Baby constipation

child_constipaton2The constipation problem may occur at any age, including a newborn babies and preschoolers. It is believed that constipation is the most common pathology of the gastrointestinal tract in children. Some parents do not pay enough attention to this aspect of the child’s life; others have the wrong idea about problem of children’s defecation and its treatment. So what is baby constipation? When should you turn to doctor?

Constipation is called a violation of bowel function, resulting in increased intervals between acts of defecation. Newborn baby who is breastfed, the frequency of stool may coincide with the number of feedings (from 2 to 6 times a day). Gradually, with age, decreasing frequency of stool, and the period of introduction of complementary foods (about 6 months) defecation occurs within one – two times a day.

In babies on artificial feeding, the frequency of defecation usually occurs two times a day. But we should remember that in healthy children of first year of life the defecation is more often mushy consistency. Those cases when the baby has noted painful defecation dense consistency of feces are also considered as baby constipation.

Defecation in baby may be daily, but accompanied by straining, the changing of defecation nature (”large” diameter of stercorous cylinder, “sheep” cal – thick, divided into smaller fragments).

This situation is also characteristic for dysfunction of the large intestine and can be characterized as chronic constipation an act of defecation in less than 6 times per week for children less than 3 years of age and at least 3 times a week for children over 3 years. Baby constipation is often accompanied by abdominal pain, which they often react with crying and anxiety.

The movement of fecal is made by reducing the intestinal muscles under the influence of nerve endings. The feces lifting down the intestine is carried out through its undulating contractions – peristalsis.

Urge to defecation occur when the fecal comes in the rectum, they stretch it and irritate the nerve endings, which are there. In older children the defecation is done consciously under the control of the central nervous system. Total immaturity of the neuro-muscular system in children’s first months of life may contribute to fecal delay.

What kinds of baby constipation are there?

Baby constipation can be divided into organic and functional.

Organic constipation associated with developmental disabilities (anatomical defects) any department of the large intestine. Most organic constipation is manifested at birth by the lack of an independent defecation. Among the organic causes of constipation are most often found Hirschsprung’s disease and dolichosigmoid.

Hirschsprungs_disease_constipationHirschsprung’s disease – congenital hypoplasia of the nerve endings in the intestinal wall, at the result of which in lower regions of the colon occurs narrowing, and in the overlying sections – an extension that creates conditions for the delay defecation. Hirschsprung’s disease can be suspected in cases where a child has no independent defecation at all practically from birth. This disease is rare – 1 case per 5000 children.

Dolichosigmoid is a lengthening of one of the divisions of the colon – the sigmoid colon. This gut has often an increased mobility, which creates conditions for violations of the formation and lifting of defecation. Dolichosigmoid occurs very often, it is believed that among children aged 3-4 years who suffer from constipation, 40% are children with dolichosigmoid.

There may also be acquired constipation associated with anatomic defects of the intestine, caused by the effects of surgical interventions in the rectal area or in the abdominal cavity – the development of adhesions.

If you exclude organic causes then your constipation has a functional character.

The causes of functional constipation in infants are:

  • Improper diet of feeding mother.
  • Lack of water schedule in the child when artificial feeding.
  • Inadequate water schedule of breastfeeding child with the introduction of complementary foods (enter “thick” lure, but did not give the baby water).
  • An early child beginning with the artificial feeding.
  • Fast changing of the baby’s food – from one mixture to another (less than 7 days).
  • Irrational diet of the child (a child for a long time gets a high content of protein, fats, which are poorly digested).
  • The presence of infant rickets, in which there is decreased muscle tone, including the muscles of the intestinal wall. In some cases, 2-3 weeks after the appointment of vitamin D constipation in child is disappeared.
  • Consequences of the central nervous system damage that evolved wrong during pregnancy and childbirth.
  • Thyroid gland (hypothyroidism). One of the clinical manifestations of hypothyroidism is constipation.
  • Iron deficiency anemia – iron deficiency occurs when there is insufficient oxygen supply muscle gut, and therefore the notes of his muscle weakness.
  • Intestinal dysbiosis – a violation of intestinal microflora, which leads to increased decay processes, reduction of motor activity of intestine.
  • Food allergies (to the protein of cow’s milk, eggs, fish, soy, cereals containing gluten (gliadin)), which leads to inflammatory changes in allergic nature of the gut wall.
  • A significant role in the development of functional infant constipation plays violation of the act of defecation as a result of oppression or lack of elaboration on the defecation reflex (conditioned reflex, psychogenic constipation). This type of constipation is often observed in children in the oppressive period of adaptation to new conditions (nursery, kindergarten). The suppression of the reflex to defecation leads to compaction of the fecal, rectal mucosa injury, the development of inflammation, pain during defecation, there is “fear of Pot”, compounded by the neurotic disorders.
  • Constipation may develop on the background of long-term use of medicines: antispasmodics – resources, reduce spasms of smooth muscles, for example, the intestines, anticonvulsants, diuretics (diuretics), psychotropic drugs, antibiotics, etc.

