Functional disorders of the gastrointestinal tract in young children. Peculiarities of digestion in young children. Colic When the child's gastrointestinal tract matures

Kate Khwan

Hello! The child is almost 9 months old, has been bottle-fed since 6 months (Nanny formula). Allergy to cow's milk protein. There was a strong allergy at the age of 1 month, until my mother stopped drinking kefir and eating cottage cheese. After an allergy up to 4 months there were leukocytes and blood in the feces. Currently, with the introduction of complementary foods, rashes begin on the 2-3rd day (mainly on the cheeks, then on the stomach and arms). Previously, in addition to these places, the shins and elbows were red. There are fewer breakouts now. We tried zucchini, cauliflower, broccoli, buckwheat porridge. On everything pours out, but not immediately. Tell me, please, is this the immaturity of the gastrointestinal tract? And what should I do now? Should I keep trying other vegetables or take a break for a couple of months to let my gut recover? Isn't it scary that a child at this age eats only a mixture? Does he have enough vitamins?

Hello. For the age of 9 months, the Nanny-2 mixture is adapted, which contains all the necessary components. Complementary foods should be introduced strictly gradually, one product at a time (i.e. strictly monocomponent). It's important to clarify. where did they start introducing complementary foods, what was the sequence. Reduce allergic phenomena can, sorbents, external cream losterin. Specify the nature of food digestion and the composition of the microbial landscape of the intestine by feces for scatology and dysbacteriosis. According to the results and additional correction in the treatment.

We switched to Nanny-2. Complementary foods were administered one product at a time with clean skin. We started with zucchini, then tried cauliflower, then broccoli, then zucchini again, after - dairy-free buckwheat porridge. Every time I waited for the disappearance of skin rashes. The analysis for dysbacteriosis and coprology is normal, the number of lactobacilli is slightly reduced. Could an allergic reaction to milk have provoked the inflammation of the intestines, as a result of which there is now such a reaction to the introduction of complementary foods? How long is the function of the gastrointestinal tract approximately restored after inflammation? And doesn’t it turn out that when I introduce a new product, I irritate the child’s intestines? I don’t want to stuff him with medicines, because even he reacts negatively to them (for example, he had a strong allergic reaction to Creon). Maybe it's really worth just waiting if the mixture contains everything you need?

Colic in newborns is quite common, in about 30-50% of children, regardless of gender, race and place of residence. Young parents, due to the lack of proper experience in caring for children, have no idea why the baby developed intestinal colic and how to alleviate his condition. Naturally, the only correct solution in such a situation is to consult a pediatrician. Intestinal colic is diagnosed in newborns according to the following signs: the child cries for a long time and restlessly, screams, it is almost impossible to calm him down, he arches and twists his legs. Relief of the condition occurs after defecation or discharge of gas.

Most pediatricians were previously inclined to believe that colic in a newborn appears as a result of a violation of the baby's feeding regimen, errors in the mother's diet, etc. To date, the first place among the factors contributing to the development of intestinal colic in children is the immaturity of the gastrointestinal tract.

Why does colic occur in newborns? The crux of the problem is…

Perhaps we should start with the fact that colic in children of the first months of life is considered normal, and, as a rule, does not require treatment. However, not a single parent can calmly watch how a child screams and cries in pain. For some time, it is possible to alleviate the condition of the baby with the help of symptomatic therapy, but more on that later. In order for colic in a newborn to cease to be the main problem, it is necessary to know the nature of their occurrence.

Immaturity of the gastrointestinal tract (GIT).

Due to the fact that at birth the baby's gastrointestinal tract is absolutely sterile, in the first few days it is colonized by microorganisms, which subsequently form the intestinal microflora. Digestive problems and the appearance of colic in a newborn are often associated with a violation of the intestinal microflora, which makes it difficult to digest food. And if we add to everything else the immaturity of the enzymatic system, problems with peristalsis (dysmotility) and errors in the mother's diet - the appearance of intestinal colic in a newborn will become a completely natural phenomenon.

