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- How to understand that a child has a problem
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A change in the frequency of a stool in a child indicates the onset of a pathological process in the intestine. Defecation becomes rare as a result of a decrease in intestinal peristalsis, hardening of the stool or the appearance of a mechanical obstruction for the normal passage of stool. The causes of the appearance of the symptom are different and may be temporary or permanent.
Constipation in a child of 3 years of life can be assumed if the act of defecation is less than once in three days or the process itself delivers the uncomfortable feeling to the child. In addition, about coprostasis is involved, if the feces of the child in a dense and fragmented( "sheep" feces).
Treatment of the symptom must begin with the clarification of the disease that caused it. Therefore, if there is constipation, you need to contact the pediatrician who, after examining the child, will conclude that it is necessary to carry out diagnostic measures and will give recommendations for restoring the normal frequency of the stool.
The cause of constipation in a small child may be functional or organic disorders. In functional pathologies, the innervation of the smooth musculature of the intestine is impaired, which leads to a decrease or absence of the motor activity of the intestine and the impossibility of passage of fecal masses.
Functional constipation can be caused by:
- malnutrition( use of a lot of fixing products, fatty foods, lack of fiber in the diet, solid foods).Protein food, flour dishes, easily digestible sugars are quickly digested by digestive juices, as a result little feces are formed and it does not stimulate intestinal motility. In healthy children, there is rarely a constipation only because of a lack of vegetables and fruits in the diet, as a rule, the reason for a monotonous diet and a sedentary lifestyle;
- excessive use of calcium-containing products( in the body, compounds that make the stool hard, which makes it difficult to move);
- insufficient fluid intake. When there is a shortage of water, the feces quickly dehydrate and become dense, so it slowly moves along the intestine;
- long-term medication. When taking antacids, antibiotics, antispasmodics, cholinolytics, sedatives or diuretics, the work of the nervous apparatus of the intestine changes temporarily or the electrolyte metabolism is disturbed, which leads to constipation. Medication constipation may be due to the intake of iron, calcium tablets, the abuse of laxatives;
- mental or nervous overstrain( in a stressful situation, the work of the autonomic nervous system changes, which leads to a change in the motor activity of the intestine);
- frequent use of stimulant defecation( if you often use cleansing enemas or purgatives, the intestine becomes "lazy", as the threshold of irritability of the receptor apparatus of the intestinal wall increases);
- organic diseases of the central nervous system. If blood circulation in the brain, tumors, traumas of the spinal cord or brain, as well as with meningitis, myelitis is disturbed, the nervous regulation of intestinal motility is disrupted. When pathology is often noted, and the disorder of the act of urination;
- is an enteric infection or a dysbacteriosis. Intamural ganglia are damaged, which are responsible for the contractile capacity of the intestine;
- violation of water-electrolyte metabolism. Stool retention occurs with loss of fluid caused by diarrhea, increased sweating during fever, with forced diuresis, potassium deficiency, kidney disease, heart failure. During the disease, water-electrolyte metabolism is disturbed, which leads to a decrease in stool, they become dry, hard and viscous, so there is a discrepancy between the capacity of the colon and the volume of its contents, which is why there are difficulties with emptying.
In organic pathology, mucosal or intestinal defects are detected that interfere with the feces passage. These can be neoplasms, fistulas, diverticula, stuck foreign bodies, which cause mechanical obstruction of the lumen of the intestine.
Mechanical constipation develops with inflammatory and cicatricial narrowing of the colon, due to ulcerative colitis, Crohn's disease, lymphogranulomatosis and other inflammatory processes that occur in the pelvic cavity. Organic defects also include Hirschsprung's disease, fistulous atresia of the anus, stricture of the rectum or anus, loss of reflex to defecation.
Organic pathologies are only removed surgically
In Hirschpung's disease, the intestinal structure is broken, roughly speaking, part of it does not work. This pathology is congenital and usually it manifests itself when the child is transferred to "adult" food or when switching to mixed feeding. If the reflex fails to defecate, emptying does not occur for 5-7 days, while the rectum is filled with feces( noticeable with a rectal examination), and painful sensations go away after a cleansing enema.
