Symptoms of gastrointestinal immaturity in infants. Transient gastrointestinal disorders in newborns. roller-like thickening of the cheeks

Lactase deficiency in newborns can cause various unpleasant symptoms from the gastrointestinal tract - bloating, excessive gas formation, colic and diarrhea. The incorrect name for this disease is often used - lactose intolerance. Infants with lactose intolerance require an appropriate diet using lactose-free modified milk. What causes this disorder, and what is the treatment for lactose deficiency?

1 What is lactose?

Lactose is a carbohydrate (sugar such as glucose or fructose) found in milk - both cow's and women's milk. It consists of glucose and galactose molecules. After entering the gastrointestinal tract, lactose breaks down in the small intestine with the help of a special enzyme into simpler products that are absorbed into the blood. In some cases, when lactose deficiency occurs, various clinical symptoms may appear.

2 Lactase deficiency

Congenital lactase deficiency is a very rare phenomenon. The first symptoms of the disease appear already in the first days of a newborn’s life, immediately after receiving mother’s milk or modified milk containing lactose. Severe diarrhea soon appears.

In case of lactose intolerance, it should be excluded from the child’s diet as soon as possible, which eliminates the symptoms of the disease and also determines the correct development of the newborn. Children with lactose intolerance should follow a lactose-free diet to avoid digestive discomfort. It is enough to exclude milk and dairy products, to which powdered milk is added, from the child’s diet.

In the diet of infants who experience chronic diarrhea, infant formula should be used without lactose or with its limitation. In some cases, mixtures with soy can be used. It happens that as the child ages, the symptoms of lactose intolerance weaken, so you can gradually include milk in the diet. In addition, because Lactose facilitates the absorption of iron; a lactose-free diet should not be used for too long. It is recommended to give children dairy products: natural yoghurts, kefir without the addition of milk powder, because they contain probiotic bacteria that have a beneficial effect on intestinal microflora and motility.

3 Causes of dairy intolerance

Lactose intolerance in infants is associated with transient immaturity of the intestinal epithelium. Lactase deficiency is most often observed in premature babies, but in children born on time, it can also be a temporary problem. Lactase activity sometimes decreases with age, so adults sometimes do not tolerate cow's milk well.

It is believed that lactose intolerance in infants may be one of the possible causes of colic. Lactose, which enters the child’s gastrointestinal tract from mother’s milk and infant formula, will be incorrectly absorbed and retained in the intestines. It becomes a breeding ground for intestinal bacteria, and the result is gas - hydrogen and lactic acid. This is expressed by bloating and diarrhea, sometimes foamy.

Lactose intolerance in children can occur due to several reasons - initially in relation to the lactase enzyme itself (then, as a rule, the disease is genetically determined). And secondary, when in the course of various diseases the mechanism of digestion and/or absorption of lactose is disrupted, despite the correct action of lactase. In the case of secondary causes, after recovery of the underlying disease, the symptoms of intolerance, as a rule, disappear.

Secondary causes occur as a result of damage to the intestine during the following diseases.

The disease progresses to atrophy of the intestinal villi, in the epithelium of which lactase deficiency occurs. This causes intolerance symptoms.

Crohn's disease is an inflammatory bowel disease in which the entire intestinal wall is damaged, which also impairs the absorption of carbohydrates.

When using certain medications, mainly antibiotics or cytostatic drugs in cases of cancer, intolerance occurs. This causes destruction of the natural bacterial flora of the intestine, which promotes the development of the pathogens listed above.

4 Symptoms of the disease

Symptoms of lactose intolerance can occur in children at any age, but the younger the child, the more severe the symptoms. The severity of symptoms depends on the amount of milk consumed and on the form of food (foods such as kefir and yogurt are better tolerated). The most common symptoms of lactose intolerance are diarrhea, flatulence and abdominal pain, vomiting and belching. They appear at different times after eating.

5 Diagnostic measures

In diagnosing intolerance, the doctor, in addition to conducting a conversation on the topic of symptoms, may prescribe additional studies.

After 2 weeks of using a lactose-free diet, symptoms should subside. If the disease reappears after reintroducing this sugar into the diet, the child may be lactose intolerant. It should be borne in mind that lactose is found not only in milk and its products, but can also be present in products such as bread, powdered soups, cakes, and candies.

The breath test is a valuable non-invasive test. It consists of administering a certain dose of lactose orally on an empty stomach and measuring the hydrogen concentration in the exhaled air. Since lactose is a breeding ground for colon bacteria, people intolerant to this sugar will have a higher concentration of hydrogen in their exhaled air than healthy people.

A stool examination is carried out. If it is sour, this indicates carbohydrate intolerance. In the case of this study, it should be kept in mind that infants and young children have more acidic stools because... they consume large amounts of lactose in breast milk, which promotes the development of anaerobic bacteria (Lactobacillus, Bifidobacterium), which cause stool oxidation.

6 Treatments

Treatment of lactose intolerance in children includes a diet that excludes foods that cause unpleasant symptoms. However, their complete elimination from the diet is not always necessary. As a rule, it is sufficient to limit the amount of lactose consumed to the amount tolerated by the child, and an absolute ban is only required in rare cases of congenital lactase deficiency.

An elimination diet can cause deficiencies in components such as calcium (lactose promotes intestinal absorption) or protein, which can lead to growth problems in children. In such cases, it is necessary to add calcium supplements to the diet. For children under 2 years of age, it is recommended to use mixtures with lactose substitutes. Older children tolerate kefir and yoghurt well. Treatment is also carried out using drugs containing an artificially produced enzyme - lactase. It is given to the child along with products containing lactose. Lactase enzyme drops are available in pharmacies. Give the appropriate number of drops to the child immediately before breastfeeding or add to the milk formula. If adding lactase to the milk mixture, make sure that it is not hot, as high temperature causes the destruction of the enzyme.

