Intestinal immaturity in a child symptoms and treatment. Peculiarities of digestion in young children. Colic. Signs of intestinal colic in a baby

§ 1. Functional immaturity of the frontal parts of the brain Already in the course of a conversation with parents, it turns out that the child is easily distracted, cannot concentrate, quickly gets tired of classes, it is difficult to interest him in anything for a long time. He is sluggish and indifferent to almost everything,

§ 2. Functional immaturity of the left temporal region A distinctive feature of the syndrome of immaturity of the temporal structures of the left hemisphere are isolated difficulties in sound discrimination and, as a result, understanding speech perceived by ear. Rest

§ 3. Functional immaturity of interhemispheric interactions of the transcortical level (corpus callosum) This syndrome is distinguished by a characteristic set of typical signs of "functional autonomy" of the cerebral hemispheres in childhood:

§ 4. Functional immaturity of the right hemisphere First of all, in the case of functional immaturity of the right hemisphere, there is a lack of spatial representations (metric, structural-topological, coordinate) and violations

§ 5. Functional deficiency of subcortical formations (basal nuclei) of the brain Among the complaints of parents of children with insufficiency of subcortical formations, the epithets “lazy”, “inattentive”, “uncontrollable”, etc., are primarily

§ 6. Functional deficiency of brain stem formations Dysgenetic syndrome These children are characterized by the accumulation of dysembryogenic stigmas: facial asymmetries, asymmetries of the palpebral fissures, abnormal tooth growth, various kinds of dystonia, including both

Well, in general, at the request 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 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, a number of digestive enzymes mature, at 3-4 months a sufficient level of local intestinal immunity is formed and the mechanisms for swallowing semi-liquid and solid food (extinction of the "spoon ejection reflex")".

World Health Organization formulates recommendations on the timing of the introduction of complementary foods in the following way: "Complementary foods should be introduced at about 6 months of age. Some breastfed babies may need complementary foods earlier, but not before 4 months of age.".

Let's see what is the readiness for complementary foods, at what age does it occur and how physiological are such terms and the complementary feeding scheme from the point of view of the work of the emerging digestive system.

Biologically speaking, a human baby is ready to be introduced to adult food when:
1) the mechanisms for its assimilation mature (physiological readiness);
2) he is able to chew and swallow food in pieces (physiological readiness);
3) able to hold a piece in his hand and bring it to his mouth (physical readiness);
4) he got a so-called. "food interest" - social behavior, which is expressed in the desire to imitate adults and eat the same as they (psychological readiness).

Let's consider these points in more detail.

1) Physiological readiness for complementary foods. Maturation of the gastrointestinal tract and enzymatic system.

How does the digestive system of an infant not receiving any other food and liquid other than breast milk work?

The activity of enzymes in a child who receives 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 explains the white coating on his tongue, which pediatricians very often mistake for thrush - a fungal disease of the oral cavity.

On exclusive breastfeeding, the stomach and pancreas do not work "at full capacity", most of the assimilation 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 child simultaneously receives substances that help his digestion.

What happens if a breastfeeding baby starts receiving formula or other foods as supplements or complementary foods before their digestive tract is ready? The mechanisms of assimilation of other food already described above will still start, because the ability of the human body 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 promote 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 from the physiologically unprepared body of the child. The most common are dysfunctions of the gastrointestinal tract in the form of abdominal pain, intestinal colic, regurgitation, vomiting and stool disorders.<...>... there are situations when early complementary foods (especially if the rules for its introduction are not followed) provoke a serious disruption of the digestive system<..>. Allergies are another common complication of early introduction of complementary foods. Its development is facilitated by the high permeability of the intestinal wall for 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 - a chronic inflammation of the skin of an allergic nature, bronchial asthma, etc.<...>There are long-term consequences of early introduction of complementary foods. Early feeding creates an increased burden on the child's immature organs, especially the gastrointestinal tract, liver and kidneys. And in the future, when the baby is already older, these organs are weaker and more vulnerable to adverse effects. For example, weakness of the gastrointestinal tract can manifest itself at 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 favorable time for this..

