What to do if a child 2-3 years constipation? Causes, treatment and diet

Description of the disease

Contents:

• Diagnosis of constipation in children
• Causes of constipation in children
• Constipation in an infant
• Signs of constipation in newborns
• Constipation after feeding
• Constipation in a child 2 years
• Constipation in children 3 years
• What to do if your child has constipation?
• Treatment of constipation in children
• Diet for constipation in children

Constipation in a child is dysfunction of the gastrointestinal tract, which is manifested by long periods without a chair when the presence or absence of urge to defecate. Sometimes a sign of constipation is a subjective feeling of incomplete emptying of the bowel.

Physiological norms of defecation in children of different ages:

• Chest (from 1 month to 1 year) – up to ten times per day;
• Nursery (from 1 year to 3 years) – daily;
• Preschool (3 to 7 years) – from three to six times a week.

These data are conditional, in different medical sources stated norms, which vary within very wide limits. However, definitely proved that a healthy child, the frequency of defecation correlate with the quality (digestibility) of food consumed and the availability of roughage – stimulator of intestinal peristalsis, as well as with the amount drunk per day of the liquid.

Constipatio (constipation) aged 0 to 16 years have a number of characteristics associated with physiological and psychological changes of a growing organism.

Physiological characteristics of constipation in children

In the diagnosis and treatment of constipation factors corresponding to the different periods of children's age, including:

• Stool frequency, character (significantly different at different ages);
• The availability of physical and instrumental diagnostic methods (some methods are ineffective or not applicable);
• Arsenal of drugs, and therapeutic and surgical treatments (consider age contraindications).

Psychological peculiarities of constipation in children

The problem of constipation in adults is not seen as a significant psychological disadvantage, with the exception of the forced prolonged stay of a person in unusual conditions. In childhood the mind is unstable, prone tothe influence of adults and staff, and regulation of bowel movement in a child is imperfect.

Constipation have a significant impact on the quality of life of children in the form of:

• Emotional lability (instability) – heightened fears, timidity;
• Mental stress – imaginary or real fear of humiliation;
• Deterioration in a child's socialization – isolation or isolation in the team.

There are four critical period from the point of view of possible development of constipation in children:

• The transition from breastfeeding to solid food (age four to six months to one year);
• Weaning from diapers, the transition to defecate in the pot (the age of about eighteen months to two years);
• Reinforcement of the regulation of defecation (the age of about three years);
• The period of socialization of the child (kindergarten, school, summer camp).

Adults are required to be attentive to these delicate problem, because the consequences of constipation in children can manifest as:

• Impossibility of self - (no enemas or laxatives) bowel movements;
• Of fecal incontinence due to atony of the anal sphincters;
• Continuous discharge of liquid feces on the background of constipation – encopresis (combined damage to the anal sphincters).

Encopresis is the most extreme form of pathological consequences of constipati. Develops in about 3% of children under three years of age, more often in boys than in girls. Encopresis and other consequences of chronic constipation is a potential cause of disability of the child.

Diagnosis of constipation in children

Normal design feces for different periods of childhood:

• With the first day of life up to six months – pasty;
• From six months to two years – mushy or proformance;
• With two years and further decorated stool (type 3-4 on the Bristol scale).

The diagnostic criteria that indicate constipation in children:

• A reduction in the frequency of bowel movements;
• Difficulty of defecation;
• Complaints about the feeling of incomplete emptying of bowel;
• Increased density and porcherot feces.

Constipation revealed in the anamnesis of up to 50% of children surveyed coming for treatment with problems of the gastrointestinal tract (GIT). Almost always (94%) children constipation is the consequence of functional disordersThe digestive tract. Dysrhythmia bowel organic origin are much rarer: according to different sources, approximately 6% of all examined patients admitted for the inpatient treatment of diseases of the gastrointestinal tract.

Diagnosis of chronic constipation in children includes a comprehensive examination, including:

• Medical history (usually a survey accompanying person describing their own subjective feelings, not the child);
• Clinical examination (detection and/or exclusion phenotypic characteristics of undifferentiated connective tissue dysplasia (STD) is one of the main causes of constipation in children);
• Laboratory methods (markers of intestinal microflora, the reliability of immune status);
• Ergography;
• Ultrasound of abdominal organs and lower GI tract.