Treatment with lactase preparations can be used safely for several months, but must be carried out under the supervision of a physician.

If the use of lactase is not necessary, the enzyme should be withdrawn gradually.

To neutralize excess gases in the gastrointestinal tract, which is the result of lactase deficiency, you can use drugs containing simethicone.

7 Doctor Komarovsky’s opinion on the problem

The main method of treating lactose intolerance is the complete exclusion of foods containing lactose from the diet. Lactase deficiency, says Komarovsky, does not appear as often as it is diagnosed. In addition, the pediatrician is confident that completely abstaining from products containing lactose in the first months of a child’s life is unacceptable. Many doctors advise nursing mothers not to breastfeed their baby and switch to a lactose-free formula. Komarovsky is categorically against this method. He assures that stopping breastfeeding will cause more harm to the baby’s health than continuing it.

Treatment of lactose intolerance in infants

Lactase deficiency Are you sure of the correct diagnosis?

To avoid problems with the baby’s gastrointestinal tract when breastfeeding, Dr. Komarovsky advises, you should follow the correct feeding technique. The milk that appears at the beginning of absorption is rich in lactose, so if after 1-2 hours the baby feeds from the other breast, he will again receive a portion saturated with this substance. If a lot of time has passed since feeding, it is best to feed the baby from one breast.

Komarovsky believes that colic due to transient lactose intolerance is not an indication for stopping breastfeeding without consulting a doctor or changing the formula to lactose-free. The enzyme lactose is not immediately produced in the gastrointestinal tract of a newborn. This takes about 3-4 months. Therefore, diagnosing him with lactose deficiency is a real crime.

Congenital defects
What congenital malformations of the digestive tract occur in children?
Life-threatening anomalies include, first of all, defects that cause obstruction of the digestive tract.
Congenital obstruction of the esophagus is atrophy of its final part, which makes it impossible for food to enter the stomach. The anomaly is often associated with a pathological connection (fistula) or duct between the esophagus and trachea. When you try to water or feed a child, food does not enter the stomach, but into the lungs, which causes choking, coughing, cyanosis (blue discoloration), and foamy discharge from the mouth. If the defect is diagnosed immediately after the birth of the child (testing of the stomach), surgical treatment saves his life.
Congenital obstruction of the rectum (anal atresia) is the absence of the anus or the formation of a membrane (similar to the hymen of the vagina), which makes it difficult to excrete feces. This defect can be combined with communication between the rectum and the urethra or vagina in girls.
The anomaly requires urgent surgical treatment.
Incomplete intestinal rotation is manifested by the fact that the fetal abdominal cavity cannot accommodate the increasing length of the intestine, so the intestine curls into loops (similar to loops of a rope). Improper formation of loops leads to intestinal obstruction, which makes it difficult to pass feces. The most dangerous complication for a newborn is the complete absence of intestinal rotation and prolapse from the abdominal cavity through the wide umbilical ring of the intestine to the outside, as well as improper rotation of the duodenum (Ledd syndrome).
Pathological narrowing or absence of part of the small or large intestine is rare but requires prompt surgical treatment.
Intestinal obstruction caused by meconium develops already in utero. A plug of thick meconium, or original feces, forms in the intestines, causing obstruction (for example, in cystic fibrosis). The prognosis is very serious, treatment consists of emergency surgery.

Digestive tract infections
What can cause digestive tract infections in newborns?
Diarrhea in newborns.
“Physiological indigestion” is not a disease. But if the newborn has signs of dehydration and there is an admixture of fresh blood, pus or a large amount of mucus in the stool, these are signs of a possible infection of the gastrointestinal tract. Bacterial infection can occur in utero (if the fetus gets contaminated amniotic fluid) or during
childbirth Bacteria can enter the bloodstream through the umbilical cord vessels, through which the fetus receives nutrients during intrauterine life. The entry point for infection can be an open wound of the umbilical cord. Possible penetration of infection through the liver - septic inflammation of the liver (jaundice!). With the blood, bacteria can enter the gastrointestinal tract, lungs, ears, brain, membranes of the brain and spinal cord. In newborns, infectious diarrhea can be one of the links in a common infection - sepsis.
After birth, due to the weak resistance of the digestive tract to bacteria, infection can occur from the outside, with contaminated foods.
This is especially true for formula-fed children. In this case, bacteria enter the blood through the intestines and cause general infection. Prevention of the disease includes meticulous adherence to the rules of personal hygiene and hygiene of feeding the newborn.
Appropriate diagnosis and treatment of bacterial infections in newborns are based on bacteriological examination of stool, blood, discharge from the ears and nose, and urine examination. Only based on the results can you correctly prescribe treatment by selecting the appropriate antibiotics.
Treatment should be carried out in a hospital.
Viral infections of the digestive tract are quite common in newborns.
Diarrhea caused by viruses is not uncommon in children during the neonatal period. Their prevention includes breastfeeding and preventing people with catarrhal symptoms from caring for a newborn. Maintaining good hygiene is of utmost importance.
Fungal infections. The oral mucosa of newborns is not able to protect them from infection.
Therefore, they often develop fungal diseases. With insufficient care and in weakened newborns, thrush - white colonies of fungi - may appear on the mucous membrane of the oral cavity and tongue. In severe cases, it can spread to the esophagus and larynx, and also enter the bloodstream. Prevention and treatment of thrush is based on compliance with feeding hygiene rules. Nipples should be boiled and stored in a container with a lid. If a child is sick, it is necessary to wipe the oral mucosa with a solution of baking soda.