IMPORTANT! Violation of the intestinal microflora is most typical for children who are bottle-fed. This is due to the fact that breast milk contains bifidus factor, which contributes to the settlement of the intestines with bifidobacteria.

Why is the intestinal microflora disturbed in a newborn? The fact is that normally both “good” and conditionally pathogenic microorganisms live in the intestine. The "good" microbes include E. coli, lactobacilli and bifidobacteria, which are responsible not only for the quality of food digestion, but also participate in the formation of the body's immune defenses. If for some reason the content of beneficial bacteria decreases, conditionally pathogenic microorganisms begin to actively multiply and prevail in quantity. As a result, food is not digested well, and the child suffers from spasms, flatulence and constipation.

IMPORTANT! It cannot be said that it is the malnutrition of the mother that causes intestinal colic in the child, but this is his small merit. The use of foods that promote constipation (rice, blueberries) and increased gas formation (cabbage, legumes, flour, dairy products, raw vegetables and fruits) by a nursing mother aggravates the course of colic in a child.

What to do?

When intestinal colic occurs in a newborn, the development of dysbacteriosis should first of all be excluded - a condition in which the ratio of bifidobacteria and conditionally pathogenic microflora is disturbed towards the predominance of the latter, due to the use of antibiotics, prolonged illness, as well as other factors that reduce the body's immune properties. The reason for the development of dysbacteriosis in the first days of life is often the close contact of the child with the medical staff, as a result of which representatives of nosocomial infections (streptococcus, hemolytic staphylococcus, etc.) colonize his intestines.

For this purpose, feces are analyzed for dysbacteriosis, the main indication for which are stool disorders: constipation, liquid stools for three or more days, an admixture of mucus or undigested food, foamy stools, etc.

An analysis of feces for dysbacteriosis allows us to assess the ratio of the number of beneficial bifidobacteria (as well as lactobacilli and E. coli) to the number of conditionally pathogenic microorganisms (fungi, clostridia, enterobacteria). In addition, this analysis can identify bacteria that can cause serious illness, such as salmonellosis or shigellosis.

IMPORTANT! Most probiotics are sold over-the-counter in pharmacies, but the decision to prescribe drugs should be made only by the attending physician.

Incorrect attachment to the breast.

Often, colic in newborns develop as a result of swallowing large amounts of air during feeding. This happens in situations where the baby has not completely or incorrectly captured the breast - only the nipple without a halo. With this application, it is very difficult for a child to suck, he quickly gets tired and falls asleep, having time to swallow air, which “bursts” the intestines, causing pain.

What to do?

Make sure that the baby completely captures the nipple. The surest sign of proper attachment: the child rests his nose on his mother's chest. The appearance of cracks on the nipples indicates improper attachment of the child to the breast. In this case, it is recommended to consult with a lactation consultant.

lactase deficiency.

As mentioned above, the immaturity of the enzymatic system leads to poor digestion of food, which contributes to the development of fermentation processes in the intestines and, as a result, increased gas formation.

Lactose is an enzyme that breaks down the milk sugar, lactose. When colic appears in a newborn, lactase deficiency should be suspected, which is also manifested by stool instability, weight loss, and the development of dysbacteriosis. Lactase deficiency can be acquired (hypolactasia), against the background of infectious diseases of the intestine, an allergic reaction, etc. The cause of congenital lactase deficiency can be aggravated heredity (intolerance to cow's milk protein in close relatives), as well as prematurity.

What to do?

To exclude lactase deficiency, as one of the causes of colic in a newborn, it is necessary to analyze feces to determine carbohydrates and acidity levels. Normally, in the stool of a newborn, the amount of carbohydrates does not exceed 0.25%, while the Ph acidity of the feces should be more than 4. When a diagnosis of lactase deficiency is made, further treatment tactics will be known only after a complete examination. Thanks to the prescription of lactase preparations, in most cases it is possible to maintain breastfeeding and normalize the work of the baby's gastrointestinal tract.

