Any newborn baby is born with an immature digestive system. The main organ for producing enzymes, the pancreas, is not able to process vegetables, fruits, juices, cereals and even fermented milk products in the first months. Therefore, doctors do not recommend introducing these products (complementary foods) into the baby’s diet until 4–5 months, when the enzymes “ripe” in most children. And even such a product as breast milk or an adapted milk formula - a breast milk substitute - not all children can digest normally. The reason is the same: immaturity of enzymes. Therefore, it is not uncommon for children to have lumps of curdled milk in their stool (which is a variant of normal stool at an early age), and colic (normally occurs in almost every child up to 3 - 3.5 months).
The most important role in ensuring normal intestinal function is played by beneficial bacteria of the intestinal flora - they neutralize toxins and allergens, stimulate intestinal function and produce up to 80% of the lactase enzyme - the one that digests milk sugar lactose - one of the key components of breast milk and infant formula. So, a child is born with a sterile intestine, that is, there are no bacteria there. Bacteria begin to colonize the intestines at the time of birth; for the first 2 months, the intestinal microflora changes several times a day, and then the process of stabilization of the intestinal microflora continues until almost 1 year. All this time, the child is predisposed to the development of dysbacteriosis, against the background of which allergies, stool disorders, and secondary lactase deficiency may develop.
By the way, secondary lactase deficiency, accompanied by abdominal pain, loose foamy stools, and bloating, is one of the most common gastroenterological problems faced by young parents. The causes are dysbiosis and enzymatic immaturity. Usually the problem is resolved by 4 - 5 months, but it can also be more protracted. In case of secondary lactase deficiency, there is no need to deprive the baby of breast milk and transfer him to lactose-free formulas - this will only slow down the development of his own enzymes.
The immune system is inextricably linked with the intestines. You can even say that the intestines are the largest organ of the immune system. A newborn baby in utero receives immune memory from its mother, which helps initially cope with harmful microbes. Breast milk plays a vital role in the further development of the immune system. The immune system has to learn, and it takes quite a long time for staphylococci and fungi to cease to be an impossible task for it. But in the first months, while immunity has not yet been formed, children often have “thrush” (caused by fungi of the genus Candida) and pustular pimples, and green feces (both can be caused by staphylococci). Any dysbacteriosis occurs against the background of weakened or immature local intestinal immunity.
The condition of the skin directly depends on the functioning of the intestines. It’s not for nothing that there is a catchphrase: “the skin is the mirror of the intestines.” Up to 90% of what appears on a baby’s skin is of intestinal origin (diathesis is one of the manifestations of dysbiosis). It should also be taken into account that the skin of babies is very delicate, sensitive, and prone to inflammation.
Immaturity of the liver and biliary tract is manifested by the state of physiological jaundice of newborns. More precisely, liver immaturity is one of the reasons for such jaundice (there are other reasons not related to gastroenterology). Physiological jaundice is considered acceptable in the first 2 weeks after birth. If the jaundice lasts longer, it is prolonged jaundice and requires treatment.
To summarize, we can say that any modern child is born insufficiently adapted to the environment. There is an explanation for this. The fact is that a person, like any living creature, can change, adapting to changing environmental conditions - this is the process of adaptation. For a long time, changes in the environment and changes in man followed parallel courses, so man adapted without any problems. But over the past 50 - 100 years, such rapid and significant changes in the environment have occurred that human changes simply cannot keep up with these processes. Adaptation disorders are the most common modern problem. And children are much more likely than adults to be susceptible to adaptation diseases.
Pediatrician Yuri Kopanev
The functioning of the digestive organs at an early age has its own specific characteristics and therefore not every specialist who treats adult patients can accurately diagnose and choose the best method of treating gastrointestinal tract diseases in a child. Detects and treats diseases of the digestive system in children pediatric gastroenterologist. A highly qualified gastroenterologist can promptly recognize and prescribe a course of treatment for diseases of the gastrointestinal tract in a child, such as gastritis, sigmoiditis, esophagitis, hepatitis, peptic ulcers (duodenal and gastric ulcers), duodenitis, colitis and others.
The slightest concern about burning and pain in the gastrointestinal tract in a child should alert you - effective treatment without possible complications of diseases of the digestive system depends on timely detection of the disease at an early stage of development.
Pediatric gastroenterologist You should definitely examine your child if the following symptoms appear:
1. Vomiting, nausea, belching, heartburn
2. Disturbance in the process of defecation
3. Chronic abdominal pain
4. Decreased appetite
5. Bleeding from the digestive organs
6. Bad breath
7. Abnormal stool (diarrhea, constipation, unstable stool)
8. Weight loss
Pediatric gastroenterologist will examine the child, listen to complaints and collect an anamnesis about the child’s development, find out the features of possible previous treatment of diseases and features of the diet. Then the gastroenterologist will prescribe additional examinations and diagnostics: stool tests for scatology, dysbacteriosis, carbohydrates,
general blood analysis,
ultrasound examination of the digestive system,
If necessary, refer the child for examination by other specialists for a more accurate diagnosis.
Below is information about the main diseases of the digestive system in children, which are detected pediatric gastroenterologist and then prescribes a course of treatment:
How to recognize the symptoms of gastrointestinal diseases in an infant?
Pain in the tummy in an infant is manifested by twisting of the legs, frequent restlessness, bending of the legs towards the stomach, and strong crying. The baby's tummy may be dense, noticeably swollen, and make specific sounds: transfusion and rumbling. At the same time, the baby strains, blushes heavily, and groans.
Abdominal pain in an infant may occur due to the accumulation of gases, severe colic (spontaneous intestinal spasms), which leads to sleep disturbances and loss of appetite.
An experienced pediatric gastroenterologist will determine the causes of symptoms of digestive diseases in an infant. The reasons can be very different:
1. General immaturity of the digestive system in an infant, characteristic of any infant at an early age (frequent colic and accumulation of gases are quite normal for completely healthy children under 4 months of age)
2. Intestinal dysbiosis
3. Lactase deficiency due to imperfect enzymatic systems in the child’s body
Lactose intolerance is a fairly common phenomenon for children under 1 year of age. Lactose (or milk sugar) is found in fermented milk products, breast milk, cow's milk and infant formula. A deficiency of the enzyme that breaks down lactose (lactase) in the baby’s body leads to poor tolerance to dairy foods and poor absorption of lactose (lactose intolerance).
Lactase deficiency in an infant can develop both due to a hereditary predisposition and against the background of intestinal dysbiosis or general enzymatic immaturity. Symptoms of lactose intolerance in an infant: tummy pain during or after feeding, frequent loose (and even foamy) stools (more than 10 times a day), bloating and weight loss. After examining the baby, the pediatric gastroenterologist may give a referral for a stool test for carbohydrates to confirm the diagnosis.