As a result of different, the above pointed reasons, changes the muscle tone of intestines. When the tone of any segment of the intestine increased there occurs spasm thus fecal can not pass quickly this place.

This is the mechanism of spastic constipation, the outward manifestation of which is the presence of dense, fragmented, “sheep” faeces. Another kind of functional constipation is a hypotonic constipation, which is characterized by delay defecation, highlighting it in the form of fecal cylinder.

Children may experience temporary delays in the defecation – “transient constipation”. This may be due to errors in diet, with dehydration stool during the acute febrile states (if the child has high fever, marked sweating, loss of fluid from vomit, etc.).

Babies who are breastfed may develop so-called “false constipation”. It arises due to the fact that infants receive a small amount of breast milk, as well as the presence of congenital defects of the oral cavity (for instance, hard and soft cleft palate), flaccid sucking, regurgitation.

In these cases, is not worth talking about baby constipation, and to take emergency measures. With the elimination of the reasons that caused defecation delay, its normalization occurs independently. Sometimes, to solve this problem, it is enough to correct the diet and water schedule.

The constipation effect on the baby’s body

  • Constipation accompanied by the development of a child’s chronic lethargy, weakness, loss of appetite to the damage of the processes of digestion and enhancing absorption of harmful substances from the stool.
  • When the accumulation of stool in the lumen of the gut is disturbed nutrition of the mucosa.
  • Chronic defecation delay leads to violation of intestinal microflora, increasing the number of pathogenic and reduce the normal microflora.
  • There is a malabsorption of vitamins and trace elements, which leads to other violations of exchange in cells and tissues of the body, gradually developing iron deficiency.
  • There also can develop inflammation in the intestine (colitis), increase intestinal motility, which is accompanied by abdominal pain, to expand the diameter of intestine, which would have increased to more constipation.

Possible complications

Long-lived constipation can cause various complications. Most often, the children experience violations of intestinal microflora, which entails a violation of the processes of digestion and absorption in its department.

Further increases intoxication caused by the increase in decay processes in the intestine, the accumulation of harmful substances. There is possible violation of blood circulation in the intestinal wall, the development of inflammation in the colon and the expansion of the intestinal lumen.

The most common cases of constipation in children of different ages are characterized by cracks in the rectum, accompanied by the appearance of red blood on the surface of stool. Persistent constipation can cause loss of rectal mucosa. When you notice these symptoms you shouldn’t engage in self-treatment, seek ambulance. In infants the painful defecation leads to fears about this process.

Emergency help in case of baby constipation

baby_constipatonAt home in case of baby constipation as a means of “emergency” you can use a cleansing enema before the doctor comes. For cleansing enema used boiled water at room temperature. To increase aperients of enemas you should add glycerin to the water – 1-2 teaspoons in a glass of water.

Also, to soften the stool you can give a child vaseline. It is important that vaseline is not absorbed in the intestine, and in appointing it in between meals does not affect the absorption of nutrients, electrolytes, and fat-soluble vitamins. Babies under one year is usually assigned 1/2-1 teaspoon, in 1-3 – 5-10 ml (1-2 tsp.), From 4 to 7 years – 10-15 ml (2-3 tsp.).

With the help of an enema is recommended to introduce the following quantities of liquid, depending on the child age:

  • Newborn- 25 ml;
  • 1-2 months – 30-40 ml;
  • 2-4 months – 60 ml;
  • 6-9 months – 100-200 ml;
  • 9-12 months – 120-180 ml;
  • 1 -2 years – 200-250 ml;
  • 2-5 years – 300 ml;
  • 6-10 years – 400-500 ml.

However, the selection of an enema, should be considered an important principle – the minimum amount of water, needed for defecation. The container used for the enema should be clean, and its tip is smeared with vaseline or oil. In order to fill the cylinder, squeeze it by hand to complete displacement of air, then dip the tip into the water and open the balloon, recruited it in the water.

After the whole procedure have been done within a few minutes, gently squeezing the buttocks of the child, in order to prevent water from pouring out too quickly. Children of the first year of life can clysterize in the supine position with elevated legs.

When bloating, increased gas formation, anxiety medications are used on the basis simethicone (SAB simplex, Espumizan), dill water, tea with fennel, chamomile

In the absence of the defecation during the day being the mechanical stimulation of the bowel, for this purpose are used: gas-collecting tube (a tube is sterilized, then brushed with liquid vaseline and inserted into the anus to a depth of 3-5 cm) suppository with glycerin (you can use them from birth), stroking the skin around the anus.

Suppository insertion

In order to make suppository insertion into the rectum of the baby you should turn him on the left side, slightly bending his knees and hip joints, and lightly fixed in that position. Then with the left hand throw the buttocks and with right hand, freeing the thin end of the suppository cone, place it in the anus. When the suppository is put into the rectum, it is important for 1-2 minutes to keep the buttocks pressed against each other, so that the suppository was not reflexively embossed back.

You should add in the baby food (if age allows) the products with remittent effect (beets, carrots, apricots, kiwi, mango, etc.). It should be noted that for a child, especially at an early age laxatives can be used only on prescription, as many of them have serious side effects.