In addition, the causes of colic in a newborn may be:

reflux of hydrochloric acid from the stomach into the esophagus (if the child is in a horizontal position most of the time after feeding);
emotional lability of the mother;
unfavorable home environment (loud noise, bright light, prolonged separation from mother), etc.

Colic in newborns. Means of first aid.

Until the cause of the development of intestinal colic in a baby is not exactly established, it is possible to alleviate his condition with the help of:

carminatives (dill water, fennel tea, chamomile decoction);
laying the baby on the tummy;
light massage of the tummy clockwise, alternately bending the legs in the knee and hip joints;
applying a warm diaper to the baby's tummy.

If the above methods of helping with colic in a child are ineffective, you can use a gas outlet tube, after lubricating the tip with petroleum jelly or baby cream.

Colic in newborns is a difficult period in the life of a young family, which you just need to survive. In the absence of serious health disorders, colic in a child goes away on its own by three to four months of life, so it is advisable to be patient and choose expectant tactics.

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 around 6 months of age. breastfeeding Complementary foods may be needed 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 in preschool age 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 administer to the child not complementary foods with adult food, but supplementary feeding with a small amount. 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.

Getting the first complementary food stimulates the activity of the enzymatic system baby. 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.

The most common disorders of the digestive tract in childhood, fortunately, are functional, i.e. not associated with a change in the structure of the body. Usually, functional disorders are associated with a change in motor function, immaturity of the enzymatic, absorbing functions of the digestive system. The most common functional disorders of the gastrointestinal tract in children of the first year of life are: intestinal colic, regurgitation syndrome (regurgitation), functional constipation.

Infant colic - what is it?

Uncontrollable and continuous crying of a child for several hours can be caused by colic, especially if the child eats well and is usually calm. Colic in babies does not pose a health risk, but it naturally worries parents. Colic occurs in almost all babies. Infantile colic can begin in a baby at the age of two weeks and last up to three months.

Causes of colic in babies:

The exact causes of colic in infants are unknown to science. Previously, it was customary to associate them with indigestion in a child. Flatulence aggravates colic, but it cannot be said with certainty that this is the only cause. A possible cause of colic in infants is often called an undeveloped nervous system.

Colic symptoms:

Uncontrollable crying of a child in the afternoon and evening
The child cannot calm down, constantly tossing and turning
Babies raise their head and pull their legs up to their belly
The child's face suddenly turns red
Baby's feet get cold
The child clenches his fists tightly
The child does not want to sleep or wakes up frequently
Some babies refuse to eat when they have colic.

Massage of the abdomen, a warm diaper, putting mom on her stomach can alleviate the condition. In case of inefficiency, Baby Calm or Espumizan (Sab Simplex) is recommended.

The regurgitation syndrome is understood as the reflux of stomach contents into the oral cavity. Most often, regurgitation is observed in the first 4-5 months of life. They are facilitated by: rapid sucking, swallowing air, overfeeding, violation of the feeding regimen, inadequate selection of mixtures, etc .; pylorospasm; perinatal damage to the central nervous system (CNS).

Proper attachment to the breast or feeding from a horn reduces regurgitation. It is also important to lay the baby on his stomach before feeding and upright position for 20 minutes after it. Often spitting up babies need to create an elevated position in bed on their side. You can raise the legs of the bed by 10-15 cm on one side.

Usually by 3 months the number of episodes of spitting up decreases significantly. If persistent regurgitation persists, this means that the child needs additional examination and diet therapy. With artificial feeding, it is also necessary to pay attention to the feeding regimen of the child, the adequacy of the selection of milk mixtures, their volume, which should correspond to the age and body weight of the child. The child should receive an adapted milk formula. Preference is given to special anti-reflux milk mixtures, as they form a denser clot in the stomach, which slows down emptying. With the ineffectiveness of diet therapy, it must be combined with drug treatment. When referring to a doctor, pay attention to the relationship of regurgitation with food (occur immediately after feeding or delayed).