When the balance of intestinal microflora is disturbed with the developing dominance of pathogenic bacteria in the gastrointestinal tract, the functioning of the digestive system is disrupted and dysbiosis begins in children. Analysis of stool for dysbacteriosis (study of intestinal microflora) allows you to accurately establish a diagnosis and prescribe appropriate treatment to correct the intestinal microflora and restore the functionality of the child’s digestive system.
Often see a pediatric gastroenterologist They bring children with periodically occurring acute abdominal pain that is not associated with diseases of the digestive system. The child complains of abdominal pain after suffering shocks and psycho-emotional stress. These are so-called neurotic pains in children. After the examination, the gastroenterologist may advise you to consult with a pediatric neurologist, a child psychologist, and also a cardiologist - abdominal pain may be part of vegetative-vascular dystonia.
Why does my child have a stomach ache? The most common causes of digestive system dysfunction in children encountered pediatric gastroenterologist in your medical practice:
1. Overeating
Often found in very young children. Do you never deny your child a supplement? Do not be surprised if, some time after overeating, the child begins to complain of pain in the tummy, he develops lethargy, apathy, and mild nausea.
If this happens, put the baby to bed and if he vomits, give him some water to drink. Enzyme preparations can significantly alleviate the condition, but they can only be given after consultation with a pediatrician!
And most importantly, try to teach your child to eat in moderation!
2. Colic (spontaneous intestinal spasms)
If the child is very small (several months old), then colic is usually provoked by air collecting in the intestines.
Manifestations of colic in a child - the baby cries a lot for a long time after eating.
What you need to do - if you are breastfeeding your baby, make sure that he grasps not only the nipple with his mouth, but also the areola around it. Try to eat only easily digestible foods. And if your baby is on artificial nutrition, then consult with your pediatrician in order to choose the appropriate baby food (formula) for the baby.
Prevention: Hold the baby upright for some time after feeding, until excess air is released from the intestines.
3. Constipation
You should be wary of your child having bowel movements that are too infrequent (only a few times a week), as well as the appearance of periodic abdominal pain and frequent flatulence.
What you need to do: Be sure to take your child for examination see a pediatric gastroenterologist. Constipation can be a consequence of functional disorders of the pancreas or thyroid gland, as well as the liver. But such reasons are not common and in most cases it is enough to change the child’s lifestyle and diet. Give your child more foods that perfectly activate the intestines, maintaining the balance of microflora - acidophilus milk, yogurt with bifidobacteria, kefir, as well as dried fruits (dried apricots, prunes, raisins) and raw and cooked vegetables (carrots, beets, apples, tomatoes) .
Constipation in a child can also be a consequence of dehydration - give the baby as much liquid as possible (juices, fruit drinks, compote).
The best way to combat constipation in a child is to eat a nutritious diet, drink as much fluid as possible and walk more in the fresh air.
4. Pathogenic bacteria
Some of the most common bacteria that cause diseases of the digestive system are salmonella and shigella.
Symptoms of salmonellosis in a child are high fever, diarrhea, diarrhea, vomiting, abdominal pain.
What to do? Be sure to show the child to a pediatrician to clarify the diagnosis. A course of antibiotic treatment is usually prescribed. Treatment begins with the use of sorbents - activated carbon, sillard, smecta.
With shigellosis (dysentery) in a child, the child’s body temperature rises to 38-39 degrees, watery stools mixed with mucus and blood, and a painful urge to defecate appear.
What to do? Be sure to take your child to the pediatrician for examination. For dysentery, treatment with antibacterial drugs is usually prescribed. It is imperative to give a glucose-saline solution, and when the baby gets better, replace it with a weak solution of unsweetened tea. Diet for dysentery - steamed cutlets, porridge, baked apples. Give more fruits, berries and vegetables (wash them thoroughly).
5. Viral diseases
A fairly diverse group of pathogenic microorganisms - enteroviruses lead to stomach upset in a child.
Enteroviral diarrhea. Absolutely any child can get sick by putting a dirty toy in their mouth or interacting with an infected peer. Typically, enteroviral diarrhea affects children under 4 years of age. Symptoms: fever up to 38 degrees, cough, stuffy nose, sore throat. If you have symptoms of diarrhea, check with your pediatrician about the dosage of cold medications and treatment regimen. Let your child drink as much fluid as possible. Build your child's immunity.
Another disease caused by a certain type of enterovirus is Hepatitis A in a child. The infection is transmitted through personal hygiene items, infected dishes, and tap water (if the child drank raw water). Symptoms: the temperature rises sharply, the child suffers from nausea and acute abdominal pain. The stool becomes discolored and the urine turns dark yellow. Yellowness of the whites of the eyes appears, then the face and then the whole body (signs of infectious jaundice).
With hepatitis A, the child will have to stay in the hospital for some time. Diet for hepatitis A - vegetable soups, dietary meat (rabbit, turkey, chicken), dishes from stewed, boiled and raw vegetables.
The best cure for hepatitis A is vaccination. Teach your child to eat only washed fruits and to wash their hands thoroughly before eating.
6. Acetonomic crisis
The causes are poor nutrition, frequent overwork, long trips - severe stress for the child's body, leading to excessive production of ketone bodies in the blood (acetone acetic acid and acetone).
Symptoms - the child often vomits undigested food mixed with bile. The temperature rises and severe abdominal pain appears. The child's breath smells like acetone.
Be sure to take your child for examination see a pediatric gastroenterologist to clarify the diagnosis. Every five minutes, give your child a teaspoon of a solution of rehydron or alkaline mineral water without gas. Do an enema to cleanse the intestines (2 teaspoons of soda per 200 grams of water). Give your child a sorbent (polysorb, smecta, sillard). Diet - for several days, give your baby porridge, crackers, pureed vegetable soups.
A nutritious diet and the exclusion of stressful situations will prevent a recurrence of the child’s acetone crisis.
Tests and diagnostics prescribed pediatric gastroenterologist :
1. Stool tests for carbohydrates, dysbacteriosis, scatology
2. Biochemical blood test
3. Diagnosis of the pancreas and liver
4. Gamma-glutamyltransferase, aspartate aminotransferase, proteinogram (protein fractions), alpha-1-acid glycoprotein, total bilirubin, antitrypsin, cholinesterase, etc.
5. Ultrasound examination (ultrasound) of the abdominal cavity
Well, in general, according to the requests of the masses, so to speak... =)
IN modern recommendations of the Ministry of Health of the Russian Federation on the nutrition of children of the first year of life it says: “The optimal timing of the introduction of various products is determined by the physiological and biochemical characteristics of the development of infants. Thus, by 3 months of life, the increased permeability of the intestinal mucosa decreases, the maturation of a number of digestive enzymes is noted, at 3-4 months a sufficient level of local intestinal immunity is formed and the mechanisms of swallowing semi-liquid and solid food (extinction of the “spoon pushing reflex”).”