By WHO data, 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 develop sufficient neuromuscular coordination to "form a food bolus, transport it to the mouth of the pharynx and swallow." Before 4 months, "Infants do not yet have the neuromuscular coordination to do so. Head control and spinal support are not yet developed, and therefore it is difficult for infants to maintain position for successful absorption and swallowing of semi-solid foods." Also, "by about 4 months, stomach acid helps gastric pepsin to fully digest protein" 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 baby begins to gradually mature to receive food other than breast milk, from about 4 months. However, firstly, the exact age of readiness of the gastrointestinal tract for each individual child cannot be established. Secondly, in addition to the readiness of the digestive system, there are other factors that need to be considered. They will be discussed below.

2) Physiological readiness for feeding. Withering away of the ejection reflex of solid food and teething.

Until 5-6 months, babies retain the so-called reflex of pushing out solid food of solid food - a natural mechanism that has been 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 pour in, but also bring a theoretical basis for it. IN already mentioned recommendations of the Ministry of Health it is claimed that "at 3-4 months<…>the mechanisms of swallowing semi-liquid and solid food mature (fading of the "spoon ejection reflex")". Pretty bold statement, which is not confirmed by practice. Most children of this age are indeed physiologically able to eat semi-liquid or thoroughly pureed food from a spoon, but this does not at all equal the extinction of the solid food push reflex. In practice, children of mothers who start complementary foods earlier than 5-6 months choke when they find the slightest lump in porridge or mashed potatoes. In addition, they may have difficulty swallowing pieces even after 6 months.

However, even if we assume that in some children the solid food ejection reflex dies off already at 3-4 months, it is incorrect to talk about the child's readiness for complementary foods on the basis of 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 that the child is ready for complementary foods. It is necessary to consider whether a particular child is ready to get acquainted with solid food individually, taking into account the totality of signs. The child is able to successfully chew food even before the appearance of the first teeth.

3) Maturation of motor skills and the emergence of food interest. Physical and mental readiness for complementary foods.

The human cub 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 laid down in him, learns to hold objects in his hands, bring them to his mouth, sit and, finally, move independently (crawl and walk). 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 the readiness for complementary foods. The child is ready to get acquainted with adult food when he has opportunity and desire try this food.

Complementary foods started "at the initiative of the mother", that is, until the moment the child has shown interest in other food and can physically get it (for example, being in the arms of the mother, grab a piece from the table and put it in his mouth), there will always be for this child "early", and therefore fraught with health risks.

Based on the foregoing, for each child, the age of the start of complementary foods will be individual, based on the totality of all the signs of maturation of his organism. But on average, in most children who are fully breastfed, all signs of readiness for complementary foods appear no earlier than 5.5 months.

Now let's figure out which children, according to WHO "complementary foods may be needed earlier (6 months), but not before 4 months of age".

Early complementary foods 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 nutrition of the child and supplement mother's milk with other foods is due<...>the need for additional introduction into the body of a growing child of energy and a number of nutrients, the intake of which only with women's milk, at a certain stage of infant development (from 4-6 months), becomes insufficient ".

Based on this statement, it is concluded that children who are exclusively breastfed up to 6 months of age are more at risk of developing iron deficiency anemia, food allergies and malnutrition (underweight).

However, this statement contradicts modern scientific data.

Studies have proven that proteins, and 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 feeding (and even in an adult) these substances from breast milk are absorbed better than from other products.

In addition, studies have long confirmed another fact - the energy value of breast milk with the age of the child not only does not decrease, but, on the contrary, increases. Such data, in particular, were obtained in the course of laboratory monitoring of the composition of breast milk, conducted by a group of specialists from the Ural State Medical Institute.

about the same WHO also writes : "The data in Table 11 show that infants in industrialized countries who consume average amounts of breast milk do not require any complementary foods to meet their energy requirements until the age of 6-8 months".

Thus, if a child is really anemic or underweight EVEN with full breastfeeding, this means that the functioning of his digestive system is already impaired. And if so, he will not absorb nutrients and microelements from other products. Moreover, increasing the volume of complementary foods by reducing the number of daily breastfeeding can lead to a decrease in weight gain, constipation and other disorders of the gastrointestinal tract, as well as the occurrence of anemia and allergies (because they create an unreasonable burden on the immature digestive tract and enzymatic system).

In other words, early feeding not only does not solve the health problems of the child, but can lead to a deterioration in his condition. A strategy to help 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 the search for and elimination of 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 introduce the child not with adult food, but with a small amount of an adapted mixture. The risk of formula supplementation at 3-5 months of age is significantly lower than that of adult formula supplementation.