Constipation is understood as defecation disorders, which are manifested by an increase in the intervals between defecation acts in comparison with the individual physiological norm and / or with systematic incomplete emptying of the intestine. This is manifested by the lengthening of the intervals between acts of defecation (more than 32-36 hours); a long period of straining - at least 25% of the total defecation time, dense stool (optional sign). The occurrence of constipation is due to dyskinesia of the colon (weak or strong contractions), a violation of the act of defecation - (spasm of the rectal sphincters, weakening of smooth muscles, etc.) or a combination of these factors.

Risk factors for the development of constipation in children of the first year of life include early artificial feeding, perinatal damage to the central nervous system, prematurity, immaturity of the newborn, food intolerance, intestinal dysbiosis, aggravated heredity for gastrointestinal diseases. Treatment of functional constipation in children of the first year of life includes diet therapy and, if necessary, drug treatment. The purpose of diet therapy depends on the type of feeding.

In children who are breastfed, it is necessary to normalize the diet to avoid overfeeding. Taking into account the fact that the composition of breast milk to a certain extent depends on the mother's diet, it is necessary to correct the woman's diet. Foods with a high amount of animal fats should be excluded from the mother's diet as much as possible, replacing them with vegetable oils. There is a direct connection between the occurrence of constipation in children with similar problems in the mother in the postpartum period, therefore, in the diet of a nursing woman, it is necessary to include foods that stimulate intestinal motility - fermented milk products, foods high in nutrients (vegetables, fruits, dried fruits, cereals, bread coarse grinding, etc.), it is necessary to observe the optimal drinking regimen.

Since constipation in children in the first months of life is often a manifestation of food allergies, foods with a high allergic potential should be eliminated from the mother's diet, and especially cow's milk, fish, nuts, the consumption of which is the most common cause of food allergies in children of the first year of life. The introduction of complementary foods into the diet of constipated breastfed children should be carried out, in accordance with the recommended feeding schedule, not earlier than 4–5 months of age.

Complementary foods in children with functional constipation should begin with the introduction of foods high in dietary fiber: fruit juices with pulp (apple, plum, prunes, apricot, etc.), fruit purees from the same fruits, then vegetable puree (zucchini puree, colored cabbage, etc.), grain complementary foods - buckwheat, corn porridge. In the absence of the effect of the ongoing dietary correction, it must be combined with drug therapy - lactulose preparations (duphalac, normase, lactusan, etc.)

For formula-fed children with constipation, mixtures containing oligosaccharides, which have a pronounced prebiotic effect, and also somewhat stimulate intestinal motility (Samper Bifidus), can be recommended. This mixture can be recommended for daily feeding in full or in quantity 1/3-1/2 of the required amount at each feeding, in combination with a regular adapted milk formula. The mixture is prescribed until a stable therapeutic effect is achieved. After that, the question of the advisability of continuing feeding with a mixture with lactulose should be decided by the doctor individually - depending on the condition of the child. Other mixtures can also be used, such as Frisovoe (Friesland Foods, the Netherlands), Nutrilon Comfort (Nutricia, the Netherlands).

Often these conditions are accompanied by intestinal dysbacteriosis, i.e. a violation of the quantity and ratio of flora. It is never an independent diagnosis and is more often temporary. In this case, the stool can be frequent or, on the contrary, rare. Deviations from the norm in the frequency and appearance of the stool does not always mean that the child is necessarily sick with something. However, a baby's stool can be a useful sign of nutritional adequacy or a symptom of an allergy. In such cases, changing the way you feed or eliminating the allergen is all that is required to solve the problem.

Often parents insist on regular examination of the child for dysbacteriosis, not realizing that the maturation of the intestinal flora takes time and can take place without our intervention. The constant intake of biological preparations is also unreasonable. The same temporary and secondary condition is lactase deficiency - a decrease in the amount of an enzyme that digests milk sugar. This condition is manifested by liquefied and foamy stools, bloating when taking milk. When the main cause of the disorder (intestinal infection, food allergy ...) is eliminated, it also goes away. Primary lactase deficiency is genetically determined and, fortunately, is rare.