In a child of 3 years, the cause of constipation can be emotional trauma or nervous shock, the so-called psychological constipation is formed. The kid does not always have time to endure to the toilet or he, having played, can ignore the urge to defecate.
If a child is scolded for dirty panties, then he can deliberately restrain himself, and this leads to the fact that stool masses stagnate, dehydrate, and expand the rectum. Usually in children, constipation occurs during adaptation to a kindergarten or if they find themselves in a new place.
How to understand that a child has a problem
A three year old child is not yet able to describe his feelings and clearly formulate the symptoms that accompany constipation, so parents should closely monitor the work of the intestine, the frequency of its emptying and the characteristics of stool. Not always with constipation the main criterion is the frequency of defecation.
On the violation of the intestine also says difficult bowel movement, even if it is daily, the lack of a feeling of complete emptying of the intestine( the child is sitting for a long time, and a small amount of feces is allocated).With constipation, the feces are dense, dry, can be fragmented, and when spasms of the distal intestine have the form of ribbons.
It can also be said of constipation if a dense stool comes out first, followed by a mild stool or after a long stool delay, a liquid stool containing a large amount of mucus( blocking diarrhea) is released. With constipation, often there are diarrheal phenomena( lack of appetite, bloating, belching, rumbling of the intestines, unpleasant taste in the mouth), often children are marked by increased nervousness, depressed mood, sleep disorder, shortness of breath, numbness of the extremities.
With atonic constipation, the rhythm of defecation changes, the stool cylinder is larger than normal. Due to paroxysmal pain in the abdomen, the child refuses to eat. In addition, the baby may have skin rashes or plaque on the tongue. With spastic constipation, feces are fragmented( "sheep" feces), and the child is disturbed by intestinal colic and increased gas production. Pain in the abdomen passes only after the bowel has been emptied, the cleansing enema does not eliminate the spasm.
Frequent constipation can lead to changes in the intestinal mucosa, therefore the symptom can not be ignored.
What to do
If constipation occurs in a three-year-old child or if chronic constipation occurs( the stool frequency is reduced within three months), you should consult a pediatrician or gastroenterologist. The specialist will collect anamnesis, prescribe laboratory tests, conduct a physical examination.
In case of constipation, the skin color changes( acquires a yellowish tinge), it can appear rashes, the tongue becomes dry, becomes covered with bloom, and the abdomen is swollen. When palpation, the areas of the large intestine filled with dense feces are found, and the cecum increases and becomes saccular. After the examination, the doctor decides whether there is a need for further investigation of the bowel functions.
In the absence of pathologies from the gastrointestinal tract recommendations are given on dietary nutrition and physical activity of the baby, tell how to develop a reflex to defecation and as an emergency measure, prescribe funds for the activation of intestinal peristalsis( candles or syrup based on lactulose).
Non-pharmacological ways to normalize the frequency of stool
With nutritional constipation resulting from poor nutrition, it is recommended to adjust the diet. The menu should include more products that have a lax effect and enhance intestinal motility. The child needs to eat more vegetables and fruits, bran, cereals, wholemeal bread.
Stimulates motor activity of the intestine cold dishes and drinks, vegetable oil, sour milk, fruit juices( especially plum and tomato), dried fruits. It is important to help the child develop a conditioned reflex to defecation.