Irrigoradiography – the main and the most informative method of diagnosis of functional constipation. This x-ray study of the distal bowel filled with contrast agent. Currently used different variants of this technique, including minimally invasive combination ultrasound and x-rays, which is suitable for safe use in children from an early age.

Using irrigography reveal:

• Incomplete emptying of the rectum (the norm after a bowel movement it is empty);
• The elongation and/or increased tone of the sigmoid colon;
• The expansion of ampoule of rectum;
• Thick-intestinal reflux.

Differential diagnosis of constipation with the purpose of determination of severity of pathology and compensatory opportunities of an organism of the child is carried out methods:

• Fibrogastroduodenoscopy (EGD) to detect various functional disorders in the upper gastrointestinal tract (e.g., reflux verkhnechirchik);
• Daily pH-metry cardia of the esophagus for the detection of diurnal changes in the acidity of the upper gastrointestinal tract;
• Ultrasound of the gallbladder to determine its contractile ability;
• Salonovations research method the propulsion (propulsive) activity of the intestinal wall;
• Electromyography, manometry, sphincterotomy – methods of diagnostics of the functional state of the anal sphincters;
• Gas-liquid chromatography (studies of short-chain volatile fatty acids (CCGC) markers of disorders of microbiocenosis of the intestine with constipation);
• Cytochemical analysis of peripheral blood lymphocytes (gives an idea about the depththe pathological process associated with constipation in a child);
• The research on mental health (usually in adolescence). Determine associated with constipation indicators of physical and emotional status and level of social adaptation (PedsQL questionnaire in the Russian version).

Causes of constipation in children

The duration of infant constipation are:

• Episodic (single or acute);
• Chronic (ongoing, with possible periods of remission).

Constipation in children, there are organic and functional nature:

• Organic constipation. Due to structural anomalies of the intestine (Hirschsprung's disease, syndrome payer, Crohn's disease). This group includes a large list of diseases of interest to a narrow group of gastroenterologists, surgeons and Coloproctology;

• Functional constipation. In children, functional disorders are the main cause of constipation. Almost all studies confirm the leading role of undifferentiated connective tissue dysplasia (STD) in the development of chronic constipation in children.

Undifferentiated dysplasia of connective tissue (NSTD) – a group of interrelated syndromes, which is a pathology of the connective tissue. NSTD manifest diverse symptoms in all the organs with a tissue.

Pathological changes NCTD for constipation found in the connective tissue the following body systems:

• Skeletal-muscle;
• Cardiovascular;
• Respiratory;
• Excretory;
• Digestive;
• Nervous.

Visceral (related to internal organs) manifestations NSTD are:

• Gastroesophageal reflux disease (GERD) is a gastrointestinal disease caused by the backward ejection of a food coma from the stomach into the esophagus;
• Duodenogastroesophageal reflux (DGER) is a disease provoked by the pathological influence of acid on the mucosa of the small intestine due to the reverse discharge of intestinal contents from the duodenum into the stomach.

Phenotypic (identified by inspection) signs NSTD having diagnostic value with constipation submitted by stigmas – diseases most often associated with undifferentiated dysplasiaconnective tissue.

1. Craniofacial stigma (signs) of chronic constipation in children:

• myopia (nearsightedness);
• congenital curvature of the nasal septum;
• malocclusion and growth of the teeth;
• anomalies in the structure of the ear.

2. Stigma musculoskeletal system, combined with manifestations of chronic constipation in children:

• kyphosis, scoliosis (curvature of the spine);

• anomalies in the shape and length of fingers .

3. Cutaneous stigma, combined with constipation in children:

• striae (stretch or atrophic scars), the mechanism and causes of their development are unknown until the end;
• multiple spots;
• hypertrichosis (excessive hair growth);

• hemangiomas (benign tumors of the first days of life).

4. Gastrointestinal stigma, coupled with chronic constipation in children:

• cardia insufficiency (incomplete closure of the valve between the esophagus and the stomach);

• hernia of the diaphragm;

• the strain or excesses of the gallbladder;
• hernia of the anterior abdominal wall.