World Health Organization formulates recommendations on timing of introduction of complementary foods in the following way: "Complementary feeding foods should be introduced around 6 months of age. Some breastfed babies may need complementary feeding foods earlier, but not before 4 months of age.".
Let's figure out what readiness for complementary feeding is, at what age it occurs, and how physiological such timing and complementary feeding patterns are from the point of view of the functioning of the developing digestive system.
From a biological point of view, a human baby is ready to be introduced to adult food when:
1) his mechanisms for its assimilation are maturing (physiological readiness);
2) he is able to chew and swallow food in pieces (physiological readiness);
3) able to hold a piece in the hand and bring it to the mouth (physical readiness);
4) he has a so-called “food interest” is social behavior, which is expressed in the desire to imitate adults and eat what they eat (psychological readiness).
Let's consider these points in more detail.
1) Physiological readiness for complementary feeding. Maturation of the gastrointestinal tract and enzymatic system.
How does the digestive system of an infant who receives no other food or liquid other than breast milk work?
Enzyme activity in a child receiving only breast milk remains low throughout the first six months of life. By the way, it is the immaturity of the enzymatic system of a normal healthy breastfed child that is responsible for the white coating on his tongue, which pediatricians very often mistake for thrush - a fungal disease of the oral cavity.
During exclusive breastfeeding, the stomach and pancreas do not work at full capacity; most of the absorption processes occur in the intestines. This becomes possible due to the special properties of breast milk, which contains enzymes in its composition. That is, with breast milk, the baby simultaneously receives substances that help digest it.
What happens if a breastfeeding baby begins to receive formula or other foods as supplementary or complementary foods before his digestive tract is ready for it? The mechanisms of assimilation of other foods already described above will still start, because the human body’s ability to adapt is very high. But these processes will be forced to start and earlier than provided for by the genetic program of this particular child. Such a child, earlier than his peers, begins to assimilate certain types of adult food and extract from it the substances necessary for growth and development. But is this an achievement and does it improve health?
There is enough evidence to doubt this. That's what writes about it pediatrician, candidate of medical sciences, employee of the Scientific Center for Children's Health of the Russian Academy of Medical Sciences: “Quite often, the early introduction of complementary foods (at 3-4 months) causes adverse reactions on the part of the child’s physiologically unprepared body. The most common dysfunctions of the gastrointestinal tract are observed in the form of abdominal pain, intestinal colic, regurgitation, vomiting and stool disorders.<...>...there are situations when early complementary feeding (especially if the rules for its introduction are not followed) provokes a serious breakdown of the digestive system<..>. Another common complication of early introduction of complementary foods is the occurrence of allergies. Its development is facilitated by the high permeability of the intestinal wall to large molecules, the immaturity of digestive enzymes and the immune system.<...>Sometimes the early introduction of a new product provokes the development of long-term and difficult-to-treat allergic diseases, for example, atopic dermatitis - chronic inflammation of the skin of an allergic nature, bronchial asthma, etc.<...>There are also long-term consequences of early introduction of complementary foods. Early complementary feeding creates increased stress on the child's immature organs, especially the gastrointestinal tract, liver and kidneys. And in the future, when the baby grows up, these organs turn out to be weaker and more vulnerable to adverse effects. For example, weakness of the gastrointestinal tract can manifest itself in preschool age with abdominal pain, vomiting and stool disorders, and at school age the development of inflammatory processes in the stomach and intestines (gastroduodenitis, colitis) is already possible. Thus, the first complementary foods should be introduced at a time favorable for this.".
By according to WHO, the minimum age at which a child can receive complementary foods without obvious harm to health is “about 4 months.” By this age, some children have developed sufficient neuromuscular coordination to “form a bolus of food, move it into the oropharynx and swallow.” Before 4 months, “infants do not yet have the neuromuscular coordination to control head movements and spinal support, and therefore infants have difficulty maintaining position to successfully absorb and swallow semi-solid foods.” Also, "at about 4 months, stomach acid helps gastric pepsin digest protein completely" and "renal function becomes much more mature, and infants are better able to conserve water and cope with higher concentrations of solutes."
Thus, we can say that the body of a healthy breastfed child begins to gradually mature to receive food other than breast milk from about 4 months. However, firstly, it is impossible to establish the exact age of gastrointestinal readiness for each individual child. Secondly, in addition to the readiness of the digestive system, there are other factors that need to be taken into account. They will be discussed below.
2) Physiological readiness for complementary feeding. The death of the reflex to push out solid food and teething.
Up to 5-6 months, babies retain the so-called reflex of pushing solid food out of solid food - a natural mechanism formed precisely so that nothing but breast milk enters the child’s body. However, man figured out how to deceive nature - he learned to grind or grind food into a homogenized mass and “pour” early complementary foods into the child either in this way or in the form of juices. And not only to pour in, but also to provide a theoretical basis for it. IN already mentioned recommendations of the Ministry of Health it is stated that "in 3-4 months<…>The mechanisms of swallowing semi-liquid and solid food mature (the extinction of the “spoon pushing reflex”).”. Quite a bold statement, which is in no way confirmed by practice. Most children of this age are indeed physiologically capable of eating semi-liquid or thoroughly pureed food from a spoon, but this does not at all equal the extinction of the reflex of pushing out solid food. In practice, children of mothers who start complementary feeding earlier than 5-6 months choke when they detect the slightest lump in porridge or puree. In addition, difficulties with swallowing pieces may persist even after 6 months.
However, even if we assume that in some children the reflex of pushing out solid food dies off already at 3-4 months, it is incorrect to talk about the child’s readiness for complementary feeding based on this sign alone.
An additional physical sign is teething. However, like the death of the adult food reflex, the mere fact of teething before 6 months does not indicate the child’s readiness for complementary feeding. It is necessary to consider whether a child is ready to be introduced to solid food individually, taking into account the entire set of signs. A child is able to successfully chew food even before the appearance of his first teeth.
3) Maturation of motor skills and the emergence of food interest. Physical and mental readiness for complementary feeding.
A human baby is born immature and completely dependent on its mother. At the age of up to 6 months, the baby gradually, in accordance with the genetic program embedded in him, learns to hold objects in his hands, bring them to his mouth, sit and, finally, move independently (crawling and walking). At the same age, by observing adults, he begins to form the first skills of social adaptation. The degree of development of the psyche and motor functions is directly related to readiness for complementary feeding. A child is ready to get acquainted with adult food when he has opportunity and desire try this food.
Complementary feeding started “on the initiative of the mother,” that is, until the moment the child has shown interest in other food and can physically obtain it (for example, while in the mother’s arms, grab a piece from the table and put it in his mouth), there will always be a need for this the child is “early”, and therefore fraught with health risks.