A few words about food allergies. This condition is ALWAYS associated with pathologies of the gastrointestinal tract. Allergy occurs due to the high permeability of the intestinal walls, unable to resist the penetration of antigens. Factors in the development of allergies in infants associated with the organization of nutrition - the lack of colostrum feeding, supplementary feeding with a mixture in the first days of life, mixed feeding. The introduction of early complementary foods to children with allergies cannot be justified by medical necessity, because early feeding necessarily means an increase in the load on the already weak and permeable gastrointestinal tract of the child. Children with allergies should only be introduced to complementary foods when they show signs of being ready for it, and very gradually. Breast milk has the mildest effect on the child's digestive system, and the enzymes contained in it help digest food, which is even more important for an allergic child than for a healthy child.

Hyperdiagnosis of anemia and malnutrition in children on exclusive breastfeeding.

If a child is found underweight first of all, it is necessary to clarify what growth rates the pediatrician uses and how much weight gain deviates from the WHO schedules for breastfed children. Perhaps the child adds absolutely normally, just does it differently than the child on the IW.

In addition, it is important to remember that the diagnosis of "hypotrophy" is made only on the basis of a combination 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 underweight, if any. At the age of 3-6 months, such factors are:

1) the absence of prolonged feedings during the day, in particular, for falling asleep, during sleep and waking up; an awake baby of this age may be weaning, suckling little, and getting less milk than necessary. For example, a lack of weight happens if a child spends all his dreams on the street or on a balcony, or falls asleep not with a breast, but with a pacifier.
2) professional massage;
3) any change in the usual daily routine and living conditions of the child (guests, trips, moving, accustoming to sleep in his own bed, etc.);
4) swimming and diving in a large bath or in a pool (especially if these procedures began to be practiced after 3 months);
5) vaccination.

Iron-deficiency anemia- a diagnosis that is made on the basis of a combination of clinical signs and always means a violation of metabolism and the functioning of the gastrointestinal tract. Based on hemoglobin tests alone, such a diagnosis is incorrect. Besides:
- norms of hemoglobin in children differ from norms of adults;
- at about 3 months in children observed physiological decrease in hemoglobin levels that does not require treatment;
- what level of hemoglobin is normal for a child on breastfeeding and whether these indicators differ from those of children on artificial feeding, has not been studied. However, according to WHO, 30% of breastfed children at the age of 1 year have lower hemoglobin than their non-breastfed peers. Such a number of "deviations from the norm" may not indicate the prevalence of pathology, but that for children on breastfeeding, lower hemoglobin values ​​at the age of 1 year are the physiological norm. In the past, WHO has already adjusted the norms of weight gain for children by breastfeeding (in the direction of decrease), it is possible that other parameters for assessing children's health need to be revised, depending on the presence or absence of breastfeeding.

In any case, when making a diagnosis of 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 foods at the age of 6-12 months and older. The nutritional value of breast milk at this age.

Receiving the first complementary foods stimulates the activity of the enzymatic system of the infant. The stomach and pancreas are involved in the process of digesting food. However, this does not happen instantly, the body needs time to "learn" to fully absorb nutrients and vitamins from other foods. And until this happens, the child gets everything he needs from breast milk.

In the first months after the start of complementary feeding, his main task is not to feed the child and not to make up for the lack of nutrients and vitamins that has arisen in his breastfeeding (since it is still impossible to do this instantly at the expense of adult food). Complementary foods at this age are needed in order to:
- introduce the child to adult food;
- stimulate the work of the enzymatic system;
- teach chewing and swallowing;
- support the food interest of the child;
- form a normal eating behavior.

The solution of all these problems contributes to the so-called pedagogical complementary foods, that is, feeding the child with small pieces (microdoses) of products included in the family's diet.

According to current WHO recommendations, in the diet of a child at the age of 1 year, breast milk (or its substitutes) should be at least 70-75%. There are other data that indicate that breast milk is quite capable of meeting all the needs of a child of 6-12 months. So, the St. Petersburg pediatrician professor I. M. Vorontsov, on the basis of his research, claims that if the mother is healthy and eats normally, the child can be on breastfeeding without complementary foods 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 vegetable fiber, breast milk was the main food of a child for at least 3-4 years (only by this age a child can fully absorb such fiber), otherwise case, without mother's milk or nurse's milk, the child did not survive.