In some cases of chronic functional constipation of childhood does not correlate with STD.

Causes of chronic functional constipation in children can also be:

Congenital or acquired anomalies of a thick intestine – dolichocolon, dolichosigma and others;

Psychosomatic factors (conscious suppression of urge to defecate);

Defects of neuromuscular or endocrine regulation of the operation of a thick intestine (Hirschsprung's disease, vegetodystonia bowel, hypothyroidism, hyperparathyroidism, degeneration of intramural ganglia due to staphylococcal infections);

Physical inactivity (sedentary lifestyle, prolonged bed rest with diseases);

Food allergies (often constipation alternating with diarrhea);

Nutritional factors (feeding disorders, muffins, small volume of food, lack of fiber, lack of fluid);

Reflexive factors (inflammatory diseases of other organs connectedfat intestine, or external and internal anal sphincters);

Intoxication or metabolic disorders, causing damage to the sensitivity of the receptor apparatus of the intestinal wall;

Dehydration (especially with symptoms of acidosis, hypokalemia, and hypercalcemia);

Iatrogenic factors (dysfunction caused by the continued unjustified use of antibiotics and other drugs without considering the consequences).

In clinical practice there is a combination of several causes of constipatio. Diagnosis of constipation in children is a difficult task due to the complex mechanism of the disease development.

The pathogenesis of chronic functional constipation of children develop one of three scenarios:

• The suppression of the propulsive (thrust) motility – disorders motility in some cases, genetically programmed, as observed familial predisposition to this kind of constipation;
• The occurrence of degenerative processes in the walls of the intestine and the violation of the sensitivity of the receptor apparatus – in some children with chronic constipation, a careful examination revealed a decrease in the function of the receptor apparatus of the intestine. In clinical practice there are also known cases of constipation, associated with damage to nerves in the dorsal and lumbosacral spine;
• Functional dystonia or barriers to the promotion of feces – constipation can be associated with spasms of the anal sphincters, preventing the evacuation of stool from the anus, and also with the lack of skills of defecation in children or pain of the act (of rectal fissures, inflammation).

Constipation in infants (monthly) child

The first month of life – the most disturbing period for a mother of a newborn, especially if it's your first one.

Signs of baby's health is the first month of life are:

• The presence of reflexes typical of this period.
• Good appetite, normal weight gain and growth;
• The regularity of natural items.

Normal cal leaves after each feeding, there is no pain reaction during defecation, the consistency of the secretions of mushy, yellow-green, the smell of sour milk. Healthy child has problems with defecation in the first month of life, there are doubtless some, however, this is not always a medical pathology.

You must beready to problems with defecation (constipation) in infants in the following cases:

• Discovered the newborn during diagnostic examinations change in the digestive tract;
• Forced medication (antibiotics) mom breast-feeding;
• Transfer the child with chest to artificial feeding;
• The abrupt change formulation the one power to another.

In some medical sources causes of constipation is also known as the late applying of the newborn to the breast, prematurity of the child and the delay of development due to poor prenatal nutrition of the fetus.

Signs of constipation in newborns

About constipation in newborn say in the following cases:

• The lack of defecation more than 1-2 days (to exclude possible underfeeding of the child, as the reason for the lack of defecation, not associated with pathology of the gastrointestinal tract);
• Anxiety and crying (prolonged absence of bowel movements on the background of calm behavior – the sign of full absorption of breast milk or baby food);
• Frequent regurgitation (backward elimination of food through the mouth without strain) immediately after feeding is a possible sign of a lack of promotion of stool in the intestine.

Constipation in the newborn, requiring immediate treatment to the doctor is rare. Meanwhile, to know the signs is essential, because constipation is one of the symptoms of "acute abdomen".

Syndrome of acute abdomen in the newborn is:

• A sharp abdominal pain is the leading symptom, then the characteristics are listed in descending order of diagnostic importance;
• Shock – progressive destruction of vital body functions (shock the first stage is accompanied by excitation, and then replaced by the sharp depression of consciousness);
• Constipation (rarely diarrhea);

• Vomiting (in newborn is rare);

• Discharge of intestinal gas (flatulence);

• Melena – black stool mushy (a sign of stomach or intestinal bleeding).

