Constipation In A Child - Constipation At 1 Month, What To Do If A Child Is 2-3 Years Old With Constipation? Treatment And Diet For Constipation In Children

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

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

Description of the disease

Content:

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

Constipation in a child is a dysfunction of the gastrointestinal tract, which manifests itself for long periods without stool with or without the urge to defecate. Sometimes a sign of constipation is a subjective feeling of incomplete bowel movement.

Physiological norms of defecation in children of different ages:

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

These data are conditional, in different medical sources the norms are indicated, which vary within a very wide range. However, it has certainly been proven that in a healthy child, the frequency of bowel movements correlates with the quality (digestibility) of the food consumed and the presence of coarse fiber in it - a stimulator of intestinal motility, as well as with the volume of liquid drunk per day.

Constipation (constipation) at the age of 0 to 16 has a number of features associated with physiological and psychological changes in a growing organism.

Physiological features of constipation in children

When diagnosing and treating constipation, factors that correspond to different periods of childhood are taken into account, including:

• Stool frequency, its nature (differ significantly at different ages);
• The availability of physical and instrumental diagnostic techniques (some research methods are ineffective or inapplicable);
• Arsenal of drugs, as well as therapeutic and surgical methods of treatment (taking into account age-related contraindications).

Psychological features of constipation in children

The problem of constipation in adults is not considered as a significant psychological inconvenience, with the exception of the forced long stay of a person in unusual living conditions. In childhood, the psyche is unstable, subject to the influence of adults and the collective, and the regulation of bowel movements in a child is imperfect.

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

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

There are four critical periods in terms of the possible development of constipation in children:

• Switching from breastfeeding to solid foods (ages four to six months to one year);
• Weaning from diapers, the transition to bowel movements in the pot (age about one and a half to two years);
• Consolidation of the reflex of regulation of the act of defecation (about three years old);
• Child's socialization period (kindergarten, school, health camp).

Adults are obliged to be attentive to such a delicate problem, because the consequences of constipation in children can manifest themselves in the form:

• Impossibility of self (without enemas or laxatives) defecation;
• Fecal incontinence due to atony of the anal sphincters;
• Continuous discharge of liquid feces against the background of constipation - encopresis (combined damage to the anal sphincters).

Encopresis is an extreme form of the pathological consequences of constipation. It develops in about 3% of children at the age of three, more often in boys than in girls. Encopresis and other consequences of chronic constipation are potential causes of a child's disability.

Diagnosis of constipation in children

The normal appearance of feces for different periods of childhood:

• From the first day of life to six months - mushy;
• From six months to two years - mushy or semi-shaped;
• From two years of age onwards - formalized feces (type 3-4 according to the Bristol scale).

Diagnostic criteria for constipation in children:

• Decreased frequency of bowel movements;
• Difficulty defecating;
• Complaints about the feeling of incomplete emptying of the intestines;
• Increased density and tuberosity of feces.

Constipation is detected in the history of up to 50% of the examined children admitted for treatment with problems of the gastrointestinal tract (GIT). Almost always (up to 94%) children's constipation is a consequence of functional disorders of the gastrointestinal tract. Intestinal dysrhythmias of organic origin are much less common: according to various sources, in about 6% of all examined patients admitted to inpatient treatment of gastrointestinal diseases.

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

• Collecting anamnesis (usually interviewing an accompanying person describing their own subjective feelings, and not the child);
• Clinical examination (identification and / or exclusion of phenotypic signs of undifferentiated connective tissue dysplasia (NCTD) - one of the main causes of constipation in children);
• Laboratory methods (markers of intestinal microflora, reliability of the immune status);
• Irrigography;
• Ultrasound of the abdominal and lower gastrointestinal tract.

Irrigography is the main and most informative method for diagnosing functional constipation. This is an x-ray examination of the distal intestine filled with contrast agent. Various versions of this technique are currently used, including a minimally invasive combination of ultrasound and X-ray examination, which is suitable for safe use in children from an early age.

Irrigography reveals:

• Incomplete emptying of the rectum (normally after a bowel movement, it is empty);
• Elongation and / or increased tone of the sigmoid colon;
• Expansion of the rectal ampulla;
• Colon reflux.