Regurgitation and vomiting
Why do newborns spit up and vomit?
Newborns often experience regurgitation due to the “physiological” weakness of the muscles at the entrance to the stomach, as a result of which food from the stomach is thrown into the esophagus. Regurgitation is promoted by the child's horizontal position during and after feeding, as well as by swallowing air (aerophagia) with food.
To prevent regurgitation, it is necessary to give the baby a semi-vertical position when feeding, and after feeding, he must be held vertically (“in a column”) to allow air to escape from the stomach.
If at 3-6 weeks of life newborns (usually boys) vomit “fountain”, we can assume a narrowing of the pylorus. Intense vomiting can also occur in a child if the structure of the genitourinary organs is abnormal.

Constipation
What causes constipation in newborns?
Persistent constipation in a newborn, often with bloating of the lower abdomen, occurs with expansion of the large intestine - Hirschsprung's disease. This condition requires surgical treatment, which is usually carried out in several stages.
Constipation may be caused by artificial feeding or unsuitable formula milk. Poor stool is possible due to a lack of breast milk from the mother.

Bloating and intestinal colic in the first three months of a child’s life
Why does a child worry about bloating and intestinal colic?
In the first three months of life, which are very troublesome for parents, children often experience painful bloating (colic), which is manifested by the baby’s crying and screaming. These transient phenomena are associated primarily with imperfect regulation of coordinated intestinal movements (peristalsis). Their prevention and treatment are based on regular feeding (observe the feeding schedule) of the baby, as well as the prevention of constipation. It may be useful to replace sugar with glucose (if you have frequent bowel movements) or vice versa - glucose with sugar (if you are prone to constipation). It is good to introduce grated apple or vegetable soups into the child’s diet after 3-4 months of life. The baby’s condition can be alleviated by using herbs: chamomile decoction, dill water.

I found this useful information on the Internet:

A universal clinical symptom complex of troubles in the upper gastrointestinal tract in newborns and children of the first year of life is the syndrome of vomiting and regurgitation. This syndrome occurs in approximately 86% of children in the first six months of life.
Vomiting is a complex neuro-reflex act, which has both a pathological significance and a protective, compensatory nature and is aimed at maintaining homeostasis and removing harmful substances from the body. Vomiting is usually preceded by nausea - an unpleasant, painless, subjective sensation, accompanied by vegetative-vascular reactions: paleness, weakness, dizziness, sweating, salivation.
Vomiting is a complex reflex act, during which the involuntary ejection of stomach contents occurs through the esophagus, pharynx and mouth, while the pylorus contracts and the fundus of the stomach relaxes, the esophagus expands and shortens, a strong contraction of the diaphragm and abdominal muscles occurs, the glottis closes, the soft palate rises . Emptying of the stomach occurs due to repeated jerky contractions of the abdominal muscles, diaphragm, and stomach.
In infants, especially premature ones, vomit is often expelled through the mouth and nose, which is due to imperfect coordination of the components of the vomiting mechanism. This creates a real threat of aspiration of vomit, the occurrence of aspiration pneumonia, and asphyxia.
Regurgitation is a type of vomiting in children of the first year of life, they occur without abdominal tension, are carried out as a result of passive reflux of gastric contents into the pharynx and oral cavity, and the child’s well-being is not disturbed.
The frequency of regurgitation and vomiting in infants is explained by anatomical and physiological characteristics.
Classification
According to the Kerpel-Frenius classification (1975), vomiting can be divided into primary, caused by pathology of the gastrointestinal tract, and secondary, unrelated to gastrointestinal diseases.

Primary – the cause of vomiting is gastrointestinal pathology.

1.Functional reasons
Violation of feeding regime
Aerophagia
Overfeeding
Cardiospasm
Gastroesophageal reflux
Pylorospasm
Esophagitis, gastritis, duodenitis
Flatulence, constipation
Perinatal encephalopathy

2. Organic causes of vomiting
Esophageal atresia
Esophageal stenosis
Chalazia (failure) of the cardia
Achalasia cardia
Sliding hiatal hernia
Short esophagus
Pyloric stenosis
Diaphragmatic hernia
Atresia and duodenal stenosis
Annular pancreas
Arteriomesenteric compression of the duodenum
Incomplete intestinal rotation
Hirschsprung's disease
Secondary
Infectious-toxic
Cerebral
Exchange

The issues of classification of vomiting remain difficult and controversial to this day.

Functional disorders

Cardiospasm (esophagospasm, hypertensive dyskinesia of the esophagus).
Cardiospasm is based on increased motility of the lower third of the esophagus with normal function of the upper third, which leads to impaired relaxation of the cardia after the act of swallowing. The causes of cardiospasm are functional disorders of the nervous system, disorders of the hypothalamic region and dystonia of the autonomic nervous system, mental trauma.

Clinic: profuse regurgitation and vomiting, during feeding with just eaten food, without previous nausea. They can occur during sleep if a prolonged spasm has led to expansion of the overlying parts of the esophagus. An early sign is pain in the chest or epigastrium, often provoked by negative emotions and hasty eating. Dysphagia is manifested by retention of food in the esophagus, a feeling of a chest lump.

Gastroesophageal reflux (GER)
This is the involuntary flow or reflux of gastric or gastrointestinal contents into the esophagus.
Reflux is the reflux of predominantly liquid contents into any communicating hollow organs in the opposite, anti-physiological direction. Rejection occurs both as a result of insufficiency of the valves and sphincters of the hollow organs, and due to a change in the pressure gradient in them.
Physiological GER is characterized by the appearance of belching or regurgitation after eating, appears both during wakefulness and during daytime sleep, is characterized by a short duration and the absence of clinical symptoms of damage to the esophagus (catarrhal, erosive esophagitis), the child is gaining weight well, the general condition of the child is not disturbed. GER is a physiological phenomenon for children in the first 3 months of life, manifested by regurgitation and rarely vomiting; it is based on the underdevelopment of anatomical structures that cause ARM; it occurs in 40-65% of healthy infants, according to various authors.