Syndrome of acute abdomen is extremely rare. Usually for elimination and prevention of constipation in newborns enough to perform abdominal massage. Be sure to consult your doctor about the advisability of the procedure taking into account individual peculiarities of the baby.

Abdominal massage for constipation includes the following manipulations:

• Stroking clockwise;
• Bringing the legs to the abdomen;
• Stroking of the back in the position of the child in the abdomen;
• Folding handles on the chest.

Time exercise individually. A very important regularity of massage in the absence of discontent from the baby.

Constipation after feeding

The first critical period from the point of view of possible development for constipation – an introduction in the diet of infants, additional products, or solid foods. Solid foods can begin from 4 months (breastfeeding) or 5-6 months (artificial feeding). The deadlines are indicative and depend on the individual development of the child.

Signs of child's readiness for the transition to solid foods:

• Indicators of weight and growth of the baby has increased two times since the birth;
• Physical development is normal (sure keeps his head and responds to visual, verbal and tactile stimulation with a rotating head);
• Breast or bottle-feeding does not cause feelings of complete saturation of the child.

To prevent constipation (diarrhea) foods gradually and conditionally divided into three periods with the introduction of new products (fruit and vegetables, cereals, meat and fish dishes). To avoid problems with the bowel can not be too quick to switch child to a new type of food. Signs of constipation in a child 4-6 months are the same as in the newborn.

Recommendations for the prevention of constipation during the transition to solid foods:

• As the first meal, use vegetable puree (steamed vegetables that contain fiber in large amounts);
• Start solid foods with minimal amounts of food;
• Lure implies the watering boiled water in the quantity necessary for the formation of a normal stool;
• Do not use for feeding products, potentially causing allergies (an Allergy – one of the causes of constipation in children);
• Additional protein in the diet to avoid constipation should be administered very careful;
• Observe the regularity of the feedings.

These recommendations are not exhaustive manual on the prevention of constipation in infants. Will definitely get additional medical advice related to individual characteristics of the digestive system of your child.

Constipation in a child 2 years

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The second critical period from the point of view of possible development of constipation in a child avoiding the use of diapers and potty training. At this time, mom's first encounter with psychological problems in the child. The transition to a controlled bowel movement occurs against a background of significant physiological changes of an organism of the child.

To two years:

• Dairy food finally becomes secondary (it increases the length of the intestine in connection with the change of type of food);
• Grow teeth (second year – up to 20 teeth), therefore, the child is able to grind food;
• Kal takes the form corresponding to the type 3-4 on the Bristol stool scale (the child's digestion is approaching the physiological norms of an adult);
• There are the beginnings of regulation the act of defecation.

Recommendations for the prevention of constipation in children two years taking into account the peculiarities of the physiology of digestion at this age:

• During this period there is a final change of type of food, milk can cause indigestion;

• The length of the intestine in a child of two years, exceeded his height to six times, and in an adult, intestinal length only about four times. This means that:

  • the passage of food in the intestine of the child is longer than in the adult time;
  • protein and fatty foods stay in the intestines longer, and therefore it should not be the basis of the diet of the child;
  • plant foods must include not digested in the intestine fiber;
  • you should regularly give the child to drink plain boiled water;
  • from the composition of the basic ration should gradually eliminate the crushed food.
• Child first alone is able to chew food. Teach him to properly chew.
• From diapers at this age it is advisable to completely give up.

Constipation in children 3 years

The third critical period from the point of view of possible development of constipation in a child is the final formation of the reflex delay of defecation and the beginning of socialization of the toddler (kindergarten). At this time there are no significant physiological changes in digestion, potentially influencingnature of defecation. However, this period of life is characterized by psychological and intellectual development of a man. Universal recommendations on prevention of constipation at the age of three and there are no identical children.

Meanwhile, important preventive measures to prevent constipation in children three years include:

• A correct diet and nutrition (a normal chair, the child should not be associated with phobias);
• The rejection of diapers, the use of which smoothes the discomfort of the child after defecation, hence, inhibits the production of reflex regulation of the act of defecation.