Differential diagnosis of constipation in order to determine the severity of the pathology and the compensatory capabilities of the child's body is carried out by the methods:

• Fibrogastroduodenoscopy (FGDS) to detect a variety of functional disorders in the upper gastrointestinal tract (for example, upper intestinal reflux);
• Daily pH-metry of the cardiac esophagus to detect daily shifts in the acidity level in the upper gastrointestinal tract;
• Ultrasound of the gallbladder to determine its contractility;
• Balloonographic method for studying the motor (propulsive) activity of the intestinal wall;
• Electromyography, manometry, sphincterometry - methods for diagnosing the functional state of the anal sphincters;
• Gas-liquid chromatography (studies of short-chain volatile fatty acids (SCFA) - markers of intestinal microbiocenosis disorders in case of constipation);
• Cytochemical analysis of peripheral blood lymphocytes (gives an idea of the depth of the pathological process associated with constipation in a child);
• Mental health studies (usually during adolescence). Constipation-related indicators of physical and emotional status, as well as the level of social adaptation are determined (using the PedsQL questionnaire in the Russian version).

Causes of constipation in children

According to the duration, children's constipation is divided into:

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

Constipation in children is of an organic and functional nature:

• Organic constipation. Caused by structural abnormalities of the intestine (Hirschsprung's disease, Payer syndrome, Crohn's disease). This group includes an extensive list of diseases of interest to a narrow group of gastroenterologists, coloproctologists and surgeons;
• Functional constipation. In childhood, functional disorders are the main cause of constipation. Almost all studies confirm the leading role of undifferentiated connective tissue dysplasia (NCTD) in the development of chronic constipation in children.

Undifferentiated connective tissue dysplasia (NCTD) is a group of interrelated syndromes that are a pathology of connective tissue. NSTD manifests itself in a variety of symptoms in all organs with such tissue.

Pathological changes in NSTD with constipation are found in the connective tissue of the following body systems:

• Musculoskeletal;
• Cardiovascular;
• Respiratory;
• Excretory;
• Digestive;
• Nervous.

Visceral (related to internal organs) manifestations of NSTD are:

• Gastroesophageal reflux disease (GERD) is a gastrointestinal disease caused by the back ejection of a food coma from the stomach into the esophagus;
• Duodenogastroesophageal reflux (DHER) is a gastrointestinal disease triggered by the pathological effect of acid on the mucous membrane of the small intestine due to the back ejection of intestinal contents from the duodenum into the stomach.

Phenotypic (detected by examination) signs of NCTD, which have diagnostic value in constipation, are represented by stigmas - diseases that are most often combined with undifferentiated connective tissue dysplasia.

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

• myopia (myopia);
• congenital curvature of the nasal septum;
• malocclusion and tooth growth;
• anomalies in the structure of the auricle.

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

• kyphosis, scoliosis (various curvature of the spine);
• anomalies in the shape and length of the fingers.

3. Cutaneous stigma associated with constipation in children:

• striae (stretch marks or atrophic scars), the mechanism and causes of their development are not fully understood;
• multiple age spots;
• hypertrichosis (excess hair growth);
• hemangiomas (benign tumors of the first days of life).

4. Gastrointestinal stigma associated with chronic constipation in children:

• insufficiency of the cardia (incomplete closure of the valve between the esophagus and stomach);
• hernia of the diaphragm;
• deformities or kinks of the gallbladder;
• hernia of the anterior abdominal wall.

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

Chronic functional constipation in childhood can also be caused by:

• Congenital or acquired anomalies of the large intestine - dolichocolon, dolichosigma and others;
• Psychosomatic factors (conscious suppression of the urge to defecate);
• Defects of neuromuscular or endocrine regulation of the functioning of the large intestine (Hirschsprung's disease, intestinal vegetative dystonia, hypothyroidism, hyperparathyroidism, dystrophy of intramural ganglia due to staphylococcal infections);
• Physical inactivity (sedentary lifestyle, prolonged bed rest for diseases);
• Food allergies (more often constipation is interspersed with diarrhea);
• Alimentary factors (violation of the diet, dry food, small amount of food, lack of fiber, lack of fluid);
• Reflex factors (inflammatory diseases of other organs associated with the large intestine or with the external and internal anal sphincters);
• Intoxication or metabolic disorders that damage the sensitivity of the receptor apparatus of the intestinal walls;
• Dehydration (especially with symptoms of acidosis, hypokalemia and hypercalcemia);
• Iatrogenic factors (dysfunctions caused by prolonged unjustified use of antibiotics and other drugs without taking into account the consequences).

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

The pathogenesis of chronic functional constipation in children develops according to one of three scenarios:

• Suppression of propulsive (pushing) motility - disturbances of peristalsis in some cases are genetically programmed, since there is a family predisposition to this kind of constipation;
• The emergence of dystrophic processes in the intestinal walls and a violation of the sensitivity of the receptor apparatus - in some children suffering from chronic constipation, a thorough examination reveals a decrease in the functions of the intestinal receptor apparatus. In clinical practice, there are also known cases of constipation associated with damage to the nerves in the dorsal and lumbosacral spine;
• Functional dystonia or obstacles to the movement of feces - constipation can be associated with spasms of the anal sphincters, which prevent the evacuation of feces from the anus, as well as with a lack of bowel movements in children or painfulness of the act itself (rectal cracks, inflammation).