Based on all of the above, for each child the age at which complementary feeding begins will be individual, based on the totality of all the signs of maturation of his or her body. But on average, for most fully breastfed children, all signs of readiness for complementary feeding appear no earlier than 5.5 months.
Now let's figure out which children, according to WHO “complementary feeding products may be needed earlier (6 months), but not earlier than 4 months of age”.
Early complementary feeding for medical reasons: yes or no.
As stated in the same modern recommendations of the Ministry of Health of the Russian Federation, "The need to expand the child's nutrition and supplement mother's milk with other food products is due to<...>the need for additional introduction into the body of a growing child of energy and a number of nutrients, the supply of which only with human milk, at a certain stage of infant development (from 4-6 months), becomes insufficient".
Based on this statement, it is concluded that children exclusively breastfed up to 6 months are at greater risk of developing iron deficiency anemia, food allergies and malnutrition (underweight).
However, this statement contradicts modern scientific data.
Research has proven that proteins, fats, and carbohydrates, as well as vitamins and minerals, are found in breast milk in the most bioavailable form. This means that throughout the entire period of breastfeeding (and even in an adult), these substances are absorbed from breast milk better than from other products.
In addition, research has long confirmed another fact - the energy value of breast milk not only does not decrease with the age of the child, but, on the contrary, increases. Such data, in particular, were obtained during laboratory monitoring of the composition of breast milk, carried out by a group of specialists from the Ural State Medical Institute.
About the same WHO also writes : “The data in Table 11 suggest that infants in industrialized countries who consume average amounts of breast milk do not require any complementary feeding to meet their energy needs until 6–8 months of age.”.
Thus, if a child actually experiences anemia or underweight EVEN while fully breastfed, this means that the functioning of his digestive system is already impaired. And if so, he will not absorb nutrients and microelements from other foods. Moreover, increasing the volume of complementary foods by reducing the number of daily breastfeedings can cause a decrease in weight gain, constipation and other gastrointestinal disorders, as well as the occurrence of anemia and allergies (since they create an unjustified load on the immature digestive tract and enzymatic system).
In other words, early complementary feeding not only does not solve the child’s health problems, but can lead to a worsening of his condition. The strategy for helping a child in case of established problems with the absorption of nutrients and microelements from mother’s milk should not be based on the introduction of complementary foods, but on finding and eliminating the cause of the disease and its drug or other therapy with the obligatory preservation of full breastfeeding. If there is a need to stimulate the enzymatic system, up to 5.5 months it is better to feed the child not complementary foods with adult food, but supplementary feeding with a small amount of an adapted formula. The risk from supplementary feeding with formula at the age of 3-5 months is significantly lower than from receiving adult food at this age.
A few words about food allergies. This condition is ALWAYS associated with pathologies of the gastrointestinal tract. Allergy occurs due to high permeability of the intestinal walls, unable to resist the penetration of antigens. Factors in the development of allergies in infants related to nutrition include lack of colostrum feeding, supplementary feeding with formula in the first days of life, mixed feeding. The introduction of early complementary feeding to children with allergies cannot be justified by medical necessity, because early complementary feeding necessarily means an increase in the load on the child’s already weak and permeable gastrointestinal tract.
Children with allergies can be introduced to complementary foods only when there are all signs of readiness for it and very gradually. Breast milk has the most gentle effect on the baby’s digestive system, and the enzymes it contains help digest food, which is even more important for an allergic child than for a healthy child.
Overdiagnosis of anemia and malnutrition in exclusively breastfed children. If a child is found First of all, it is necessary to clarify what weight gain standards the pediatrician uses and how much weight gain deviates from the WHO schedules for breastfed children. Perhaps the child gains absolutely normally, he just does it differently than a child on IV.
In addition, it is important to remember that the diagnosis of “hypotrophy” is made only on the basis of a set of signs, including the state of the child’s muscle tone, his skin, assessment of physical and mental development, and not on the basis of absolute weight indicators.
If the fact of insufficient weight gain is established, the next step is to assess the organization of breastfeeding and eliminate risk factors for weight loss, if they occur. At the age of 3-6 months these factors are:
1) the absence of long feedings during the day, in particular, when falling asleep, during sleep and when waking up; An awake baby of this age may be distracted from the breast, suckle little and receive less milk than necessary. For example, underweight occurs if the child spends all his sleep on the street or on the balcony, or falls asleep not with the breast, but with a pacifier.
2) professional massage;
3) any change in the child’s usual daily routine and living conditions (guests, trips, moving, learning to sleep in his own bed, etc.);
4) swimming and diving in a large bathtub or pool (especially if these procedures began to be practiced after 3 months);
5) vaccination.
Iron-deficiency anemia- a diagnosis that is made based on a combination of clinical signs and always means a metabolic disorder and gastrointestinal tract function. Based on hemoglobin tests alone, such a diagnosis is incorrect. Besides:
- hemoglobin standards in children differ from those in adults;
- at approximately 3 months, children experience physiological decrease in hemoglobin levels, not requiring treatment;
- what level of hemoglobin is normal for a child on breastfeeding and whether these indicators differ from those of children on artificial feeding have not been studied. However, according to WHO, 30% of breastfed children at the age of 1 year have lower hemoglobin than their peers who do not receive breast milk. Such a number of “deviations from the norm” may not indicate the prevalence of the pathology, but rather the fact that for children on breastfeeding, lower hemoglobin levels at the age of 1 year are the physiological norm. In the past, WHO has already adjusted the norms for weight gain for children during breastfeeding (downwards); it is possible that other parameters for assessing child health, depending on the presence or absence of breastfeeding, also need revision.
In any case, when diagnosing iron deficiency anemia, it is necessary to take into account not only the numbers in the tests, but the general condition of the child, the presence or absence of clinical signs of the disease.
Volumes of complementary feeding at the age of 6-12 months and older. Nutritional value of breast milk at this age.
Receiving the first complementary foods stimulates the activity of the infant's enzymatic system. The stomach and pancreas are involved in the process of digesting food. However, this does not happen instantly; the body takes time to “learn” to fully absorb nutrients and vitamins from other foods. Until this happens, the baby gets everything it needs from breast milk.
In the first months after the start of complementary feeding, its main task is not to feed the child and not to compensate for the lack of nutrients and vitamins that arose during breastfeeding (since it is still impossible to do this instantly with adult food). Complementary feeding at this age is needed in order to:
- introduce the child to adult food;
- stimulate the functioning of the enzymatic system;
- teach chewing and swallowing;
- support the child’s food interest;
- form normal eating behavior.
The solution to all these problems is facilitated by the so-called pedagogical complementary feeding, that is, feeding the child small pieces (microdoses) of products included in the family diet.