It is necessary to teach the crumb to empty the intestines at a certain time. The most natural time for a bowel movement 15-30 minutes after a hearty breakfast, and if a child attends preschool, it is possible to move the "planned action" on the evening, the main thing that the baby was comfortable.
necessary to ensure that the child drink plenty of fluids
Secure gastro-intestinal reflex as follows:
- give crumbs to drink on an empty stomach cold juice or water( liquid contributes to the launch of the intestinal motor activity);
- feed the child;
- if the urge to defecate is no, then do 10 times the exercise: to draw inspiration belly as you exhale push forward the anterior abdominal wall. It is also possible to stimulate intestinal motility with the help of abdominal massage, rhythmic retraction of the anus, pressing between the coccyx and the anus;
- ask the baby to squat. It is impossible to sit on the toilet for a long time, since this can lead to undesirable consequences. More complete emptying of the intestine occurs in a posture when the knees are tightened and are just above the pelvis( you need to put a bench under your feet or put the child on a pot);
- if the measures taken did not produce the desired result, then you should use laxative rectal suppositories.
As a rule, the reflex to defecation is produced on 3-5 days( if no candles were used).It will help to restore the frequency of defecations moderate physical activity. During the change in the position of the body with respiratory acts, intra-abdominal pressure changes, which helps to reduce and relax the abdominal muscles and promote the fecal masses. Any load( walks, running, morning exercises, cycling) will be useful.
funds for the treatment of constipation
If necessary, designate drug therapy, which may include the use of laxatives or antispasmodics, candles with novocaine, papaverine, belladonna. With atonic constipation, the intake of B vitamins, nootropics, prokinetics is recommended. Showing laxatives only with acute constipation.
For a short time, it is better to use antispasmodics, which contribute to the removal of spasm of smooth muscles of the intestine. If the ratio of intestinal microflora is disturbed, doctors recommend taking drugs containing useful microorganisms or being a nutrient substrate for them.
Children are most often prescribed a syrup based on lactulose. Lactulose passes the small intestine in an unchanged form, since there are no enzymes for its cleavage. In the colon it under the action of the bifidobacteria and fermented to useful decomposes acid( lactic, acetic, formic) which exhibit an osmotic activity.
Thanks to this, the useful microflora thrives in the intestine, as it has enough nutrition, and water retention, which leads to an increase in the volume of fecal matter and activation of peristalsis. Lactulose preparations are non-toxic, do not cause allergic reactions, can be used for a long time, so they are often prescribed to children with constipation.
The constipation can be cured only by eliminating the underlying cause that caused intestinal motility disorder
The effect after taking is noticeable after 24-48 hours. Since lactulose is a nutrient substrate for beneficial microflora, often due to the rapid growth of microorganisms, increased gassing occurs. To avoid this, pediatricians recommend starting a laxative with a small dose and gradually increasing it.
The drug is taken 1-2 times a day for several weeks. The maximum daily dose of the drug for a three-year-old child is 5 ml of a 66.7% solution of lactulose. If after a week of taking such a dose of a positive effect is not noticed, then you need to contact the doctor to change the tactics of treatment. The withdrawal of the drug is also gradual.
- Romfalak, etc.
As an emergency measure for constipation in children, rectal glycerin suppositories can be used. The agent has a laxative, dehydrating effect. Glycerin makes the feces soft, which facilitates their passage through the large intestine, in addition, it irritates the intestinal mucosa, which causes a reflex stimulation of the motility of the lower intestinal tract.
Thus, treatment of constipation in children begins with a nutritional adjustment. In the diet of the child should increase the number of foods that contain fiber, pectin, vitamins. It is necessary to make sure that during the day the baby drinks enough water. Improves the motor activity of the stomach massage, exercises for the press, relaxing heat.
The laxative effect is noticeable within 15-30 minutes after the application of the
suppository. It is also recommended to help the child develop a reflex to defecation. In children of 3 years, the development of psychological constipation is possible, so it is important at this age to protect the child from strong emotional experiences and not to blame for stained panties. The cured coprostasis can develop again if we return to the previous diet and move little.
If the frequency of defecation is disrupted for a long time, you should consult a doctor. Only after examination and diagnosis can the doctor give recommendations how to treat constipation in a child. In most cases, funds are prescribed with lactulose, probiotics or prebiotics, laxative suppositories, but it may be necessary to take antispasmodics, prokinetics, nootropics. In rare cases, you need to do an operation.