This theory is supported by the state of affairs in modern Africa, where, in conditions of a lack of protein food, the duration of breastfeeding can indeed become a matter of survival of the child. scientists described the disease "kwashiorkor"- a severe form of malnutrition due to protein deficiency, often accompanied by a lack of vitamins and the addition of an infection that usually develops after weaning the baby. The disease usually occurs in children 1-4 years old.<...>When a baby is weaned, in the case when products that replace mother's milk contain a lot of starches and sugars and few proteins<..>, the child may develop kwashiorkor. This name comes from one of the languages ​​of the coast of Ghana, its literal meaning is "first-second", which means "rejected", reflecting that the condition begins in the eldest child after weaning, often due to the fact that the family was born another child."

In practice, based on the experience of mothers living in modern civilized countries, breast milk is enough for a child to meet the nutritional needs for at least 1.5 years. When the body ceases to have enough calories or some trace elements from breast milk, a child of this age himself increases the amount of adult food or some specific foods in his diet - the main thing is not to spoil his eating behavior by force-feeding and give him access to family "resources", then eat to take with you to the table and offer a variety of food.

The digestive system of a child is mainly formed by the age of 2 years. Until this age, breast milk supports the work of the child's digestive system, helps the absorption of essential nutrients, reduces the risks of diseases of the digestive system, and contributes to a milder transfer of infectious and inflammatory diseases of the gastrointestinal tract.

- a clinical syndrome that occurs against the background of the morphofunctional immaturity of the digestive tract and its neuroendocrine regulation in the first months of a child's life and proceeds with paroxysmal pain in the intestine. Intestinal colic is accompanied by crying and screaming of the newborn, restlessness, tension and bloating. The diagnosis of intestinal colic in newborns is based on a characteristic clinical picture, scatological examination data, stool culture, ultrasound of the abdominal organs. Treatment of intestinal colic in newborns includes the mother's diet, adherence to feeding techniques, selection of an adequate mixture, light abdominal massage, taking herbal remedies, antispasmodics, probiotics.

General information

Intestinal colic in newborns is a condition associated with age-related functional disorders of the digestive tract in infants and is accompanied by paroxysmal abdominal pain. In children of the first six months of life, various functional disorders of the gastrointestinal tract often occur: regurgitation, intestinal colic, functional diarrhea and constipation. Intestinal colic, according to the results of various studies, occurs in 20 - 70% of newborns.

The greatest severity and frequency of intestinal colic is observed in children aged 1.5 to 3 months. Intestinal colic is more common in boys and firstborns. Intestinal colic can disrupt the diet and sleep of the newborn, serve as a reason for emotional stress and nervousness of young parents. A comprehensive solution to the problem of intestinal colic in newborns and children in the first months of life is dealt with by pediatrics, pediatric gastroenterology, and neurology.

Causes of intestinal colic in newborns

The mechanism of development of intestinal colic in newborns is due to a violation of the motor function of the digestive tract and increased gas formation in the intestine, causing sharp local spasms and bursting of the intestinal wall. The main etiological factors of intestinal colic in newborns can be associated directly with the child himself or with his mother.

On the part of the newborn, morphofunctional immaturity of the digestive tract, a violation of the neuroendocrine regulation of its function can contribute to the appearance of intestinal colic; reduced enzymatic activity of the digestive tract, lack of hydrochloric acid, lactase deficiency, disorders of the intestinal microbiocenosis.

Intestinal colic in newborns is due to the anatomical features of the structure of the intestine and the maturation of the nervous system, which lasts up to 12-18 months of age and may be accompanied by vegetative-visceral disorders. If the technique of feeding a child is violated, sucking on an empty nipple or breast with a small amount of milk, as well as in premature babies, excessive swallowing of air (aerophagia) is observed, leading to the appearance of intestinal colic in newborns. Age and individual immaturity of enzymatic systems and intestinal dysbacteriosis in newborns cause incomplete breakdown of fats and carbohydrates, contributing to increased gas formation and expansion of the intestinal lumen.

The development of intestinal colic in newborns may be associated with a deficiency of certain hormone-like substances (gastrin, secretin, cholecystokinin, motilin), which regulate the motor and secretory functions of the gastrointestinal tract. The cause of intestinal colic in a newborn may be the hypoxia and asphyxia suffered by him in the prenatal period or during childbirth. It has been established that the lower the gestational age and body weight of the newborn (i.e., the greater the degree of prematurity), the higher the risk of developing intestinal colic. In premature newborns, intestinal colic, as a rule, is more pronounced and more protracted.