According to modern WHO recommendations, breast milk (or its substitutes) should make up at least 70-75% of a child’s diet at the age of 1 year. There is other evidence that suggests that breast milk is quite capable of meeting all the needs of a child of 6-12 months. Thus, St. Petersburg professor-pediatrician I.M. Vorontsov, based on his research, claims that if the mother is healthy and eats normally, the child can be breastfed without complementary feeding for up to 9-12 months without any harm to himself.
There is a theory (it is put forward by ethologists) that at the dawn of evolution, when a person ate mainly coarse plant fiber, breast milk was the main food of a child until at least 3-4 years of age (only by this age can a child fully absorb such fiber), otherwise case, without mother's milk or nurse's milk, the child did not survive.
This theory is confirmed by the state of affairs in modern Africa, where, in conditions of a lack of protein foods, the duration of breastfeeding can truly become a matter of child survival. Scientists disease "kwashiorkor" described- a severe form of malnutrition due to protein deficiency, often accompanied by a lack of vitamins and the addition of an infection, which usually develops after weaning the child. “The disease usually occurs in children 1-4 years old.<...>When a child is weaned, in the case when products replacing mother's milk contain a lot of starches and sugars and little protein<..>, the child may develop kwashiorkor. This name comes from a coastal language in Ghana, its literal meaning is "first-second" and means "rejected", reflecting that the condition begins in the eldest child after weaning, often due to being born into the family. another child."
In practice, based on the experience of mothers living in modern civilized countries, breast milk is enough to meet the nutritional needs of a child for at least 1.5 years. When the body no longer has enough calories or some microelements from breast milk, a child of this age himself increases the volume of adult food or some specific products in his diet - the main thing is not to spoil his eating behavior by force-feeding and give him access to family “resources”, then Take food with you to the table and offer a variety of food.
A child's digestive system is mainly formed by the age of 2. Until this age, breast milk supports the functioning of the child’s digestive system, helps absorb essential nutrients, reduces the risk of diseases of the digestive system, and contributes to a milder transfer of infectious and inflammatory diseases of the gastrointestinal tract.
Vomit is a complex reflex act with the participation of the vomiting center, which is located in the medulla oblongata, near it there are respiratory, vasomotor, cough and other autonomic centers. All centers are functionally interconnected, so vomiting is accompanied by changes in breathing, circulatory disorders, and the release of large amounts of saliva.
Regurgitation- elimination of eaten food without effort, without contractions of the muscles of the anterior abdominal wall, immediately after feeding or after a short period of time. The general condition of the child is not disturbed, there are no vegetative symptoms, appetite and mood do not change.
In newborns and children in the first months of life, there is a tendency to regurgitate, which is due to the anatomical and physiological characteristics of the stomach in newborns - weakness of the cardiac sphincter with a well-developed pyloric sphincter, horizontal position of the stomach and the child itself, high pressure in the abdominal cavity, large volume of nutrition (1/5 body weight per day). Overfeeding and aerophagia contribute to regurgitation.
At overfeeding regurgitation occurs immediately after feeding or after a certain period of time in a small volume of unchanged or slightly curdled milk. The child’s general condition does not suffer and he is gaining weight. When carrying out control weighing, the volume of milk consumed by the newborn is determined, which is much more than is required according to the norm. When overfeeding, it is recommended to change the breastfeeding time of the baby or first express part of the milk, which is easily sucked out, but is less rich in nutritional ingredients.
Aerophagia- swallowing a large amount of air during feeding, occurs in hyperexcitable, greedily sucking children, from the 2-3rd week of life with a small amount of milk in the mammary gland or bottle, when the child does not grasp the areola, with a large hole in the nipple, horizontal position of the bottle when the nipple is not completely filled with milk, with general muscle hypotonia associated with the immaturity of the body.
Aerophagia most often occurs in newborns with low or very high birth weight. Children are restless after feeding, and there is bulging in the epigastric region. 5-10 minutes after feeding, regurgitation of unchanged milk is observed. In case of aerophagia, it is necessary to have a conversation with the mother about the correct feeding technique. After feeding, it is necessary to hold the baby upright for 15-20 minutes, which helps the air swallowed during feeding to escape. It is recommended to place children with an elevated head end.
Regurgitation and vomiting can be one of the important symptoms in many diseases associated with the pathology of the gastrointestinal tract itself (primary) and causes outside the digestive tract (secondary). Functional and organic vomits are also distinguished. Organic vomiting is associated with malformations of the gastrointestinal tract. There are 3 main groups of causes leading to secondary vomiting:
- infectious diseases,
- cerebral pathology,
- metabolic disorders.
Functional forms of vomiting
The most common functional pathology of the gastrointestinal tract is cardia failure. Newborns do not have a pronounced sphincter in the area of the transition of the esophagus to the stomach; the cardia is closed by the valve apparatus. Cardia insufficiency may be caused by impaired innervation of the lower part of the esophagus (often observed in perinatal encephalopathy), increased intra-abdominal and intragastric pressure in certain diseases.
With cardia deficiency, regurgitation occurs immediately after feeding, in a horizontal position of the child, frequent, not abundant. Reflux esophagitis, which develops with this pathology, can cause the development of cardiovascular failure. The child develops cyanosis, weakness, adynamia, tachyatrythmia, shortness of breath, liver enlargement, oliguria, and wheezing appears in the lungs.
Treatment. It is recommended to place the child on his stomach with the head end elevated by 10°, split meals of 40-50 ml up to 10 times a day, prevention of aerophagia. Medicines prescribed: bethanechol, domperidone (Motilium), cerucal or raglan 30 minutes before meals 3 times a day.
Esophageal achalasia (cardiospasm)- persistent narrowing of the cardiac region due to impaired innervation as a manifestation of congenital pathology or various diseases. In this case, the opening of the cardia during swallowing is disrupted, atony of the esophagus is noted, food is retained above the spasmodic cardia and the esophagus gradually expands.
The main symptom in newborns is vomiting during feeding with just eaten milk, difficulty swallowing, and it seems that the child is “choking” while eating. Repeated aspiration may result in pneumonia.
The diagnosis is confirmed by endoscopic and x-ray examination.
Treatment. We recommend split meals up to 10 times a day, large doses of vitamin B: intramuscularly, antispasmodics, sedatives, 0.25% solution of novocaine, 1 teaspoon before each feeding, 2.5% solution of aminazine and pipolfen, 0.25 % solution of droperidol with novocaine - prescribed 1 tsp. 3 times a day 30 minutes before meals.
Pylorospasm- spasm of the pyloric muscles, leading to difficulty emptying the stomach. Increased tone of the pyloric region is associated with hypertonicity of the sympathetic nervous system due to perinatal encephalopathy and hypoxia. Typically, children with pylorospasm are hyperexcitable, intermittent regurgitation appears from the first days of life, and vomiting appears as the amount of food increases. Vomiting is daily, not the same number of times during the day, vomiting appears closer to the next feeding, the vomit is abundant, with curdled acidic contents without an admixture of bile, the volume does not exceed the volume of food eaten. The child, despite vomiting, gains weight, although not enough, as a result of which malnutrition develops. The stool is normal. The diagnosis is confirmed by x-ray.