Pathological GER in 99-100% of cases is manifested by regurgitation and vomiting, which are persistent. Pathological GER is characterized by frequent and prolonged episodes of reflux, observed both day and night and causing symptoms of damage to the mucous membrane of the esophagus and other organs. Complications of pathological GER are reflux esophagitis, ulcers and strictures of the esophagus, microaspiration with the development of pathology of the respiratory system (recurrent bronchitis, segmental and subsegmental atelectasis in the lungs). The main causes of pathological GER are incompetence of the gastroesophageal junction (LES), increased episodes of transient relaxation of the LES, insufficient ability of the esophagus to cleanse itself (extended esophageal clearance) and neutralize hydrochloric acid, and gastric pathology in the form of impaired motility or its partial obstruction.

Pylorospasm
This is a spasm of the pylorus without organic changes in the pyloric part of the stomach, which is based on hypertonicity of the sympathetic nervous system due to hypoxia or natal injury to the cervical spine and spinal cord.
The clinic of the syndrome of regurgitation and vomiting is observed from the first days of life with an inconsistent frequency with curdled or just eaten milk, an admixture of bile is possible, in a volume equal to or less than one feeding. There is no visible intestinal peristalsis. Neurological status: syndrome of increased neuro-reflex excitability. Weight gain is within the age norm or slightly reduced.

Acute gastritis
Causes:
Nutritional – a sharp transition to artificial feeding, improper preparation of the formula.
Medications (antibiotics, aminophylline), prescribed orally.
Infectious (ingestion of infected amniotic fluid, infected formula, milk).
Clinic: regurgitation and vomiting are erratic, repeated, with curdled milk, often accompanied by diarrhea, with an infectious lesion - signs of infectious toxicosis.

Flatulence
In newborns and infants, it can lead to regurgitation and vomiting syndrome. With flatulence, pressure in the abdominal cavity increases, gastric evacuation is disrupted, and the tone of the cardiac sphincter decreases. Flatulence in an infant can be caused by dysbiosis, inappropriate quality and volume of food for age, lactase deficiency, and constipation.
Clinic: regurgitation intensifies with increasing flatulence, stool retention, varies in frequency and volume, and is more pronounced in the afternoon.

Organic causes
Esophageal atresia (often combined with tracheoesophageal fistula). An important symptom is polyhydramnios in the mother, false hypersalivation, foamy saliva on the baby’s lips, which appears within a few hours after birth, and hoarse breathing. Regurgitation at the first meal, following a swallow. Attacks of coughing and choking when trying to feed a child are a reliable sign of an esophageal-tracheal fistula.

Congenital esophageal stenosis
The cause of stenosis may be a narrowing involving all layers of the organ, hypertrophy of the muscular layer, a membrane formed by the mucous membrane, cartilaginous inclusions in the wall of the esophagus, as well as compression of the esophagus from the outside by abnormally located blood vessels.
Clinic: with a sharp degree of stenosis, the symptoms are the same as with atresia, appearing from the moment of birth. With less severity of stenosis, dysphagia and regurgitation during and after meals occur when feeding denser foods. Putrid odor from the mouth, excessive regurgitation in a horizontal position, especially during sleep, appear with suprastenotic dilatation of the esophagus with stagnation of food. Excessive regurgitation can lead to aspiration pneumonia.

Chalazia (failure) of the cardia
This is a congenital failure of the cardiac esophagus due to underdevelopment of intramural sympathetic ganglion cells.
The clinical picture is caused by cardia insufficiency and reflux of stomach contents into the esophagus. It manifests itself as persistent regurgitation and vomiting after feeding, flattening of the weight curve, possible admixture of blood in the vomit due to the development of erosive esophagitis due to the irritating effect of gastric juice on the esophageal mucosa, further development of peptic stricture of the esophagus, hypochromic anemia.

Achalasia cardia
It is rare, accounting for 1% of all esophageal diseases in children, mainly in children over 3 years of age. The cause is a congenital defect of the intramural (parasympathetic) ganglia in the lower esophagus, which leads to non-opening of the cardia and prevents the passage of food from the esophagus to the stomach.
Clinic: regurgitation and vomiting syndrome from birth, vomiting occurs during feeding, maybe during sleep. The vomit contains food that has just been eaten. Dysphagia is manifested by increased swallowing movements and choking while eating. Children over 2 years old eat very slowly, choke when eating quickly, especially if the food is dense, often wash down food with water, and often stretch their necks and bend down before swallowing. The pain occurs after eating, is intermittent, aching, behind the sternum or in the epigastrium, can radiate to the back, disappears after vomiting. Malnutrition and anemia may develop.

Hiatal hernia
Causes: congenital underdevelopment of connective tissue structures that strengthen the esophageal opening of the diaphragm. A hernia can be: sliding, when the upper part of the stomach can exit through the esophageal opening of the diaphragm into the chest cavity and slip back, and paraesophageal - the cardiac part of the stomach is located in its usual place, and part of the base of the stomach penetrates through the enlarged esophageal opening of the diaphragm into the chest cavity.
The clinic is determined by the symptoms of cardia failure and reflux esophagitis: soon after birth, belching and vomiting appear, usually immediately after feeding. There is often an admixture of blood in the vomit due to esophagitis and stagnation of blood in the stomach, which ends up in the chest cavity.