Thus, functional disorders of the digestive system do not need enhanced treatment, but more often require the normalization of the mode and nature of feeding and, especially, our patience.

All young parents are extremely interested in absolutely everything related to children. Including features of the digestive system in children. The fact that the digestive system of crumbs is different from that of adults is beyond doubt. But what exactly are these differences? That is what we will try to find out today in this article.

How did it all start?

And let's start talking about the features of the digestive system in children from the very beginning, namely, from the moment the egg is implanted in the uterine mucosa. Indeed, at this stage of development, nutrition is simply vital for the fetus. As soon as the embryo is implanted in the uterus, it begins to feed on a secret that is produced by the uterine mucosa.

After about a week, the embryo begins to feed on the contents of the yolk sac. And already from about the middle of the second month of pregnancy, the nutrition of the crumbs becomes hemotrophic - that is, the fetus receives nutrients from the mother's body, with the help of the placenta.

However, the fetus's own digestive system does not stand aside - it is directly involved in the processing of nutrients such as protein, water, glucose, and others that it receives from the mother's body. Despite the fact that the maturation of the digestive system in the fetus occurs extremely quickly, the child is born with a very significant physiological immaturity of the salivary glands, pancreas, liver and other organs responsible for proper digestion.

Fortunately, nature is extremely wise. She foresaw this too - for the first few months after the baby was born, the only food for him is mother's milk. Mother's milk is not only easily absorbed by the still immature digestive system of the crumbs, but also fully satisfies all its physiological needs. By the way, all this is true for artificial milk mixtures. Although, of course, if it is possible to breastfeed the baby, it is better to give preference to mother's milk.

Salivary glands

The anatomical formation of the salivary glands of the crumbs ends by the time of birth. But the secretory function of the salivary glands is still far from ideal. And they will begin to fully function only in 4 - 5 months. By the way, the active production of saliva that occurs in a child at this age is very often taken by parents as a signal that the crumbs are starting to cut teeth.

In fact, strong salivation in the crumbs is due to the pronounced immaturity of the mechanisms that regulate salivation and ingestion. Saliva plays a very important role in the digestion of crumbs - for the first few months of life, it is necessary for the proper sealing of the mouth during sucking. In addition, it is with the help of saliva that small clots of casein, a substance found in breast milk, are formed.

And during the period when the first complementary foods are introduced into the child's diet, the role of saliva simply cannot be overestimated. It is simply necessary in order for the correct food lump to form. If this does not happen, then the likelihood of developing a variety of digestive problems in the baby is very high.

Pancreas and liver

By the time the baby is born, his pancreas is still relatively immature. Although the breakdown of those easily digestible nutrients that are in mother's milk or artificial milk mixtures, she copes very easily. By the way, in the event that the child is bottle-fed, the maturation of the pancreas occurs much faster. In all the rest of the crumbs that eat mother's milk, the final maturation of the pancreas occurs at a time when they begin to introduce complementary foods into their diet.

It is the pancreas that supplies the duodenum with juice containing enzymes such as lipase, which breaks down fats, and trypsin, which breaks down carbohydrates. And, of course, it is the pancreas that produces the hormone insulin, which plays a huge role in the regulation of carbohydrate metabolism. In the event that insulin is produced in insufficient quantities, the likelihood of developing such an unpleasant disease as diabetes is very high.

The pancreas secretes pancreatic juice into the duodenum, which contains enzymes: trypsin, which digests proteins, lipase, which breaks down fats, and amylase, which breaks down carbohydrates. In addition, the pancreas produces the hormone insulin, which is the main regulator of carbohydrate metabolism. With insufficient production of insulin, a serious disease develops - diabetes mellitus.