Treatment. At the beginning of feeding, you can give 1 teaspoon of 10% semolina porridge, which promotes the mechanical opening of the pylorus. Antispasmodic and sedative therapy.
Organic forms of vomiting (malformations of the gastrointestinal tract)
Esophageal atresia- one of the most common malformations of the esophagus, often combined with a lower tracheoesophageal fistula. Clinical manifestations: from the first hours of life, foamy mucus is released from the child’s mouth and nose, which, after suction, accumulates again, and aspiration pneumonia develops. Esophageal atresia can be diagnosed using probing; the probe does not pass into the stomach (an obstacle is felt), air quickly introduced with a syringe through the probe comes out with noise back through the nose or mouth, and with normal patency it silently passes into the stomach. Treatment is surgical.
Congenital intestinal obstruction.
The causes of congenital intestinal obstruction can be malformations of the intestinal tube itself (atresia, stenosis, membranes), malformations of other organs leading to compression of the intestine, and blockage with thick viscous meconium.
Clinically, congenital intestinal obstruction manifests itself in newborns acutely from the first days or hours of life. Depending on the level of obstruction, it is divided into high and low intestinal obstruction. If there is an obstruction in the duodenum, intestinal obstruction manifests itself as upper, and if there is an obstruction in the jejunum, ileum, or colon - as low.
With high intestinal obstruction, the contents that accumulate in the stomach and duodenum are released through vomiting and regurgitation. Vomiting appears on the first day or hours of life, profuse, with gastric contents (sometimes mixed with bile), infrequent; if the child is fed, then vomiting appears after feeding; the amount of vomit approximately corresponds to the amount of milk received by the child during feeding. Excessive vomiting can lead to dehydration and the development of aspiration pneumonia. Meconium passes, but there is no subsequent stool; there is a long passage of meconium (within 5-6 days) in small portions. There is bloating in the upper parts of the abdomen, which disappears after vomiting or bowel movements during probing, and then appears again. In other parts of the stomach, the abdomen may be sunken. Symptoms of exicosis are noted.
The diagnosis is confirmed by x-ray.
Low intestinal obstruction. Almost immediately after birth, bloating is observed, which does not disappear after vomiting or artificial emptying of the stomach. Meconium does not pass; lumps of mucus, slightly green in color, are observed instead of stool. Vomiting appears on the 2-3rd day of life, the vomit may contain an admixture of intestinal contents (“fecal” vomiting), vomiting is more frequent than with high obstruction, but less profuse. The general condition suffers significantly, symptoms of intoxication are pronounced, with late diagnosis of the disease, symptoms of peritonitis appear: a sharply swollen abdomen, not accessible to deep palpation, a pronounced subcutaneous venous network on the abdomen, swelling of the subcutaneous tissue in the area of the anterior abdominal wall, especially in the lower parts, cyanotic tint of the skin covers on the stomach.
The diagnosis of low intestinal obstruction is confirmed by x-ray.
Preoperative preparation in the maternity hospital: withdrawal of enteral nutrition, installation of a gastric tube for regular gastric emptying.
Atresia of the anus and rectum.
Highlight:
- atresia of the anus and rectum without fistulas;
- atresia of the anus and rectum with fistulas (external - perineal, internal - fistulas with the urinary and reproductive system).
With atresia of the anus and rectum, the absence of the anus can be seen and the absence of meconium passage is noted.
Treatment is surgical or conservative, specialized in the surgical department.
Secondary forms of vomiting (symptomatic)
Vomiting can be one of the symptoms of an infectious, cerebral disease, or metabolic disorder.
Vomiting associated with cerebral pathology. The most common cause of vomiting and regurgitation in newborns is a pathology of the central nervous system of hypoxic, traumatic or infectious origin. In addition to vomiting, newborns have symptoms of brain damage: a monotonous weak cry or a piercing cry, a groan, bulging and tension of the large fontanel, syndromes of depression or excitation of the central nervous system, convulsive syndrome, etc. Vomiting with damage to the central nervous system is associated with both central mechanisms: increased intracranial pressure, edema brain cells, irritation of the vomiting center, and with disorders of the autonomic system that regulates the functions of the digestive organs, which leads, in particular, to pylorospasm.
Vomiting due to pathology of the central nervous system can be a persistent “fountain” or manifest itself as regurgitation.
Treatment of vomiting syndrome against the background of cerebral pathology - the underlying disease is treated.
Nutritional dyspepsia. In view of the existing physiological characteristics of the digestive system of newborns, any errors in nutrition can lead to dyspeptic disorders:
- quick transfer to artificial feeding,
- feeding with unadapted formulas,
- non-compliance with the rules for preparing and storing mixtures,
- overfeeding,
- indiscriminate feeding.
If the breakdown of carbohydrates is disrupted, which often happens when a child is given sweet tea or overfed with sweet formulas, there is bloating, restlessness, regurgitation, loose, watery, foamy, yellow stools, there may be an admixture of greens, with a sour odor, a large amount of iodophilic substances in the stool analysis bacteria.
If protein digestion is impaired, the stool is loose, yellow-brown, with a strong unpleasant odor, bloating and constipation are noted. X newborns are rare.
The most common type of dyspepsia in newborns is a violation of the digestion and absorption of fats. The stool has a shiny appearance with white cheesy lumps; stool analysis reveals neutral fat and fatty acids.
Nutritional dyspepsia in newborns can lead to insufficient weight gain, but with this form of dyspepsia there is practically no weight loss and dehydration, and there are no symptoms of intoxication.
Treatment. Within 8-12 hours, fractional drinks are prescribed (glucose-saline solutions, water, 5% glucose solution). Then breastfeeding is resumed, starting with S the prescribed volume and, over the course of 2-3 days, brought to the full volume. The number of feedings is increased to 8-10 times. If it is impossible to feed the baby with breast milk, an adapted milk formula is selected. Bifidumbacterin, pancreatin, festal and others are prescribed.
Decoctions of herbs that have an astringent effect are used: rhizomes of cinquefoil, burnet, serpentine, bird cherry fruits, blueberries, alder fruits; herbs that have an anti-inflammatory effect - chamomile flowers, St. John's wort, mint; carminative effect - dill herb, caraway fruits, fennel, centaury stems, chamomile flowers, mint. Steam 10 g per 200 ml of water, boil in a water bath for 30 minutes, cool and bring the volume to 200 ml with boiled water. Give children 5 ml 3-4 times a day 15 minutes before feeding.