Hypertrophic pyloric stenosis (pyloric stenosis)
This is concentric hypertrophy of the muscles in the pyloric region. The predominant age of patients is from two weeks to three months, the ratio of boys to girls is 4:1.
Clinic: fountain vomiting of curdled milk without bile, appearing at 3 weeks of life and later. The volume of vomit exceeds the volume of the previous feeding. The frequency of vomiting increases every day. The appetite is preserved, but the child does not gain weight due to frequent regurgitation. Stool with tendency to constipation. Due to water and electrolyte disturbances, tissue turgor decreases and oliguria is noted. On examination, the lower part of the abdomen sinks; in the upper part (during feeding) in the pyloroduodenal zone, peristalsis in the form of an “hourglass” is visible (from left to right).

Diaphragmatic hernia
Penetration of the stomach and part of the intestine into the chest cavity not only through the esophagus, but also through the thoracic opening in the diaphragm. Frequency 1:3000 newborns (usually left-sided - hole in the lumbocostal triangle). Clinic: with large hernias in a newborn, cyanosis, decreased breathing on the side of the hernia. Often pulmonary hypoplasia. Possible vomiting.

Atresia and duodenal stenosis
Causes: primary stenosis of the duodenum or compression of it by a tumor of the head of the pancreas, an annular pancreas, which should be considered in very young children.
Clinic: signs of atresia appear already in the first days of life, symptoms of stenosis, primarily vomiting, are detected later. These anomalies are most common in children with Down syndrome. Vomiting of light-colored contents indicates stenosis above the confluence of the bile duct. An admixture of bile is characteristic of stenosis located below this place.
Arteriomesenteric compression of the duodenum - its lower section is compressed by the vessels of the mesenteric root.
Clinical picture: a picture of obstruction of the small intestine, a kind of vicious circle may arise - weight loss, vomiting, exacerbation and increased duodenal compression against this background.

Intestinal malrotation.
Incomplete rotation, in which partial intermittent obstruction is noted in the area of ​​​​the transition of the duodenum to the jejunum.
Reason: the pathology is based on a disorder of embryonic development, in which the initial section of the small intestine remains in the left half of the upper abdomen, and does not move to the right. Because of this, a very steep transition is created between the duodenum and the jejunum. Along with incomplete rotation in such cases, there is a high position of the ascending colon.
Clinic: with partial obstruction, profuse vomiting, not a stream, with an admixture of bile in children aged from several days to three weeks. Recurrent abdominal pain, forced knee-elbow position. Abdominal bloating, visible peristalsis.

Hirschsprung's disease (congenital megacolon).
Prevalence 1:5000 newborns. Boys get sick 4 times more often than girls.
Reason: the disease is based on the absence of ganglion cells of the Auerbach and Meissner plexuses in the intestinal wall of a certain part of the colon (usually the descending, sigmoid or rectum), but in severe cases there may be aganglionosis of the entire intestinal tube. As a result, peristaltic waves are interrupted in the affected area and feces are retained, stretching the upstream areas of the intestine.
Clinic: in newborns the onset of the disease is from the 1st day of life - late passage of meconium is noted, in small portions. Half of the children from the second day of life have vomiting mixed with bile, congestive, mainly in children with widespread intestinal aganglionosis. Often there is bloating in the abdomen already in the first week of life and intoxication, which causes vomiting. When signs of the disease appear in children over one year of age, the leading symptoms are constipation and flatulence.

Health to our children! So that no one encounters this!

Microflora is a collection of microorganisms living within the same environment. This article will focus on the intestinal microflora in children. We will talk about maintaining the balance of beneficial bacteria in the small and large intestines in newborns and older children.

The composition of microflora affects the health of the entire human body.

The role of intestinal microflora and the consequences of its disturbance

Microbes living in the intestines are in symbiosis with humans - in a relationship that is beneficial to each party.

Beneficial bacteria use the child's body as a nutritious habitat. But does the child need them? Necessary!
They participate:

• in the synthesis of enzymes that break down proteins and carbohydrates to a state in which they can be absorbed by the body;
• in the synthesis of B vitamins;
• in the synthesis of proteins when they are insufficiently supplied with food;
• in the process of absorption of iron, calcium and vitamin D by the intestinal walls;
• in the fight against harmful microorganisms;
• in the processing of toxic substances to neutral ones and their rapid elimination;
• in the formation of children's immunity and the synthesis of immune bodies.

If breastfeeding is not possible, then the child's food should be enriched with prebiotics.

If the microflora is disrupted, the child’s body suffers entirely:

• Digestion worsens due to lack of enzymes;
• stool is disturbed;
• the synthesis of proteins and vitamins is disrupted;
• the effect of toxic substances increases;
• the ability of the intestines to absorb vitamins and minerals deteriorates;
• the amount of pathogenic microflora increases;
• immunity deteriorates.

Normal intestinal microflora is extremely important for the baby - it not only participates in metabolism, but also plays the role of an army against harmful representatives of the microcosm.

Composition of microflora. Balance and imbalance

All microorganisms living in the intestines are divided into two groups:

1. Obligatory (or mandatory). This is a group of beneficial bacteria that must certainly be present in the body: bifidobacteria, lactobacilli and E. coli. Without them, a person cannot be healthy. This also includes microorganisms that are neutral in relation to human health: enterococci and bacteroides.
2. Optional. This group includes conditionally pathogenic (Klebsiella, Clostridia) and harmful to humans bacteria (Proteus, Staphylococcus), microscopic fungi (Candida yeast), the presence of which in the body is not necessary or undesirable at all.

Normal microflora ensures the correct development of the child and forms immunity.

An indicator of intestinal health is the correct ratio of obligate and facultative groups of bacteria. For children, the following microflora composition is considered normal:

• No less 97% - obligate bacteria;
• No more 3% - facultative microorganisms.

If a child has exactly this composition of intestinal flora, then this condition is called balance. If for some reason the content of obligate bacteria from all microorganisms populating the intestines falls below 97%, then they speak of an imbalance. Otherwise, it is called dysbiosis - a condition in which the number of pathogenic bacteria and fungi in the intestines has increased.