Allergic reactions (gastrointestinal form of food allergy during the transition from natural feeding to artificial feeding, the presence of food additives in mixtures, etc.) can also cause intestinal colic in newborns. Rarely, the causes of intestinal colic in newborns can be congenital developmental anomalies (cleft lip, non-closure of the hard palate, tracheoesophageal fistulas).

Maternal factors provoking the development of intestinal colic in newborns include a burdened obstetric and gynecological history (gestosis), inverted nipples, bad habits and nutritional errors of a nursing mother (excess cow's milk, very fatty foods, foods that increase flatulence), violation of feeding technique (overfeeding , incorrect dilution of mixtures); emotional instability and stress in the family.

Symptoms of colic in newborns

Intestinal colic in newborns occurs in the first 3-4 weeks of life and lasts up to 3, less often - 4-6 months of age. Attacks of intestinal colic in newborns usually begin unexpectedly, without any apparent reason, usually at the same time of day, directly during or after feeding.

Episodes of intestinal colic last up to 3 or more hours a day, recur at least three days a week and last at least three weeks in a row. Intestinal colic in newborns is accompanied by loud shrill crying, screaming, expressed by the anxiety of the child, who twists his legs and pulls them to his stomach. At the same time, hyperemia of the skin of the face, bloating and tension of the anterior abdominal wall are noted. One attack of intestinal colic can last from 30 minutes to 3 hours.

With intense intestinal colic in newborns, there is a violation of appetite and digestion, rumbling in the abdomen, regurgitation, increased irritability and excitability, sleep disturbance. Relief from intestinal colic in a newborn occurs after the passage of gases or defecation. The general condition of the newborn between attacks of intestinal colic is not disturbed, there is no pain on palpation of the abdomen, a good appetite remains, weight gain corresponds to age. Intestinal colic in newborns can be combined with constipation, dyspepsia, gastroesophageal reflux.

Diagnosis in newborns

The diagnosis of intestinal colic in a newborn is established on the basis of characteristic clinical symptoms and the results of a comprehensive examination, including a general blood and urine test, fecal tests: (coprogram, determination of the carbohydrate content and the level of fecal calprotectin), stool culture for the intestinal group and for dysbacteriosis, ultrasound of the abdominal organs cavities.

The level of calprotectin makes it possible to differentiate functional disorders of the gastrointestinal tract from chronic inflammatory diseases - Crohn's disease and ulcerative colitis. In newborns, the level of calprotectin in the feces is higher than in older children (up to 1 year of age, the level of PCP> 500 mcg / g; up to 4 years -<100 мкг/г).

If there is fever, vomiting, blood in the feces, refusal to eat and stool retention against the background of intestinal colic, an additional more in-depth examination of the newborn and consultation of a pediatric surgeon are necessary.

It is advisable to conduct a differential diagnosis of intestinal colic in newborns with surgical pathology (acute intestinal obstruction), gastrointestinal form of food allergy, lactase deficiency, dysbacteriosis, acute intestinal infections, perinatal lesions of the central and autonomic nervous system.

Treatment of intestinal colic in newborns

Treatment is carried out jointly by a pediatrician and a pediatric gastroenterologist, is individual in nature and is aimed at eliminating the main cause of this condition, correcting motor and functional disorders of the gastrointestinal tract.

Some cases of intestinal colic in newborns who are breastfed can be prevented by observing the diet of the nursing mother. Products containing cow's milk protein and beef meat are excluded from her diet; food rich in fats, and also contributing to increased gas formation (raw and pickled vegetables and fruits, legumes; fresh yeast bread and kvass), chocolate, sweets and pastries are limited.

Before each feeding, it is necessary to lay the baby on the stomach for 5-10 minutes, and then lightly stroke the abdomen in a clockwise direction to improve intestinal motility and gas discharge. With intestinal colic, you can warm the belly of the newborn with a warm diaper or carry it in your arms, pressing the anterior abdominal wall against the mother's stomach.

For the prevention of aerophagia, it is important to observe the feeding technique, keep the child in an upright position for 10–15 minutes after feeding for better belching of air; limit sucking on pacifiers and select an adequate mixture. If a gastrointestinal form of food allergy is suspected in a child, they switch to mixtures based on protein hydrolyzate (casein or whey), with lactase deficiency - to low-lactose or lactose-free mixtures. Frequent use of gas tubes and enemas is not desirable due to the slight vulnerability of the intestinal mucosa in newborns, especially premature ones.