If despite a healthy diet, the observance of a day regimen and normal psychological climate in the family the child has ongoing constipation, perhaps, their reason is medical problems. Then the only correct advice is to contact the clinic for full examination and to the psychologist to determine the emotional causes of disease.

Starting from the age of three, children are diagnosed diseases such as encopresis and fecal incontinence:

• Fecal incontinence – a consequence of the thoughtless use of diapers in children after three years. Sometimes the problem lies in other causes, which can handle only a doctor on the basis of thorough research;
• Encopresis is a disorder which is manifested by constant soiling of the underwear and is mistaken for diarrhea. But it is always the result of constipation. In the ampoule of the rectum instrumental examinations diagnosed by fecal compaction;
• Psychological problems are always individual, it is unreasonable to restrict Internet tips, how to talk to a three year old experiencing difficulties with defecation.

What to do if your child has constipation?

First thingthat you should do is to learn how to assess the situation. If the problem, in your opinion, threatens the life of a child, immediately contact the medical facility. On the other hand, constipation may be imaginary. Its main feature is the absence of defecation in the background of the common behavior of the child, without colic (abdominal pain).

We should pay attention to the following circumstances:

• Insufficient weight gain in a child is perhaps the reason for the lack of defecation is to underfeeding, and restlessness associated with hunger;
• Weight gain in normal – perhaps breast feeding is almost completely absorbed by the child (tummy is not enlarged, no pain, baby is developing well).

The second is to seek the advice of aspecialist, a parent of the child. The inexperienced mother is not always able to independently and adequately assess the situation. Professional pediatrician can help you to understand the possible causes of constipation.

The third is to master the simple curative and preventive treatments (massage, enema, or rectal introduction through the mouth of laxatives, effective for a child). Do not attempt to manipulate the courses of instruction, ask the service technician to demonstrate their correct implementation.

The fourth is to learn to identify signs of hazardous conditions that threaten the health of the child (syndrome of acute abdomen, which characterize the different diseases of the gastrointestinal tract in a child, accompanied by constipation). Find out where to go for help in such a situation.

There are also many special products which help you to normalize a chair at the child, see article - what helps with constipation?

Treatment of constipation in children

Treatment of constipation in a child involves several aspects:

• Symptomatic treatment. The elimination of the main symptoms of pathology laxatives drugs of different groups used in pediatric practice, as well as enemas and physiotherapy manipulations aimed at bowel movements;
• Etiotropic therapy. The elimination of the causes of constipation. This is the most difficult aspect of the treatment, it depends on many factors: the results of diagnostics, the condition of the body of the child, the etiology of the disease (congenital, acquired). Based on these data choose tactics of treatment: therapeutic (treatment with medication and physical therapy) or surgical (surgical removal of defects that cause chronic or acute disritmia intestine);
• Pathogenetic therapy. Treatment is aimed at eliminating evolved in the course of the disease pathogenetic symptoms (intoxication, retarded growth, disturbances of the cardiovascular system). The Arsenal of drugs and physical therapy tools is enormous, the selection is individual, and depends on the pathogenesis of the disease.

Diet for constipation in children

Appointment diet children and possibly around two to three years. Until that time, just include in the diet of plain boiled then cooled to room temperature water.

When the child will be able to take normal diet, the diet will need to include mealsmade with the following products:

• The first meals. Soups on fish broth (hake, cod, saffron cod), soups on meat broth (beef, Turkey), vegetable soups (squash, tomatoes, carrots, potatoes, beets, cabbage, pumpkin);
• The second dishes. Cabbage rolls, meatballs (rice limit or exclude), meatballs, fish and meat (beef), omelettes;
• The garnishes. Porridges made of buckwheat, barley and pearl barley on the low-fat meat broth, cooked pasta, vegetables (listed above);
• Drinks. Compotes of dried fruits (dried apricots, raisins, prunes, figs), tea, vegetable and berry juices, fruit drinks;
• Desserts. Green tea cheesecake, honey, candy, jellies;
• Bread from flour of the second grade with the addition of whole grains and bran, dietary bread.

See article - what you can and can't eat for constipation

Constipation in children should limit the use of the following products: fatty meats and fish, smoked and spicy foods, raw whole milk, radishes, onions, garlic, rice, semolina, chocolate.