Symptoms of dysbiosis

• increased gas formation;
• Sometimes - ;
• allergic reaction to the skin in the form of;
• weakening of the immune system.

Dysbacteriosis is characterized by general malaise, which is accompanied by abdominal pain.

If such symptoms are present in your child, take measures to restore the intestinal microflora. It will not be superfluous to prevent infectious diseases, to which the baby is most susceptible during this period.

But don't forget that Intestinal colic may also present with similar symptoms, characteristic of newborns and considered normal.

It is possible to judge with confidence the presence or absence of dysbacteriosis only after analysis.

Analysis of the composition of intestinal microflora and preparation for it

A stool test for dysbacteriosis is prescribed:

• newborns from the risk group (if there was a late attachment to the breast, disturbed microflora of the mother’s vagina, intolerance to mother’s milk, a long stay in the maternity hospital, being in intensive care and the presence of infections);
• infants with poor weight gain, frequent allergies, anemia and artificial feeding and early introduction of complementary foods;
• children of preschool/school age with allergies, frequent colds.

In Russian public clinics, stool analysis for dysbacteriosis, carried out on the direction of a pediatrician, is free.

In private clinics, depending on the region of Russia, the cost of analysis ranges from 700-1500 rubles. In Moscow - from 900 rubles.

The container with stool must be delivered to the laboratory within 3 hours after collection.

To ensure that the analysis results are reliable:

1. For three days, stop giving your child laxatives, including rectal suppositories.
2. If you are on antibacterial treatment, then the analysis can be collected only after 12 hours (however, bowel movements cannot be restrained).
3. Evacuation should be natural. Feces released after an enema are not suitable for analysis.
4. Do not collect stool if it has come into contact with urine.
5. Place the collected material in a sterile container - the volume should not be less than 10 ml.
6. Deliver the container to the laboratory within 3 hours of collection.

Nastya wrote in her review:

“I didn’t think it was so important to follow all the rules for collecting analysis. My daughter was 1 year old, and we needed to have her stool tested for flora testing. Business as usual, I thought. I put my daughter on the potty, where she did all her business. And then I just took it from there with a toothpick and put it in a container. The results of the analysis were sad, but there were no symptoms. The doctor asked how the material was collected. It turns out that everything must be sterile. But I didn’t even wash the pot, and collected urine... Don’t do this if a reliable result is important! Repeated stool testing according to all the rules showed the norm.”

Laboratory assistants will examine the composition of the intestinal microflora under a microscope and compare the results obtained with the norm. Based on the analysis, the doctor will make a diagnosis.

Attention! You should not do a stool test if the child has diarrhea or another symptom of microflora imbalance - an isolated case.

But consult a doctor if loose stools are very frequent, and your baby has a fever.

Formation of intestinal microflora in newborns. Colic

Before birth, there are no bacteria at all inside the baby's intestines - it is completely sterile. The first colonization and contact with microorganisms occurs at the moment the child moves through the birth canal. And here the composition of the mother’s vaginal microflora is important: if she has untreated infections, they will definitely manifest themselves in the child.

Cramps, bloating and rumbling in the abdomen, anxiety and moodiness - all these are symptoms of intestinal dysfunction.

Important! The formation of intestinal microflora in children born surgically is sluggish, since contact with the mucous membrane of the birth canal is excluded. There is an increased risk that the first inhabitants will be pathogenic microorganisms. Therefore, natural childbirth is always a priority if there are no contraindications to it.

The formation of the microflora of a newborn is positively influenced by:

• Attachment to the breast in the first 2hours after birth. This promotes the colonization of the baby's oral cavity with bacteria that live in the mother's intestines. Subsequently, beneficial microorganisms move through the gastrointestinal tract and colonize it.
• Sharing a baby withmother. The mother has long ago formed her own microflora: in close contact with the child, she shares it. This is beneficial for newborns.
• The mother's nipples and areolas have the same composition of flora as in the intestines. Bacteria are also found in milk. Therefore, children fed with mother's milk always have stronger immunity. In artificially raised children, the content of opportunistic and pathogenic microbes in the intestines is usually higher, and they can cause infection.

Breast milk is the best cure for intestinal diseases in infants.

Despite the presence of beneficial microorganisms in the gastrointestinal tract, all newborns are bothered by intestinal colic and stool disorders - signs of imbalance. Modern medicine accepts this condition as a physiological norm. The fact is that up to 3 months, the intestinal microflora is unstable, and its composition changes day by day. But this condition cannot be called dysbacteriosis, because the flora is still at the stage of formation.

Symptoms of intestinal colic in newborns or the “rule of three”

• Tummy problems(crying, bloating, groaning, pulling legs towards the tummy) - begin at 3 weeks of life.
• The child suffers from colic every day for 3 hours a day.(mainly before bedtime).
• Colic continues for 3 months then they pass on their own.

If your baby is worried about newborn colic, you can help your baby

• massage;
• hot diaper;
• gymnastics.

Pay attention to your diet if you are breastfeeding. Additionally, contact your pediatrician, who will prescribe your baby a carminative drug for bloating, the cause of pain.

For simplicity and ease of use, Espumisan is available in the form of an emulsion and in the form of drops.

Tatyana writes:

“After a long stay with my infant son in the hospital, intestinal problems began. The doctor diagnosed dysbacteriosis. And I don’t know how we would cope if it weren’t for modern drugs. Nam, which was taken three times a day for 2 weeks.”

Lactase deficiency

Lactase deficiency is a rare congenital disorder consisting in the inability of a child to absorb milk sugar due to the lack of necessary enzymes. Lactose accumulates in the intestines and causes fermentation and rotting. These processes lead to disruption of the intestinal flora. Symptoms of dysbiosis and intestinal colic appear. But none of the methods of treating them will help.