Liver. Despite the fact that the size of the liver of a newborn child is quite large, it is still far from functional maturity. The excretion of those bile acids that are necessary for the digestion of solid food is still too small. It begins at about the same time when additional complementary foods are introduced into the diet of the crumbs.

At the time of the baby's birth, his liver is about twice as large as that of an adult. Of course, as a percentage of body size. But, as mentioned above, the baby's liver is still very, very immature. Although, despite this, the liver successfully copes with many of the functions assigned to it. The liver is a real storehouse of many nutrients, such as fats, glycogen, proteins. And another extremely important function of the liver is antitoxic. It is the liver that is one of the main "filters" that remove all toxic substances from the human body.

Stomach

Despite the fact that the volume of the stomach in a newborn child is rapidly increasing, its secretory function is extremely weak. Its full functioning begins at about 9 - 10 months of a baby's life. Yes, and the anatomical and physiological features of the stomach of the crumbs are very peculiar. The bottom of the stomach is extremely poorly developed, like the entire muscle layer. But the entrance to the stomach small child still wide enough.

It is the combination of all these three factors that leads to the fact that young children spit up very often. Yes, and vomiting is also quite common. Although, of course, the swallowing of air during sucking also contributes.

The mucous membrane of the child's stomach is extremely delicate, replete with blood vessels. The stomach of a child has all the same glands that adults have. And that is why the gastric juice of a child contains almost all the "adult" components, such as rennet, pepsin, hydrochloric acid, lipase, and many, many others. However, of course, in a completely different percentage than in adults.

So, for example, rennet is extremely important for the digestion of a child - it is he who causes curdling of milk. By the way - women's milk curdles more slowly than cow's milk, on the basis of which most milk mixtures are made. After curdling milk, pepsin comes into play, which is designed to break down milk proteins. And the breakdown of fats occurs under the influence of lipase.

Oral cavity

The oral cavity of the child also has its own characteristics, one way or another associated with the sucking of milk. The oral cavity itself in the crumbs is still very small - because of the low sky, which does not yet have a vault. The tongue of a small child is wide and short, with pronounced papillae. In addition, the chewing muscles are extremely well developed in the child.

It is thanks to all this complex that the baby manages to very tightly wrap around the nipple of the mother's breast. Negative pressure is created in his mouth, due to which milk enters the baby's oral cavity. If the baby was born full-term, all sucking and swallowing reflexes are very well developed in him.

The mucous membrane of the oral cavity in a child is extremely rich in blood vessels, but very dry. Remember, we talked about the fact that saliva in babies of the first months of life is not yet fully produced. All food consumed by the child is liquid, so there are no problems.

But here it is worth reminding parents that, due to increased dryness of the oral cavity, the mucous membrane is especially sensitive. Therefore, it is necessary to treat it with increased attention and caution. Make sure that the child does not pull rough diapers, toys into his mouth. Otherwise, abrasions and wounds may appear on the surface of the mucous membrane of the child. These injuries are extremely painful and can lead to the fact that the child will not be able to suck out the amount of milk he needs.

The saliva of a child, as well as any other person, contains various enzymes that begin to break down food even in the oral cavity. Of course, we are now talking about complementary foods, and not about milk.

Intestines

The intestines also play an important role in digestion. In babies, the intestine compensates for the immaturity of all other organs of the digestive system. After all, it is the intestines of the child that are responsible for membrane digestion, which is so relevant for the crumbs eating mother's milk or milk formula. It is in the intestines that the instant splitting of nutrients into components occurs. And already from the intestines, these same nutrients are absorbed into the blood.

As the food that enters the stomach is digested, it moves to the intestines under the influence of intestinal peristalsis. Its first stage is the duodenum, where, under the influence of enzymes produced by the pancreas and liver, further digestion occurs.

Leaving the duodenum, food enters other parts of the small intestine, where it continues to be digested already under the influence of intestinal juices. This is where the digestion process ends. By the way, the length of the intestine in a child is twice that of an adult - it is six times the size of a crumb.