With significantly pronounced intestinal colic, newborns are prescribed herbal remedies with a carminative and relaxing effect (based on fennel, dill, chamomile, mint), defoamers based on simethicone, antispasmodics (drotaverine, suppositories with papaverine), sorbents. Medicines are used both during an attack of intestinal colic, and to prevent their development in newborns at each feeding. Probiotics are used to correct dysbacteriosis.

The prognosis of intestinal colic in newborns

The prognosis of intestinal colic in newborns is favorable, in most cases they disappear after the 3rd month of a child's life, in rare cases - after the 4-6th month.

Young parents should be patient and remain emotionally calm. Compliance with the recommendations of the pediatrician, primarily the regimen and feeding technique, makes it possible to alleviate the condition of newborns with intestinal colic.

Vomit is a complex reflex act involving the vomiting center, which is located in the medulla oblongata, near it are the respiratory, vasomotor, cough-left and other autonomic centers. All centers are functionally interconnected, so vomiting is accompanied by a change in breathing, circulatory disorders, and the release of a large amount of saliva.

regurgitation- the release of food eaten 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 regurgitation, 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, the horizontal position of the stomach and the child itself, high pressure in the abdominal cavity, a large amount of food (1/5 body weight per day). Contribute to regurgitation overfeeding and aerophagia.

At overfeeding regurgitation occurs immediately after feeding or after a certain period of time in a small amount of unchanged or slightly curdled milk. The general condition of the child does not suffer, he gains weight. During the control weighing, the volume of milk eaten by the newborn is determined, which is much more than required by the norm. When overfeeding, it is recommended to change the time of breastfeeding or first express the part of the milk that is easily suctioned, but less rich in food ingredients.

Aerophagia- swallowing a large amount of air during feeding, occurs in hyperexcitable, eagerly 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 capture the areola, with a large hole in the nipple, the horizontal position of the bottle when the nipple is not completely filled with milk, with general muscular hypotension associated with the immaturity of the body.

Aerophagia is more common in neonates with low or very high birth weight. Children are restless after feeding, there is swelling in the epigastric region. 5-10 minutes after feeding, regurgitation of unchanged milk is noted. With aerophagia, it is necessary to have a conversation with the mother about the correct feeding technique. After feeding, it is necessary to hold the child upright for 15-20 minutes, which contributes to the discharge of air swallowed during feeding. It is recommended to lay 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:

1. infectious diseases,
2. cerebral pathology,
3. metabolic disorders.

Functional forms of vomiting

The most common functional pathology of the gastrointestinal tract is insufficiency of the cardia. Newborns do not have a pronounced sphincter in the area of ​​​​the transition of the esophagus to the stomach, the closure of the cardia occurs by the valvular apparatus. Insufficiency of the cardia may be due to a violation of the innervation of the lower part of the esophagus (often observed in perinatal encephalopathy), an increase in intra-abdominal and intragastric pressure in certain diseases.
With cardia insufficiency, regurgitation occurs immediately after feeding, in the horizontal position of the child, frequent, not abundant. Reflux esophagitis, which develops with this pathology, can cause the development of cardiovascular insufficiency. The child develops cyanosis, weakness, adynamia, tachyarrhythmia, shortness of breath, liver enlargement, oliguria, wheezing appears in the lungs.

Treatment. It is recommended to lay the child on the stomach with the head end raised by 10°, fractional nutrition of 40-50 ml up to 10 times a day, prevention of aerophagia. Of the medicines prescribed: bethanechol, domperidone (motilium), cerucal or raglan 30 minutes before meals 3 times a day.

Achalasia of the esophagus (cardiospasm)- persistent narrowing of the cardiac section due to impaired innervation as a manifestation of congenital pathology or various diseases. At the same time, the opening of the cardia during swallowing is disturbed, atony of the esophagus is noted, food lingers over the spasmodic cardia, and the esophagus gradually expands.
The main symptom in newborns is vomiting during feeding with freshly eaten milk, difficulty in swallowing, 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. Recommended fractional 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 chlorpromazine and pipolfen, 0.25 % solution of droperidol with novocaine - appoint 1 tsp. 3 times a day 30 minutes before meals.

