

Constipation is accompanied by a number of unpleasant local and general symptoms. Among the local manifestations, parents usually note in a child:

• decreased frequency of bowel movements;
• incomplete bowel movement;
• dense consistency of feces;
• baby complains of pain during bowel movements.

With constipation, especially prolonged, the general condition of the child may suffer. In many cases, this is due to intoxication of the body. In particular, parents notice:

• weakness, fatigue, loss of appetite and headache;
• appearance of pimples on the skin;
• bloating due to accumulation of gases.

At the same time, one should not forget about the clinical symptoms of the underlying disease (if any), against which constipation appeared.

In order to recognize the problem of constipation in a child and consult a doctor in time to select a treatment, parents need to know the norms for the frequency and nature of the stool in children of different ages.

Classification and stages of development of constipation

A unified classification of this pathological condition has not been developed. However, in clinical practice, depending on the origin, there are:

• primary constipation - occurs as a result of anomalies in the development of the digestive system;
• secondary constipation - is a symptom of another disease;
• idiopathic constipation - the exact etiology of the pathological condition has not been established.

According to the nature and duration of the course, constipation can be:

• acute, when problems with bowel movement occur suddenly;
• chronic, in which the child suffers from a defecation disorder for more than 3 months.

There are also constipation:

• functional when there is no organic lesion of the digestive tract;
• hypertensive - the intestines with feces are in a strong tone;
• hypotonic - the tone of the intestine is weakened and in this state is not able to maintain normal motility.

There are also 3 stages of compensation for the pathological condition:

1. Stage 1, fully compensated - bowel movement occurs 1 time in 2-3 days;
2. Stage 2, subcompensation - the act of defecation in a child happens 1 time in 5-7 days;
3. Stage 3, decompensation - stool occurs once a week or less.

Mechanism of constipation

In constipation, stool stays in the intestines for a long time, which makes it even drier and denser, as additional fluid is absorbed. Bowel movements are difficult and painful. Often there is injury to the mucosa. During the act of defecation, the child experiences very unpleasant sensations, so he tries to restrain himself.

The more often this happens, the faster the intestines adapt to this condition. First, there is a slowdown in impulses signaling the need for an act of defecation. Further, fecal masses begin to stagnate. All this provokes the development of general intoxication of the body, contributes to the appearance of dysbacteriosis, indigestion and further aggravates the child's condition.

Fossilized feces gradually stretch the capsule of the rectum. The anal sphincter weakens. Liquid calculi begin to flow around the formed lump, and stone smearing begins.

When should I see a doctor?

The child needs medical attention if:

• the child complains of severe abdominal pain;
• no stool for more than 3 days;
• when emptying the intestines, the rectal mucosa falls out, or hemorrhoids appear;
• there are traces of fresh blood or mucus in the stools;
• stool changes its characteristics - becomes dry, hard, fetid;
• the general condition of the child suffers - the body temperature rises, flatulence, nausea, and vomiting appear.

Diagnostic methods

First, at the appointment, the doctor collects an anamnesis of the disease, asking the parents in detail, and also evaluates the diet and drinking regimen of the baby based on the data. Next, the doctor conducts a general examination of the child, paying attention to the skin turgor and its color, palpates the abdomen. If necessary, conducts a digital examination of the rectum, assessing the condition and filling of its ampoule, sphincter tone and the integrity of the mucosa.

After the examination, the doctor recommends to the parents a full examination of the child, which usually includes:

intestinal endoscopy (colonoscopy, sigmoidoscopy) is a study that allows you to study the condition of its mucosa and diagnose a number of pathologies of the digestive tract.

Only on the basis of the results of the examination, the doctor can determine the cause of constipation and prescribe the appropriate treatment.

Constipation treatments

Treatment of constipation should only be complex. It is prescribed necessarily taking into account the causes and concomitant pathologies. The treatment regimen includes drugs, herbal medicine, physiotherapy (electrophoresis), reflexology, exercise therapy.

But first of all it is necessary to change the way of life. If a child is diagnosed with functional constipation, he is advised to move more, since any physical activity stimulates the motor function of the intestine.

The second aspect is diet. The child's diet should contain a sufficient amount of foods rich in fiber, which stimulates digestion and peristalsis. In parallel, it is necessary to adjust the baby's drinking regimen.

As a drug treatment for constipation, parents can use:

• probiotics and prebiotics with lactulose;
• laxatives and cholagogues;
• antispasmodics.

Only the attending physician can prescribe a specific drug and adjust the dosage according to age.

Diet for constipation

Correction of diet for constipation is the main component of the success of treatment. Nutrition should be age-appropriate and meet its needs for essential substances.

If the baby is breastfed, continue breastfeeding. If necessary, it is worth adjusting the mother's diet: reduce consumption or completely eliminate foods that increase gas formation from the diet. With artificial feeding, it is recommended to choose a mixture containing special additives.