The intestines of the child have very active peristalsis - it makes movements of two types:

Worm-like movements

With the help of this type of movement, food moves through various parts of the intestine. Without these movements, the normal process of digestion is simply impossible.

pendulum movements

With the help of pendulum movements, the process of digestion of food takes place directly, as well as its subsequent absorption into the blood of a person - in this case, a child.

Normally, intestinal peristalsis in an adult occurs under the influence of food that has entered it. However, in babies, peristalsis can occur and intensify not only due to the mechanical effect of food, but also under the influence of some other factors: prolonged crying of the child, overheating, excessive physical activity.

The intestinal mucosa of a child is extremely delicate and sensitive, and its walls are extremely permeable. That is why intestinal infections and toxins are especially dangerous for a small child. They very quickly penetrate the intestinal wall into the circulatory system, thereby provoking the development of intoxication, sometimes very strong. In young children, the most common food poisoning can result in such serious consequences as heart failure, meningitis and others.

Microbes in the gastrointestinal tract

During fetal development, the intestines of the crumbs are absolutely sterile. However, just a few hours after birth, the baby's intestines are inhabited by a huge number of a wide variety of bacteria. They disappear into the body of the child through the nose, mouth, anus. Approximately on the second day after birth, a huge amount of a wide variety of bacteria can be found in the feces of the crumbs. Moreover, there are practically no bacteria in the stomach or in the upper intestines. They are mainly localized in the large intestine and the lower part of the small intestine.

Which microbes predominate in the intestines of a child depends solely on the nature of feeding the child. In the event that the child feeds on mother's milk, which is extremely rich in carbohydrates, the bacteria that are necessary for the fermentation of carbohydrates will mainly prevail in the intestines of the child. It is this microflora that is physiological for an infant.

In the same case, if a child receives artificial milk mixtures made on the basis of cow's milk, Escherichia coli predominates in his intestines. Unfortunately, this intestinal microflora for a child is no longer physiological. And therefore, under the influence of adverse factors, they can provoke the development of various intestinal diseases. That is why it is precisely those children who are bottle-fed that most often suffer from intestinal disorders.

Chair in children

You can not ignore the question of the chair of the child. Indeed, in infancy, a baby's bowel movements can tell a lot about his health. Within the framework of the physiological norm, in the first day or two after birth, the child should have the first-born feces - meconium. Meconium has a viscous oily consistency and dark green light.

Meconium is odorless and sterile. It is formed in the intestines of the baby during fetal development - from the digestive juices swallowed amniotic fluid and intestinal epithelium. Normal bowel movements appear approximately on the third day. They consist mainly of the remains of undigested milk, digestive juices, salts and bacteria.

In children of the first months of life, a chair occurs, as a rule, two to three times a day. However, very often the stool in the first four to five weeks of life happens much more often - 8 to 9 times a day, sometimes even has a liquid consistency. Of course, almost all mothers are very scared, believing that the baby is very sick. However, in the event that the general well-being of the child does not suffer in any way, the baby eats well and gains weight within the normal range, such frequent stools should not be treated with increased anxiety.

Of course, what to say about this to the doctor - the pediatrician is still necessary. However, in most cases, doctors associate this phenomenon with insufficiently fast adaptation of the crumbs to the living conditions that are still new for him outside the mother's body. Especially often this happens in children who rushed to be born, or were born weakened and with low body weight.

However, there is also the opposite situation, in which children who eat the same mother's milk have stools only once every two to three days. And this is explained very simply - mother's milk is digested very well. And it is absorbed almost completely, which means that there is practically no waste left.

By the way, those babies who eat artificial mixtures made from cow's milk, the stools are darker in color, thicker in texture, and have a more unpleasant odor. As the child grows older, the stool becomes less and less frequent. However, of course, the full maturity of digestion is still very far away. Fully maturation of the digestive tract ends only by 15-16 years. Until then, parents will have to take into account the peculiarities of digestion in children all the time, making up their menu.

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