Pylorospasm- spasm of the pylorus muscles, leading to difficulty emptying the stomach. Increased tone of the pyloric section is associated with hypertonicity of the sympathetic section of the nervous system due to perinatal encephalopathy, hypoxia. Usually, children with pylorospasm are hyperexcitable, intermittent regurgitation appears from the first days of life, as the amount of food increases, vomiting appears. Vomiting is daily, not the same number of times during the day, vomiting appears closer to the next feeding, vomit is abundant, curdled sour contents without bile, the volume does not exceed the volume of food eaten. The child, in spite of vomiting, gains weight, although not enough, as a result of which malnutrition develops. The chair is normal. The diagnosis is confirmed radiographically.
Treatment. At the beginning of feeding, you can give 1 teaspoon of 10% semolina, which contributes to the mechanical opening of the pylorus. Spasmolytic 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 secreted from the mouth and nose of the child, which, after suction, accumulates again, aspiration pneumonia develops. It is possible to diagnose esophageal atresia using probing, the probe does not pass into the stomach (an obstacle is felt), the air quickly injected with a syringe through the probe exits with noise back through the nose or mouth, and with normal patency it silently passes into the stomach. Treatment is operative.

Congenital intestinal obstruction.
The causes of congenital intestinal obstruction may be malformations of the intestinal tube itself (atresia, stenosis, membranes), malformations of other organs leading to intestinal compression, blockage by thick viscous meconium.
Clinically, congenital intestinal obstruction manifests itself acutely in newborns from the first days or hours of life. Depending on the level of obstruction is divided into high and low intestinal obstruction. In the presence of an obstruction in the duodenum, intestinal obstruction manifests itself as an upper one, and in the presence of an obstruction in the jejunum, ileum, and large intestine, as a low one.
With high intestinal obstruction, the contents that accumulate in the stomach and duodenum are released outward with vomiting and regurgitation. Vomiting appears on the first day or hours of life, profuse, 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 is passed, and there is no stool in the future, there is a long-term discharge of meconium (within 5-6 days) in small portions. There is bloating in the upper sections, which disappears after vomiting or emptying during probing, and then reappears. In other departments, the abdomen may be sunken. Exicosis symptoms are noted.
The diagnosis is confirmed radiographically.
Low intestinal obstruction. Almost immediately after birth, abdominal distention is noted, which does not disappear after vomiting or artificial emptying of the stomach. Meconium does not pass, lumps of mucus, slightly green in color, are noted instead of stool. Vomiting appears on the 2-3rd day of life, in the vomit there may be an admixture of intestinal contents ("fecal" vomiting), vomiting is more frequent than with high obstruction, but less abundant. The general condition suffers significantly, symptoms of intoxication are expressed, with late diagnosis of the disease, symptoms of peritonitis appear: a sharply swollen abdomen, deep palpation is not available, the subcutaneous venous network on the abdomen is pronounced, swelling of the subcutaneous tissue in the anterior abdominal wall, especially in the lower sections, cyanotic shade of skin covers on the abdomen.
The diagnosis of low intestinal obstruction is confirmed radiographically.
Preoperative preparation in the maternity hospital: the abolition of enteral nutrition, install a gastric tube for regular emptying of the stomach.

Atresia of the anus and rectum.

Allocate:

1. atresia of the anus and rectum without fistulas;
2. atresia of the anus and rectum with fistulas (external - perineal, internal - fistulas with the urinary, reproductive system).

With atresia of the anus and rectum, the absence of the anus can be seen and the absence of meconium discharge 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, metabolic disorders.

Vomiting associated with cerebral pathology. The most common cause of vomiting and regurgitation in newborns is the pathology of the central nervous system of hypoxic, traumatic or infectious origin. In addition to vomiting, symptoms of brain damage are noted in newborns: a monotonous weak cry or a piercing cry, groaning, bulging and tension of the large fontanelle, syndromes of depression or excitation of the central nervous system, convulsive syndrome, etc. Vomiting in case of 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 in the pathology of the central nervous system can be persistent "fountain" or manifested by regurgitation.
Treatment of vomiting syndrome against the background of cerebral pathology - the underlying disease is treated.

Alimentary dyspepsia. In view of the existing physiological characteristics of the digestive system of newborns, any errors in nutrition can lead to dyspeptic disorders:

1. quick transition to artificial feeding,
2. feeding with unadapted mixtures,
3. non-compliance with the rules for the preparation and storage of mixtures,
4. overfeeding,
5. irregular feeding.

