Constipation In Infants: Causes, Signs, Treatment Of The Child

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Constipation in infants

The content of the article:

1. Features of digestion in infants
2. The reasons
3. Diagnostic criteria
4. Symptoms

5. Treatment of constipation in infants

   1. Conservative treatment
   2. Surgery
6. Video

Constipation in infants is a special form of bowel pathology, which is associated with an increase in the intervals between acts of defecation or with a systematic insufficient emptying of the gastrointestinal tract in infants (it is generally accepted to consider infancy from 1 month to 1 year of life). This problem occurs in 20-40% of all newborns. In most cases, parents conduct a course of treatment at home.

Constipation in infants is manifested, in addition to the absence of stool, intestinal colic

Features of digestion in infants

Breast age is associated with a number of features that cause constipation:

1. The specific nature of the diet (extremely limited diet, mainly consisting of milk). For this reason, in babies in the first months of life, stool frequency can be 5 to 7 times a day, provided that they are exclusively breastfed. As complementary foods are introduced, the stool becomes thicker and thinner, which reduces the number of bowel movements (by the year, approximately 1-3 times a day).
2. Underdevelopment of some parts of the gastrointestinal tract and weakness of the enzyme system (only lactulose works at the optimal level).
3. During the transition from breastfeeding to adequate nutrition, so-called functional constipation occurs, which does not require therapeutic measures (it is a natural reaction of the body).
4. Weak waves of peristalsis due to imperfection of the sympathetic and parasympathetic nervous systems. In this regard, there is a separation of constipation according to the hypertensive and hypotonic type (the latter is more severe).

The reasons

The most common causes of constipation in infants are shown in the table.

Group of diseases	Example	Characteristic
Nervous regulation disorders	Hirschsprung's disease birth injuries of the spine	Of importance is the lesion at the level of the central nervous system (lumbar spinal cord) and the violation of local innervation directly in the intestinal wall (areas of agangliosis). The same group includes the lack of urge to defecate in focal brain lesions.
Infectious and inflammatory processes in the intestine	Necrotizing enterocolitis severe forms of enterovirus infection	As a result, areas of hypogangliosis may occur, which leads to a decrease in the general sensitivity of the intestinal receptor apparatus.
Alimentary violations	Malabsorption	These are the following factors: · Terms of introduction of complementary foods (should not be earlier than 6 months); · The type of products introduced (it is more optimal to start with dairy-free cereals); · The amount of introduced food (calculation according to special formulas, taking into account the age of the child). This group includes feeding errors on the part of the mother.
Endocrine system pathologies	Hypothyroidism, hyperparathyroidism, insufficiency of the adrenal cortex	Motility disorders are associated with glandular hypo- or hyperfunction.
Disorder of the musculo-ligamentous apparatus	Hernia of the anterior abdominal wall	Muscle divergence and pressure redistribution in the abdominal cavity are noted.
Congenital malformations	Rectal atresia, anus ectopia, intrauterine incomplete bowel rotation, Ledd's syndrome	The problem is caused by mechanical bowel obstruction; surgical treatment is often required.
Anorectal pathology	Anal fissures	In addition to the anatomical violation of the integrity of the intestinal area, a psychological block occurs due to binding at the subconscious level of pain and defecation.
Medication effect	Iron preparations, anticonvulsants	They can affect both the motility of the intestine itself and the density of feces.
Diseases of the lower gastrointestinal tract	Intussusception, strangulated intestinal obstruction	This group includes all options for intestinal obstruction, regardless of the cause. Often, such constipation is acute and can occur as a result of a pronounced infectious process (rotavirus infection).
Disruption of enzyme systems	Enzyme deficiency of the pancreas, enzyme deficiency of the liver	It can be established no earlier than by the end of the first year of life (relative stabilization of the intestines and the establishment of a normal diet).
Benign and malignant formations of the abdominal cavity and retroperitoneal space	Neuroblastoma	Often, the formation is determined even in utero and does not have time to give a clinical picture of constipation (an emergency operation is performed).
Idiopathic constipation	In children, it occurs relatively rarely (often there is a clear morphological substrate of the disease). It is permissible to exhibit this type of constipation only after a thorough examination and exclusion of other diseases.

Often, stool retention in infants occurs as a combined pathology caused by a number of reasons, which is important to understand when drawing up a treatment regimen.

Diagnostic criteria

To diagnose constipation in an infant, the duration of the observed defecation disorders should be at least 1-2 months.

According to the Paris Consensus, constipation is exhibited when 2 or more of the following signs are present:

• bowel movements less than 3 times a week;
• uncontrolled bowel movements more often than 1 time per week;
• a large volume of feces;
• palpable fecal masses in the colon or rectum;
• pain and delay in the act of defecation.

In accordance with the Rome III criteria, in children under four years of age, 2 or more of the following signs must be identified to establish a diagnosis:

• less than 2 bowel movements per week;
• 1 episode of fecal incontinence per week, subject to the acquisition of toilet skills;
• periods of prolonged stool retention and containment of the bowel movement itself;
• soreness during bowel movements (feces have a hard, dense consistency);
• incomplete emptying and the presence of a large amount of fecal masses in the rectum;
• indications of a history of large-diameter stools.