For the first feeding, it is better to choose puree from vegetables that stimulate intestinal motility: zucchini, pumpkin, cauliflower. All babies, regardless of the type of feeding, after the start of complementary foods, need a sufficient amount of boiled water.

If an older child has constipation, it is essential to include enough fresh fruits and vegetables, natural sources of fibre, in the diet. There are some exceptions to this rule: for example, pears, persimmons, and blueberries are astringent and can aggravate constipation.

A significant amount of fiber is also found in oatmeal and buckwheat, wholemeal bread, and bran. Specially prepared bran can be purchased at a pharmacy. To treat constipation in a child, bran is poured with warm water, settled for 20 minutes and added to main dishes. The dose is selected individually, starting with 1 teaspoon. With constipation, bran should be given 2-3 times a day, and after solving the problem, the frequency of intake is reduced to 1 time per day. When taking bran, it is necessary to provide the child with plenty of fluids, otherwise bran can play the role of a sorbent and further increase constipation.

The child's food should be mainly crumbly, contain meat (poultry, fish) in pieces. Breakfast should be plentiful in order to reflexively stimulate the act of defecation in the morning.

To eliminate constipation, you should avoid eating pureed foods, strong tea, coffee, jelly, rice and semolina porridge. It is also necessary to minimize the presence of sweets and muffins in the diet. It is better to replace fresh milk with fermented milk products.

The best drink for children suffering from chronic constipation is plain boiled water. You can give diluted vegetable and fruit juices with pulp. Without following the condition of abundant drinking, any adjustments to the child's diet may be ineffective.

Daily routine

The habit of following a daily routine helps to establish the correct functioning of the vegetative part of the nervous system and develop the habit of emptying the intestines at a certain time.

In the morning, immediately after waking up, give your child half a glass of water (for children under 3 years old - a third of a glass). Then the child can do morning hygiene procedures, exercises. Usually these actions take no more than 20 minutes, after which the baby has breakfast.

Ideally, a defecation should occur after a meal. By agreement with the attending physician, it can be called in auxiliary ways, for example, with the help of a candle or microclysters. In case of success, the child should definitely be praised, and if he did not succeed, do not scold.

All children need walks and active play. Movement stimulates peristalsis, which ensures effective prevention of constipation in a child - this rule is also relevant for babies at 1-2 years old, and preschoolers 5-6 years old, and older children.

Possible complications of constipation

Long-term constipation may cause distension of the colon. If the feces stand in one place for a long time, this can lead to impaired blood circulation in the intestinal walls and the formation of hemorrhoids. With excessive straining, the rectum sometimes falls out.

Constipation can lead to general intoxication, dysbacteriosis, provoke colitis, paraproctitis and other chronic bowel diseases.

Prognosis and prevention

The prognosis for the pathological condition is favorable, but the sooner attention is paid to the problem, the better for the child.

Prevention of constipation consists in the gradual introduction of complementary foods, rational nutrition, adherence to the drinking regimen, periodic examinations for helminths and timely treatment of pathologies of the digestive tract.

How to calculate the correct amount of fluid for a child

1. Babies under 1 year of age should drink at least 100 ml of water per day.
2. After one year, if the child weighs 10–20 kg, add another 50 ml per kilogram to the original 100 ml.
3. Children over 20 kg should add 20 ml per kilogram to 600 ml.
4. For babies 3-5 years old and older, the calculation of the daily volume of liquid is easier - just take 30 ml of water per kilogram of body weight.

Questions most frequently asked by parents

What is forbidden to do with constipation in a child?

Small children, who have just started to potty training by their parents, should not be shouted at and forced to sit on it. In addition, with constipation at any age, you should not give foods that slow down intestinal motility (semolina and rice porridge, persimmon, pear, jelly).

What can be done before the doctor arrives?

Parents can give a laxative suppository and a microclyster. Laxatives, even if there is an instruction, are recommended to be given only after consulting a doctor.

How to make an enema for a baby?

It is necessary to take a rubber bulb of small volume, draw water at room temperature (temperature not higher than 22–26 ° C), grease the tip with Vaseline. Babies up to a year old are placed on their backs, older children on their left side. With one hand, the buttocks are parted, with the other, the tip of the rubber bulb is carefully inserted to a depth of 3–5 cm.

Then the bulb is slowly squeezed and the entire portion of water is squeezed out. Then the pear is taken out, the buttocks of the child are squeezed for 2–3 minutes, after which they are put on a potty or sent to the toilet.

What can be given to a child for constipation?

Kefir, beetroot juice, chamomile decoction, dates, walnuts and dried apricots have a laxative effect.

What should be the baby's diet so that he does not suffer from constipation?