In violation of the breakdown of carbohydrates, which often happens when a child is supplemented with sweet tea, overfeeding with sweet mixtures, bloating, anxiety, regurgitation, stools are liquid, watery, frothy, yellow, there may be an admixture of greenery, with a sour smell, in the analysis of feces a large number of iodophilic bacteria.
In violation of protein digestion, the stool is loose, yellow-brown, with a sharp unpleasant odor, bloating, constipation is noted. X newborns are rare.
The most common type of dyspepsia in newborns is a violation of the digestion and absorption of fats. At the same time, the stool has a shiny appearance with white curdled lumps; in the analysis of feces, neutral fat and fatty acids are found.
Nutritional dyspepsia in newborns can lead to insufficient weight gain, but with this form of dyspepsia there is practically no weight loss and dehydration, there are no symptoms of intoxication.
Treatment. Within 8-12 hours, a fractional drink is prescribed (glucose-salt solutions, water, 5% glucose solution). Then breastfeeding is resumed, starting with S of the prescribed volume and brought to the full volume within 2-3 days. The number of feedings is increased up to 8-10 times. If it is impossible to feed the baby with breast milk, an adapted milk formula is selected. Assign bifidumbacterin, pancreatin, festal and more.
Apply decoctions of herbs with astringent action: rhizome of cinquefoil, burnet, serpentine, fruits of bird cherry, blueberries, alder seedlings; herbs with anti-inflammatory action - chamomile flowers, St. John's wort, mint; carminative action - dill grass, caraway fruits, fennel, yarrow 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 is sterile in utero during physiological pregnancy, begins to be colonized by microorganisms during childbirth in the birth canal, after birth, microorganisms from the environment enter the gastrointestinal tract of the child. By the end of the first day, the intestines of the child are populated by various microorganisms - cocci, enterobacteria, yeast, conditionally pathogenic and pathogenic - and transient dysbacteriosis develops. By the 7th-8th day of life, the intestinal microbiocenosis of the newborn 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 staff of maternity hospitals, non-compliance with hygiene standards when caring for newborns, late attachment of the child to the breast, a decrease in the overall immunological reactivity of the newborn in pathology (asphyxia, birth trauma, intrauterine infections, HDN, blood loss, etc.), antibiotic therapy.
Dysbacteriosis is a qualitative and quantitative change in the composition of the intestinal microflora.
Dysbacteriosis is manifested by persistent dyspeptic disorders. There is bloating, regurgitation, appetite decreases, stools are liquefied, quickened, with greens, undigested particles, an unpleasant odor, slow recovery of body weight is noted, poor weight gain during the first month of life.
Treatment. It is best to feed a child with breast milk; in the absence of breastfeeding, mixtures with bioactive additives are shown - lysozyme, bifidobacteria, immunoglobulins; milk mixtures 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, Escherichia 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 the intestinal microflora: bifidumbacterin, lactobacterin, bactisubtil, pancreatin, festal and more. The duration of treatment of 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, chloride, potassium) through the intestines with diarrhea. Allocate 3 degrees of dehydration, respectively, weight loss: I - up to 5% of the mass; II - 6-10%; III - more than 10%.
With moderate dehydration, there may be a slight retraction of the large fontanel, eyeballs, dry mouth of the mucous membranes, and a decrease in diuresis. BP is usually normal, and the child may be lethargic or agitated.
Blood pressure may decrease, the pulse quickens, weak filling, a decrease in diuresis is characteristic. The child is very lethargic, there may be convulsions, later - loss of consciousness, coma. Increased hematocrit and hemoglobin in the blood, hyponatremia, hypokalemia. With severe diarrhea, the child can lose more than 15% of the weight in a few hours, which is usually accompanied by hypovolemic shock.

Other complications in acute intestinal infections are less common: sepsis, DIC, pneumonia, urinary tract infection, otitis, meningitis.
In the diagnosis, the seeding of a pathogenic agent from feces is of decisive importance. In the study of stools, the best results are obtained with sowing in the early stages of the disease before the start of antibiotic therapy. For research, the most altered particles of fresh feces are selected.
Specific diagnosis of viral diarrhea is carried out by electron microscopy of feces and various immunological methods.

Treatment of acute intestinal infections

Basic principles of treatment of acute intestinal infections in children:

1. Diet.
2. rehydration therapy.
3. Enzyme therapy.
4. Symptomatic therapy.
5. Etiotropic therapy.
6. syndromic therapy.
7. Surveillance and control.