There are only two options here:

1. Stop breastfeeding and switch to lactose-free formula.
2. The child takes a drug with an enzyme that breaks down lactose. Then breastfeeding can continue.

Veronica left a review:

“I have always believed that breast milk is the healthiest thing that can be given to a newborn. But not with my Ksyusha. I thought she had severe colic. I stroked her tummy and put on a tube, but there was no improvement. I examined my daughter, after which I was shocked: my daughter simply could not digest my milk because she had lactose intolerance. We were prescribed a special mixture, and since then the problems have stopped bothering us.”

Microflora disorders in older children

The microflora formed in infancy can change its composition or even be disrupted in older children for various reasons. Factors contributing to this:

• Treatment with antibiotics that kill both harmful and beneficial bacteria. That's why .
• Poor nutrition and sudden changes in diet.
• Climate change (acclimatization process is underway).
• Psychological and endocrine disorders.
• Weak immunity and infection.

The disadvantage of antibacterial treatment is that antibiotics “eat” any bacteria - unfriendly and friendly to us.

Symptoms of disturbed microflora are:

• , sometimes alternates with ;
• bloating and sharp pain in the abdomen;
• anemia, vitamin deficiency due to impaired ability to absorb vitamins and minerals;
• weakness;
• lack of appetite;
• headache;
• allergic skin rashes;
• weakening of the immune system, which is manifested by colds, herpes, fungus;
• the predominance of pathogenic microflora in the intestine - microbes and bacteria classified as pathogenic.

Classification of drugs for microflora restoration

All drugs intended to restore intestinal microflora can be divided into 4 groups:

• Monoprobiotics- preparations containing only one type of beneficial bacteria. Bifidobacteria can be populated with the help of, lactobacilli - by taking, and E. coli - with the help of Colibacterin.
• Polyprobiotics- preparations that include several types of bacteria beneficial to the intestines and substances that enhance the activity of beneficial microflora. These include Atsilakt, Bifilong, Bifikol.
• Self-eliminating probiotics- drugs with bacteria that are not usually present in the intestines, but they actively fight pathogenic microflora. They do not cause harm, and after a month they leave the body on their own. These are Biosporin, Sporobacterin and Baktisubtil.
• Probiotics on sorbents- preparations with beneficial bacteria and sorbents. Sorbents are thickening agents. In medicine they are used to treat diarrhea. In combination with probiotics, sorbents accelerate the colonization of the intestines with beneficial microflora. Medicines in this category include Bifidumbacterin Forte and Probifor.
• Drugs that create conditions for the growth of beneficial intestinal flora - .

Normal intestinal microflora is the key to good health and immunity. Create favorable conditions for its proper formation and preservation in children. If the bacterial balance in the intestines is disturbed, take measures to normalize it. And be attentive to your child!

Alisa Nikitina

Doctors and scientists have been studying the digestive characteristics of children and the impact of various factors on it for many decades. Dietary recommendations undergo changes from year to year, are revised in accordance with modern data and are improved. So how does baby digestion work? And what is the correct way, from a physiological point of view, to feed babies? Let's talk about it.

1. Seize the moment.

While the baby is in the mother's tummy, he receives nutrition through the umbilical cord and placenta. At this time, his digestive system is not yet as active as that of those who have already been born. But still, the baby swallows amniotic fluid, and, therefore, its glands gradually start working. By the time of birth, a sufficient amount of meconium accumulates in the baby’s intestines, which consists of the remains of amniotic fluid and particles of desquamated epithelium. After cutting the umbilical cord, the baby begins to eat by mouth, and his digestion is activated.
The first days of life are the most important for normalizing digestion, so you need to know some of the features of the body of newborns in order to properly organize their nutrition. The oral cavity of babies is relatively small, but the chewing muscles are well developed in it. In addition to this, there are special lumps of fat in the cheeks and the mucous membranes of the lips and tongue are arranged in a special way. All these anatomical features are aimed at effectively sucking the mother's breast from birth. Due to this structure of the oral apparatus, the baby grasps the nipple with the isola, lining the tongue along the lower sponge and turning the lips outward - this allows you to create a vacuum and suck effectively.
A healthy full-term baby has a sucking reflex from birth, but in order to launch and strengthen it, you need to start putting the little one to the breast as early as possible (preferably in the first half hour of life). If at this time you separate the baby from his mother and give him a pacifier instead of a breast, then the innate program will go astray. And “retraining” will not have an effect - the baby will still suck the breast incorrectly. He will injure the mother's nipples, and may even abandon the breast altogether.