Each person's body is individual. The assimilation of products occurs in different ways. Therefore, no one will give a definite answer, except for a doctor who has been observing a child since birth. Only he will help to create the optimal menu for him, taking into account all the features of his digestive system.

symptoms, causes, diagnosis, how to help a child with constipation

How to solve the problem and help the baby?

Constipation is one of the most common problems in children. According to statistics, in Russia constipation occurs in every fourth child ¹ . And this problem significantly complicates the calm and cheerful life of both the child and and parents, because constipation often causes pain, the child the mood deteriorates, the parents are on their nerves - in general, there is little good.

In order not to miss the problem of constipation in the baby, we armed ourselves
scientific knowledge and talk about how to identify constipation,
why does it occur and what to give a child with constipation?

Causes of constipation in children

There are quite a few of them and almost all of them depend on age child. That is, constipation in infants and schoolchildren cause different reasons. Let's consider them in more detail.

Stress and change routine

These reasons are typical, as a rule, for babies. under the age of one year. In this tender age, coordination muscle contractions of the intestinal wall can be violated ⁵ , which leads to difficulties with defecation. In addition, constipation in infants may occur after switching to artificial mixtures ¹ . In breast milk contains many beneficial intestinal flora substances - dietary fiber, a large amount of fat, proteins in the optimal ratio. All of them contribute normal bowel movements ⁶ .

Stress and change routine

Common causes of constipation are new conditions that break the child's usual daily routine and environment. So, for example, a violation of defecation often appears during potty training, with the start of attending kindergarten or schooling ¹ .

Irritable syndrome intestines

This disorder is noted in an older age group - in children from 4 to 18 years old. In this disease, the child periodically abdominal pain occurs, which may be accompanied by symptoms indigestion and constipation ^1.7 .

How to understand that a child has constipation?

It seems that the answer to this question very simple - child rarely walks "big". However, this is not quite correct figure. Case that the frequency of stool in healthy children can be very different ¹ .

However, if a child's routine of going to the toilet has changed, you should be alert and analyze what is happening. Yes, yes, literally turn into a patient detective and examine the contents of a pot or toilet. This may not be the most pleasant occupation, but the result of research can greatly facilitate both your life and the child's.

So, first of all, you need to evaluate the shape of the stool. This will help to determine with some accuracy whether there is constipation or not ¹ . We will not determine the shape “by eye”, but with the help of the Bristol scale of fecal shapes, developed by doctors. According to this scale, there are seven types of stool. We are only interested in two of them.

Criteria for constipation according to the Bristol Stool Form Scale

Hard and dry, nut-like lumps (called "sheep" stool)

Sausage-shaped stool with a lumpy texture.

In addition to determining the shape of the stool, you should pay attention to other signs of constipation. For example, a child may begin to push too hard, take uncharacteristic positions, try to poop, and in general, spend much more time on the potty or toilet than usual. ¹

If there is no stool for several days, constipation is considered acute. If the constipation problem persists for 3 months or more, this is regarded by specialists as a “chronic condition” ^2.4 .

Treatment of constipation in a child

So what should you do if your child is constipated?
First of all, you need to make certain changes in the daily routine. All of them are quite simple and effective. Remember.

Maintain regular toileting

Natural urge to defecate usually appears after eating. Therefore, a small child stands in the morning some time after taking put food on a pot or invite him to go to the toilet. You can develop a kind of reflex in a child - for example, "had breakfast - pooped" ¹ .

Comfort

To form a positive perception of going to the toilet in a child, it is also important to provide comfortable conditions for him: for example, to choose a suitable potty so that the child can take a comfortable position ¹⁰ . In addition, it is necessary that during defecation, the baby has some kind of support where you can rest your feet, for example, a low bench that can be placed in the toilet, since an increase in intra-abdominal pressure when straining is important to resolve constipation ¹ .

Adjust nutrition

This is a very important step in the treatment of constipation. From the menu you need to remove fats, sweets (yes, we understand how difficult it is with this item) and marinades.
And replace all this splendor with cereals, vegetables and fruits. Especially good for constipation are plum, peach and apple purees and juices ¹ .

Important to understand

Lifestyle changes may not help immediately. Therefore, there are modern remedies for constipation in children, which can contribute to a faster resolution of this problem. One of these is Guttalax®, a topical laxative that can stimulate the activity of the large intestine, which can lead to softening of the stool and normal defecation ⁸ . However, it is important to remember that prescription medications in children drugs should only take place after consultation with a doctor. Only a specialist can determine the cause of constipation and help deal with them.

Unlike other laxatives, which can sometimes focus the child's attention on a problem, for example, they do not have an acceptable taste for everyone ¹¹ , or are administered rectally, which can increase the child's fear and discomfort regarding defecation ¹² , Guttalax® you can let your baby quietly and naturally normalize the bowel rhythm ^8.

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