When should you contact the doctor

baby_constipaton_doctorIf the breastfed infant has no defecation for 2 days, you should immediately consult a doctor!

If the child is older, you should seek medical help in the following cases:

  • constipation accompanied by complaints of abdominal pain, abdominal distention, reduced appetite;
  • in the child’s stool there have been seen blood;
  • Child holds defecation for emotional reasons, especially on a pot;
  • baby periodically observed encopresis, where the solid fecal accumulate in the rectum, and liquid faeces excreted as a result of involuntary loss of control over the child’s muscular rectum.

First of all you should visit the pediatrician, that he should determine the necessity of other specialists consultations (child neurologist, endocrinologist, surgeon).

Baby constipation correction

The main purpose of treatment of constipation in children is to restore the consistency of the intestinal contents and the rate of progress on the colon. In pediatric practice applied conservative and surgical methods for treatment of baby constipation.

1. Conservative treatment:

  • diet therapy;
  • drug therapy;
  • physiotherapy;
  • therapeutic exercise (gymnastics), and massage;
  • mechanical depletion.

2. Surgical treatment (restoration of patency of the intestine, reducing its length, removing the altered sections of intestine).

There are different approaches to the correction of baby constipation in the natural and artificial feeding.

Correction of functional baby constipation with breastfeeding

  • If the cause of infant constipation is a lesion of the central nervous system during pregnancy or childbirth, he needs treatment for child neurologist.
  • If the cause of baby constipation – rickets, a child needs a medical correction of rickets, which carries a pediatrician.
  • If there are diseases of the endocrine system (like hypothyroidism) therapy is determined by the endocrinologist.

child_constipatonIn any cases, correction of constipation should be comprehensive and primarily include adherence and diet therapy. In some cases, constipation developed against the background of violations of the date and nature of child’s nutrition. In this situation, hygiene measures and dietary correction is enough to adjust the child defecation.

  • The child must have an active motor mode. In the first months of life the baby should be laid on his stomach before each feeding for 5-10 minutes. In the morning hours to engage in exercise by age for 10-15 minutes, this complex must necessarily include stroking the abdomen in a clockwise direction. With every passing month motor exercises should be expanded, i.e. include more exercises with the active participation of the arms, legs and abdomen, and its duration should be increased on 5-10 minutes.
  • No less important role should be paid for proper nutrition of the child. Breastfeeding is best for the child of the first year of life. Today it’s recommended to put a baby to breast as often as he requires, not respecting the time intervals between feedings, including night hours.
  • The importance of prevention and correction of constipation in the infant has the right food with the exception of the nursing mother of gas-forming products (cabbage, grapes, dark breads), the correct water schedule (at least 2500 ml of fluid per day), as well as the normalization of intestinal motility in lactating women (regularly eat vegetables, vegetable soups, porridge, bread with bran, prunes, figs)
  • The diet of the infant’s age is introduced cereals or vegetables complementary feeding (in consultation with the pediatrician) as a source of dietary fiber.
  • After the introduction of “dense” foods to make sure that the child had an adequate water schedule (pre-boiled water to 100 ml / day), as well as the shortage of water in the body it is absorbed from the colon, and dry stool do not cause reflex due to direct intestine.
  • In identifying violations of intestinal microflora on the analysis of feces for bacteria overgrowth correction is carried out using the pro-and prebiotics, which are assigned by the doctor.
  • For the elimination of reduced muscle tone (hypotension), intestines, doctors recommend courses of massage and exercise therapy.
  • If you can’t make a regular defecation, with the above activities, it is recommended laxative containing lactulose (a synthetic carbohydrate), such Duphalac. Lactulose not only increases the volume of stool, softens the stool and promotes depletions, but also contributes to the growth of normal intestinal microflora. Dose is adjusted individually, appointed by a doctor. The course of treatment can range from 2-3 weeks or more before the normalization of the defecation.
  • Physiotherapy treatment is used in the treatment of constipation in children older than 3 years. Hypotonic constipation apply galvanization (use with the medical purpose of continuous direct electric current of low power and low voltage), ultraviolet irradiation of the abdomen. In spastic constipation – pulse currents (of varying frequency, shape and polarity), electrophoresis of drugs, possessing antispastic properties, paraffin bath on his stomach, etc. Acupuncture also provides the positive effect.

Correction of functional baby constipation on artificial feeding

Correction of functional constipation in babies on artificial feeding involves:

1. Implementation of major activities such as for children being breastfed (see above).

2. In addition to the infants of the first year of life, which are on artificial feeding, used special treatment mixtures containing dietary fiber, lactulose or adapted milk mixtures. These mixtures contribute to the formation of a loose mixture of chyme (intestinal content), increase the viscosity and stool volume, improve the motility and growth of normal intestinal microflora.

To prevent constipation, you should keep breastfeeding as long as possible, do daily exercises with a child, to conduct courses of massage and prevention of rickets, anemia, food allergies and intestinal dysbiosis.