Dysbacteriosis. The fetus in utero during physiological pregnancy is sterile, it begins to be colonized by microorganisms during childbirth in the birth canal, and after birth, microorganisms from the environment enter the child’s gastrointestinal tract. By the end of the first day, the child’s intestines are populated by a variety of microorganisms - cocci, enterobacteria, yeast, opportunistic and pathogenic - and transient dysbiosis develops. By the 7-8th day of life, the microbiocenosis of the newborn's intestines is established: the main microflora is 95% bifidobacteria, the accompanying microflora is lactobacilli and normal strains of Escherichia coli, the residual microflora is saprophytes and opportunistic microbes (enterococci, non-pathogenic staphylococci, Proteus, yeast, etc. .), this part should not be more than 1%.
The process of establishing normal intestinal microflora has become longer, which is associated with dysbiocenosis of the vagina and intestines of the mother and the staff of maternity hospitals, non-compliance with hygiene standards when caring for newborns, late latching of the child to the breast, a decrease in the general immunological reactivity of the newborn in pathology (asphyxia, birth trauma, intrauterine infections, tension-type headache, blood loss, etc.), antibiotic therapy.
Dysbacteriosis is qualitative and quantitative changes in the composition of intestinal microflora.
Dysbacteriosis manifests itself as persistent dyspeptic disorders. There is bloating, regurgitation, decreased appetite, loose, frequent stools, with greens, undigested particles, an unpleasant odor, slow restoration of body weight, and poor weight gain during the first month of life.
Treatment. It is best to feed the child with breast milk; in the absence of breastfeeding, mixtures with bioactive additives are indicated - lysozyme, bifidobacteria, immunoglobulins; milk formulas enriched with protective factors - adapted with the addition of acidophilus bacillus, lacto- or bifidobacteria, lysozyme, immunoglobulins (“Malyutka”, “Bifidolact”, etc.).
Drug treatment is carried out in 2 stages:
Stage I - suppression of the growth of opportunistic microorganisms. If there is a predominant growth of staphylococcus, E. coli or Proteus, then the appropriate bacteriophage is prescribed. If there is an increase in several types of microbes, then furadonin or furazolidone, bactisubtil are prescribed for 5-7 days.
Stage II - normalization of intestinal microflora: bifidumbacterin, lactobacterin, bactisubtil, pancreatin, festal and others. The duration of treatment at stage II is selected individually, on average 3-4 weeks.
Complications.
Dehydration is the most common and severe complication of gastroenteritis. Loss of water and electrolytes (sodium, chlorine, potassium) through the intestines during diarrhea. There are 3 degrees of dehydration according to weight loss: I - up to 5% of weight; II - 6-10%; III - more than 10%.
With moderate dehydration, there may be a slight retraction of the large fontanelle, eyeballs, dry mouth, mucous membranes, and decreased diuresis. Blood pressure is usually normal, but the child may be lethargic or agitated.
Blood pressure may decrease, the pulse quickens, filling is weak, and diuresis is characteristically decreased. The child is very lethargic, there may be convulsions, followed by loss of consciousness, coma. Increased hematocrit and hemoglobin in the blood, hyponatremia, hypokalemia. With severe diarrhea, a child may lose more than 15% of body weight in a few hours, which is usually accompanied by hypovolemic shock.
Other complications with acute intestinal infections are less common: sepsis, disseminated intravascular coagulation syndrome, pneumonia, urinary tract infection, otitis media, meningitis.
In diagnosis, culture of the pathogenic pathogen from stool is crucial. When examining stool, the best results are obtained by culture in the early stages of the disease before the start of antibacterial therapy. The most modified particles of fresh feces are selected for research.
Specific diagnosis of viral diarrhea is carried out by electron microscopy of stool and various immunological methods.
Treatment of OKI
Basic principles of treatment of acute intestinal infections in children:
- Diet.
- Rehydration therapy.
- Enzyme therapy.
- Symptomatic therapy.
- Etiotropic therapy.
- Syndromic therapy.
- Surveillance and control.
", September 2012, p. 12-16
E.S. Keshishyan, E.K. Berdnikova, A.I. Khavkin, Federal State Budgetary Institution "Moscow Research Institute of Pediatrics and Children's Surgery" of the Ministry of Health and Social Development of the Russian Federation
It is well known that functional intestinal dysfunctions occur in almost 90% of young children, with varying intensity and duration, and in most children they are completely relieved at the age of 3–4 months. Why is this problem of particular interest to pediatricians, neonatologists, gastroenterologists and even neurologists? Strange as it may seem, the management of such children causes great difficulties for specialists, due to the fact that, on the one hand, little is taken into account the fact that the child’s digestive system adapts most difficultly to extrauterine existence, on the other hand, the influence of parents’ worries, which makes a number of In cases where doctors prescribe unreasonably serious examinations and medicinal interventions. However, if “intestinal colic” occurs in almost all young children, then it is a functional, to some extent “conditionally” physiological state during the period of adaptation and maturation of the gastrointestinal tract of an infant. .
“Maturation” of the gastrointestinal tract lies in the imperfection of motor function (determines the presence of regurgitation and intestinal spasms) and secretion (variability in the activity of gastric, pancreatic and intestinal lipase, low pepsin activity, immaturity of disaccharidases, in particular lactase), which underlie flatulence. All this is not associated with organic reasons and does not affect the child’s health. But, also, one cannot discount various dietary versions: intolerance to cow's milk proteins in formula-fed children, fermentopathy, including lactase deficiency. However, in this situation, “intestinal colic” is only a symptom.
Our comparative studies of the duration and severity of functional intestinal colic in full-term and premature infants have established that the severity and severity of functional intestinal colic increases with increasing gestational age. In the group of very premature babies (gestation period 26–32 weeks), the problem of intestinal colic practically did not exist. We assume that this is due to the deep immaturity of the neuro-reflex regulation of the gastrointestinal tract, as a result of which intestinal spasm does not manifest itself, although gas formation in these children is increased due to the immaturity of the enzymatic system and the lengthening of the period of colonization of the microflora of the gastrointestinal tract. Slower peristalsis and a tendency for the intestine to distend without spasm may explain the frequency of constipation in these children.
At the same time, in children with a gestation period of more than 34 weeks, the intensity of colic can be quite pronounced, since by this period the maturation of neuromuscular relationships mainly occurs. Moreover, a relatively later time of onset of intestinal colic has been established, corresponding to 6–10 weeks of postnatal life. (But taking into account gestational age, these periods do not differ from those of full-term children - 43–45 weeks of gestation). The duration of colic is increased to 5–6 months.
Colic comes from the Greek kolikos, which means pain in the colon. It is understood as paroxysmal pain in the abdomen, causing discomfort, a feeling of fullness or compression in the abdominal cavity. Clinically, intestinal colic in infants occurs in the same way as in adults - abdominal pain that is spastic in nature or associated with increased gas production.