Both of these clinical classifications do not take into account the division of children by age (neonatal, infant, or infant). Children under 4 years of age are combined in one scheme, which makes it somewhat difficult to diagnose constipation in infants.

Symptoms

With various diseases (Hirschsprung's disease, intussusception), there are different clinical signs of constipation in infants, but, in addition to stool retention, there are some common points:

1. The stool is dense, fragmented (like a sheep's). Sometimes the density is noted only at the beginning of the act of defecation, and then the feces acquire a soft consistency.
2. Large amounts of stool. As a rule, the stool is shaped and does not contain pathological impurities.
3. Incomplete emptying of the intestine is noted, which can increase the number of bowel movements and cause severe indigestion.
4. The main complaint from the parents of the child is constant bloating and pain in the tummy like intestinal colic. The symptom may disappear slightly after stool discharge. On examination, there is some asymmetry and tympanitis over various parts of the intestine.
5. Kalomazaniya occurs in older children more often than in infants (extremely rare cases).

There are a number of alarming signs of constipation in infants, which indicate the presence of serious anatomical abnormalities in the structure of the gastrointestinal tract:

• onset at less than 1 month of age;
• discharge of meconium later than the second day;
• a history of close relatives with Hirschsprung's disease;
• ribbon stool;
• blood in the stool;
• lag in physical development;
• vomiting with bile;
• thyroid abnormalities;
• persistent bloating;
• abnormal position of the anus and lack of anal / cremasteric reflex;
• perianal fistula;
• decrease in strength and tone of the lower extremities.

Alarming symptoms are direct indications for hospitalization.

Treatment of constipation in infants

Treatment measures have a clear dependence on the cause and are represented by two approaches:

• conservative therapy (helps in 80-90% of cases);
• surgical methods.

Conservative treatment

Method	Characteristic
Diet	In the case of breastfeeding, the mother is shown a diet: A balanced diet with sufficient calories (up to 2500 kcal); · Water regime (1-1.5 liters per day); · The ratio of proteins, fats and carbohydrates as 1: 4: 1; · A large amount of protein and plant foods. In the case of artificial feeding, the replacement of some mixtures with others containing thickeners (gum) in full daily volume is shown. Examples: Frisov, Nutrilon, Antireflux. Avoid significant breaks in feeding (the hungry period should not exceed 4-5 hours in children of the first half of the year and more than 6 hours in children of the second half of life).
General recommendations	They do not depend on the causes of constipation, they provide assistance in any form and as a prevention: 1. Frequent walks in the fresh air. 2. A course of general strengthening exercises. 3. Massage on the anterior abdominal wall in order to strengthen the muscles and eliminate intestinal colic due to increased gas production. 4. Correct planting on a pot (a certain time and a calm atmosphere). Starting from 1-1.5 years old, it is required to plant the child on the potty at least 1-3 times a day (preferably in the morning).
Enemas	They are used in order to effectively combat the overstretching of intestinal loops (relieves stagnation of contents in the intestine). The main options are: · Cleansing enemas - do every day at the same time for 3-5 days; · Microclysters - to establish the urge to defecate. Cannot be used for a long time, as addiction develops.
Laxatives	To normalize intestinal peristalsis, the following groups of drugs are used: 1. Salt laxatives - mineral waters of high mineralization (Essentuki No. 17); magnesium sulfate or sodium sulfate. 2. Osmotic laxatives - Lactulose, Polyethylene glycol, Transipeg, Forlax. 3. Herbal laxatives - hay, joster, buckthorn. They have a number of limitations due to the anatomical features of the intestines of newborns. They are rarely used in pediatric practice (with the exception of Lactulose).
Irritant agents	A group of drugs with a pronounced irritating effect to stimulate rectal mechanoreceptors: · Plant anthraglycosides (rhubarb, buckthorn, senna); Castor oil and glycerin; · Synthetic means synthetic Phenolphthalein or Bisacodyl. Usually used in the form of rectal suppositories.
Enzyme preparations	They are used in children over 1 year of age with severe disorders of the liver or pancreas (laboratory confirmed). Pancreatin is most commonly used.
Biological active substances	Preparations containing bifidobacteria or lactic acid bacteria to improve the functioning of the digestive system (colonization of the intestine with normal microflora): Linex, Bioflor, Bifidumbacterin.
Emollients	Used to loosen stools and at the same time to prevent the phenomenon of anal fissures, this group includes oils: vaseline, olive, almond oil.

Regular gymnastics and light massage combined with adjusting the menu can help your baby get rid of constipation.

Surgery

It is required to treat constipation surgically in extremely rare cases and in the presence of strict indications (pronounced defects in the digestive system).

Methods used:

1. Laparotomy - refers to operations with a wide operative access, is used in the case of severe surgical pathology requiring the elimination of an obstruction, agangliosis or tumor.
2. Laparoscopy - allowed for the elimination of hernias or other relatively small bowel defects. If it is necessary to remove a section of the intestine and remove a temporary stoma, laparotomy is still the best treatment option.

The treatment regimen can be supplemented on an individual basis. Constipation in babies usually requires long-term treatment, but they also tend to self-regress.

Video

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

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