2. First days.

One of the features of baby digestion is the poor development of the salivary glands, which are located in the oral cavity. Therefore, during the first 1.5-2 months there is some dryness in the mouth, little saliva is produced, and insufficient hydration. Because of these features, the mucous membrane becomes vulnerable and sensitive to infection. In addition, in the first months, the mucous membrane practically does not produce protective immunoglobulin class A - special antibodies that are responsible for protection against the penetration of microbes and viruses. This is why babies often develop thrush, a fungal disease of the oral cavity. Thrush creates an unpleasant sensation in the mouth, discomfort when sucking, and the baby may cry and refuse to latch on to the breast. If you find cheesy deposits on the cheeks, gums and tongue (signs of thrush), you need to treat the baby’s chest and mouth with a solution of soda and a special anti-fungal remedy, which the doctor will recommend. With proper treatment, thrush will go away in 4-5 days.
The baby's stomach, unlike ours, is located almost horizontally. In addition, its sphincters, the circular muscle fibers at the entrance and exit of the stomach, have special features. The cardiac sphincter, that is, the input sphincter, works poorly, but the pyloric, that is, the output sphincter, is already well developed. Therefore, if the stomach is stretched too much, the entrance to it will remain open, but the exit to the intestines will be closed, and regurgitation or vomiting is possible. If air gets into the stomach, then when you change the position of the body, it will come out through the slightly open top into the esophagus and then into the mouth - a belch will occur.
Knowing these structural features of the sphincters, you will understand why it is so important to ensure that the baby attaches correctly to the breast and does not “suck” air (this is evidenced by any sounds when sucking, except for sips). If the baby is “artificial”, you need to monitor the volume of portions. The fact is that the baby simply cannot overeat, because milk does not flow from the breast in a stream, and the baby is able to regulate its volume by sucking. Having eaten, he will simply let go of the breast. When feeding from a bottle, milk flows continuously, and the baby has no choice but to swallow, swallow and swallow again. And, as a result, overeat. When calculating the amount of nutrition for an artificial baby, remember: the volume of the stomach during the newborn period is 25-30 ml, by a month it is up to 100 ml, by 3 months
up to 150 ml, by six months up to 200, by a year up to 250-300. And it should be no more than 2/3 full!

3. Often and little by little.

In the mother's tummy, the baby received continuous nutrition. And therefore, immediately after birth, he cannot switch to portioned “eating food”. Because of this, infants feed on demand, receiving milk at short intervals and little by little. Usually milk stays in the stomach for 15-20 minutes and gradually enters the intestines in small portions. It is for this reason that regimented feedings did not justify themselves. In addition, frequent breastfeeding effectively empties and stimulates the breasts, giving an influx of even greater volumes. It is extremely difficult to feed artificially-fed children with small volumes all the time, so feeding by the hour was chosen. However, recently this method has also been revised towards a more free feeding regime, with variations in the volume of the mixture. Until about six months, the digestive glands of the stomach are not yet actively producing gastric juice, so the child should not receive any other food other than milk or formula. The baby’s intestines are longer than ours, but their motor activity is still insufficient - there is not enough coordinated muscle work to move food from the stomach to the rectum. Therefore, babies often experience constipation and bloating, popularly called “colic.” By about 3-4 months, muscle activity returns to normal, and everything falls into place. In the first months, you can help the baby activate peristalsis by placing it on the tummy more often or massaging the anterior abdominal wall.

By the way, the characteristics of a child’s stool are also determined by the work of the intestines and muscle contraction, as well as the type of feeding - breast or artificial. Within the first two days after birth, the intestines should empty of meconium. If during this period the baby receives colostrum, which has a laxative effect and activates the liver, meconium is excreted faster. Consequently, the likelihood of developing jaundice decreases, and even if it occurs, the severity will not be so pronounced. At the time of birth, the baby’s intestines are sterile, and microbial colonization begins within the first hours. Therefore, it is extremely important what kind of microflora the ventricle gets acquainted with - from the skin of the mother and her breasts (when staying together and breastfeeding) or from the air of the maternity hospital and from the hands of staff in the children's department. And this is another argument in favor of breastfeeding immediately after birth and in favor of early cohabitation. There are a lot of microbes on the mother's nipple, but they are not dangerous for the baby - with milk he receives factors that promote the colonization of beneficial bacteria (they form lacto-bifid flora) and the destruction of harmful ones.
In the first 6-10 weeks, the baby’s stool often frightens parents, as it constantly changes its character. But if the child is exclusively breastfed, his stool “has the right” to such inconstancy. This is the so-called physiological dysbiosis - a condition when the work of the microflora is adjusted. Under the influence of the immune defense of milk, beneficial microbes pacify and crowd out violent neighbors (UPF opportunistic flora). At the same time, the mother (through milk) transfers the already formed immunity to this flora. Therefore, staphylococcus, Klebsiella or E. coli found in the feces of a baby do not require special treatment. All therapy involves breastfeeding. At the time of birth, the baby’s intestines are sterile, and microbial colonization begins within the first hours.
Are greens in your stool alarming? It is caused by the breakdown products of bilirubin, which is usually elevated in the baby in the first months of life (sometimes manifested by jaundice). But foamy and watery stools are explained by excess foremilk, which is formed between feedings. During the first months of life, the baby experiences a relative lack of the enzyme lactase, which breaks down the milk sugar of foremilk (lactose). As a result, with an excess of foremilk, not all lactose is broken down and enters the large intestine, where it is fermented by microbes. Hence the formation of carbon dioxide and excess water - foam and water in the stool. In this case, more frequent and longer feedings will help.
White lumps in the stool usually indicate oversaturation with milk, when a small part of it does not have time to be digested and ends up in the large intestine in the form of curdled lumps. Separately, it is worth mentioning the frequency of the child’s stool. It can be different: from several times a day to once every few days, but in a larger volume. This applies, first of all, to infants - milk is so well absorbed by the child that almost no waste remains, and stool occurs when a sufficient volume of contents has accumulated in the rectum to trigger the defecation reflex. If you feel normal, have a soft tummy and have passed gas, there is no need to stimulate stool, even if you haven’t had one for several days - the child will handle it on his own. For “artificial” patients, with an adequate selection of the mixture and its correct dosage, it is permissible to wait no more than 2-3 days for stool. Unfortunately, the mixtures are not digested so well and tend to cause constipation.

5. New dishes.

When can you start complementary feeding? From the point of view of the physiology of digestion, most enzymes of the stomach, liver and pancreas mature by 6-8 months, and the intestinal wall becomes less permeable to allergens and harmful substances by 4-6 months. Therefore, it is correct for children of all types of feeding to introduce complementary foods at six months, unless for special indications the doctor prescribes it earlier (for example, introducing porridge into the diet in case of poor weight gain).

Material taken from Young Family magazine, November 2011.