The attack, as a rule, begins suddenly, the child screams loudly and piercingly. The so-called paroxysms can last a long time, redness of the face or pallor of the nasolabial triangle may be noted. The abdomen is swollen and tense, the legs are pulled up to the stomach and can instantly straighten, the feet are often cold to the touch, and the arms are pressed to the body. In severe cases, the attack sometimes ends only after the child is completely exhausted. Often noticeable relief occurs immediately after bowel movement. Seizures occur during or shortly after feeding. Despite the fact that attacks of intestinal colic are repeated frequently and present a rather frightening picture for parents, we can assume that the child’s general condition is not disturbed and in the period between attacks he is calm, gains weight normally, and has a good appetite.
The main question that every doctor who observes young children needs to decide for himself: if attacks of colic are common to almost all children, can this be called a pathology? If not, then we should not engage in treatment, but in the symptomatic correction of this condition, giving the main role to the physiology of development and maturation.
We have developed a certain phasing of actions to relieve this condition. Measures for relieving an acute painful attack of intestinal colic and background correction are highlighted.
The first very important stage is having a conversation with confused and frightened parents, explaining to them the causes of colic, that it is not a disease, explaining how it progresses and when it should end. Relieving psychological stress and creating an aura of confidence also helps reduce the child’s pain and carry out all the pediatrician’s prescriptions correctly. Recently, many works have appeared proving that functional gastrointestinal disorders are more common in first-born children, long-awaited children, children of elderly parents and in families with a high standard of living, i.e. where there is a high threshold of anxiety about the child’s health. This is due to the fact that frightened parents begin to “take action”, as a result of which these disorders are consolidated and intensified. Therefore, in all cases of functional disorders of the gastrointestinal tract, treatment should begin with general measures that are aimed at creating a calm psychological climate in the child’s environment, normalizing the lifestyle of the family and the child.
It is necessary to find out how the mother eats and, while maintaining the variety and adequacy of the diet, suggest limiting fatty foods and those foods that cause flatulence (cucumbers, mayonnaise, grapes, beans, corn) and extractive substances (broths, seasonings). If the mother does not like milk and rarely drank it before pregnancy or the flatulence increased after pregnancy, then it is better now to replace the milk with fermented milk products.
Currently, in pediatric practice, the diagnosis of lactase deficiency, made only on the basis of an increase in fecal carbohydrates, has become very common. However, these changes only indicate insufficient digestion of carbohydrates in the intestines. Currently, the amount of carbohydrates less than 0.25% is considered normal. If this indicator is higher, it is considered that the child has lactase deficiency, on the basis of which nutritional correction, treatment and significant restriction of the diet of the nursing mother are prescribed. This is not always true. In pediatric practice, we often encounter practically healthy children whose carbohydrate levels are significantly higher. In follow-up, carbohydrate levels return to normal by 6–8 months of life without any corrective measures. In this regard, the priority factor determining the management tactics of such children should be considered the clinical picture and condition of the child (primarily physical development, diarrhea syndrome and abdominal pain syndrome).
If the mother has enough breast milk, it is unlikely that the doctor has the moral right to limit natural feeding and offer the mother a formula, even a medicinal one.
If the child is on mixed and artificial feeding, then you can change the diet, for example, exclude the presence of animal fats and fermented milk components in the mixture, taking into account the very individual reaction of the child to lactic acid bacteria.
In background correction, it is advisable to use herbal remedies with carminative and mild antispasmodic effects: fennel, coriander, chamomile flowers.
Secondly, these are physical methods: traditionally it is customary to hold the child in an upright position or lying on his stomach, preferably with his legs bent at the knee joints, on a warm heating pad or diaper; massage of the abdominal area is useful.
If a child is characterized by colic that occurs after feeding, then it is largely due to increased gas formation during the digestion of food. And here drugs based on simethicone, for example the drug Sab Simplex, can become irreplaceable and effective.
The drug has a carminative effect, impedes the formation and promotes the destruction of gas bubbles in the nutrient suspension and mucus of the gastrointestinal tract. The gases released during this process can be absorbed by the intestinal walls or excreted from the body due to peristalsis; Sab Simplex destroys gas bubbles in the intestines, is not absorbed into the bloodstream and, after passing through the gastrointestinal tract, is excreted unchanged from the body. Depending on the intensity of the attack and the time of occurrence, Sub Simplex is given to the baby before or after feeding; doses are selected individually (from 10 to 20 drops). However, based on the mechanism of action, simiticone preparations are unlikely to serve as a means of preventing colic. It promotes the removal of gases, thereby reducing pressure on the intestinal walls and this helps reduce pain. The effectiveness of the drug also depends on the time of onset of colic; if pain occurs during feeding, then it is worth giving the drug during feeding. If after feeding, then at the moment of their occurrence. It must be borne in mind that if flatulence plays a predominant role in the genesis of colic, then the effect will be remarkable. If the genesis mainly plays a role in impaired peristalsis due to the immaturity of the intestinal innervation, then the effect will be much less. The drug Sab Simplex has a number of advantages that have won it stable trust from parents. This is, first of all, ease of dosing (drops) and taste sensations. Sub Simplex is tasty for a child and a pleasant taste sensation for many babies is an excellent “distractor” - having felt a new and pleasant taste sensation, a child who was previously screaming furiously suddenly calms down and “smacks” his tongue. This time may be enough for the drug to penetrate the stomach and small intestine and the process of gas absorption begins. In addition, given that the bottle contains 50 doses of the drug, one bottle lasts for more than 10 days, which is also convenient for parents and reduces the price of one dose. All this makes the drug Sab Simplex in many homes where there are children in the first months of life, an irreplaceable and main means of making family life easier. The next stage is the passage of gases and feces using a gas outlet tube or an enema; it is possible to introduce a suppository with glycerin. Children who have immaturity or pathology in nervous regulation will be forced to more often resort to this particular method of relieving colic. If there is no positive effect, prokinetics and antispasmodic drugs are prescribed. The idea of “step-by-step” or step-by-step therapy is that we try to alleviate the child’s condition step by step. It is noted that the effectiveness of staged therapy for intestinal colic is the same in all children and can be used in both full-term and premature infants. The use of special examination methods is used only if there is no real effect from corrective measures, taking into account the natural physiological dynamics of the intensity of colic. After all, colic begins at 2–3 weeks of life, reaches its peak in intensity and frequency by the age of 1.5–2 months, then begins to decrease and ends by the age of 3 months. The advisability of including enzymes and biological products in the complex for the correction of pain syndrome in intestinal colic remains controversial, although in most cases in the first months of life there is a delayed formation of intestinal microbiocenosis. In any case, when deciding to prescribe biological products, it is better to use eubiotics rather than try to “correct” the dissociation of microorganisms revealed by analysis for dysbacteriosis! Thus, the proposed scheme allows us to correct the condition in the vast majority of children with the least drug burden and economic costs, and only in the absence of effectiveness prescribe expensive examination and treatment.
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