Constipation in an infant (month old) baby

The first month of a baby's life is the most disturbing period for the mother of a newborn, especially if it is the firstborn.

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

• The presence of reflexes characteristic of this period;
• Good appetite, normal weight gain and height;
• Regularity of natural discharges.

Normally, the feces leave after each feeding, there is no pain reaction during bowel movements, the consistency of the secretions is mushy, the color is yellow-green, the smell is sour milk. A healthy child certainly has problems with defecation during the first month of life, but this is not always a medical pathology.

It is necessary to be prepared for problems with defecation (constipation) in infants in the following cases:

• Changes in the gastrointestinal tract found in a newborn during diagnostic examinations;
• Forced intake of medications (antibiotics) by a breastfeeding mother;
• Transfer of a child from breastfeeding to artificial feeding;
• A sharp change from one food recipe to another.

In some medical sources, the causes of constipation are also called untimely attachment of the newborn to the breast, prematurity and developmental delay due to poor intrauterine nutrition of the fetus.

Signs of constipation in newborns

Constipation in a newborn is said in the following cases:

• Absence of defecation for more than 1-2 days (it is necessary to exclude possible underfeeding of the child, as the reason for the absence of defecation, not related to the pathology of the gastrointestinal tract);
• Anxiety and crying (prolonged absence of bowel movements against the background of calm behavior is a sign of complete assimilation of breast milk or baby food);
• Frequent regurgitation (backward excretion of food through the mouth without straining) immediately after feeding is a likely sign of a lack of movement of feces in the intestines.

Constipation in a newborn, requiring immediate medical attention, is rare. Meanwhile, it is necessary to know its signs, since constipation is one of the symptoms of an "acute abdomen".

Acute abdominal syndrome in a newborn is manifested as follows:

• A sharp pain in the abdomen is the leading symptom, then the signs are listed in descending order of diagnostic significance;
• Shock - progressive destruction of vital functions of the body (shock at the first stage is accompanied by excitement, and then gives way to a sharp depression of consciousness);
• Constipation (much less often - diarrhea);
• Vomiting (rarely observed in newborns);
• Discharge of intestinal gases (flatulence);
• Melena - black, mushy stools (a sign of gastric or intestinal bleeding).

Acute abdominal syndrome is extremely rare. Usually, abdominal massage is sufficient to eliminate and prevent constipation in newborns. Be sure to consult with your doctor about the appropriateness of the procedure, taking into account the individual characteristics of the baby.

Abdominal massage for constipation includes the following manipulations:

• Stroking clockwise;
• Bringing the legs to the stomach;
• Stroking the back with the child on his stomach;
• Folding the handles on the chest.

The exercise time is individual. The regularity of the massage is very important, provided there is no discontent from the baby.

Constipation after complementary feeding

The first critical period from the point of view of the possible development of constipation is the introduction of additional foods into the baby's diet, or complementary foods. Complementary feeding can be started from 4 months (breastfeeding) or from 5-6 months (bottle feeding). The indicated dates are indicative and depend on the individual development of the child.

Signs of a child's readiness to switch to complementary foods:

• Your baby's weight and height have doubled since birth;
• Physical development is normal (he holds his head confidently and reacts to visual, verbal and tactile stimuli by turning his head);
• Breastfeeding or formula feeding does not make the baby feel full.

To prevent constipation (diarrhea), complementary foods begin gradually and are divided conditionally into three periods with the introduction of new products (fruits and vegetables, cereals, meat and fish dishes). To avoid problems with the work of the intestines, do not switch the child to a new type of food too quickly. Signs of constipation in a 4-6 month old baby are the same as in a newborn.

Recommendations for the prevention of constipation when switching to complementary foods:

• Use vegetable puree as the first complementary food (steamed from vegetables containing high amounts of fiber);
• Start complementary foods with minimal amounts of food;
• Complementary feeding means drinking boiled water in the amount necessary for the formation of normal feces;
• Do not use foods that are potentially allergic to complementary foods (allergies are one of the causes of constipation in children);
• In order to avoid constipation, additional protein in the baby's diet should be introduced very carefully;
• Observe regular feedings.

These guidelines are not intended to be comprehensive guidelines for the prevention of constipation in infants. Be sure to get additional medical advice related to the individual characteristics of your child's digestion.

Constipation in a child 2 years old

The second critical period in terms of the possible development of constipation in a child is refusal to use diapers and potty training. At this time, mothers first encounter psychological problems in a child. The transition to controlled defecation occurs against the background of significant physiological changes in the child's body.

By age two:

• Dairy food finally becomes secondary (the length of the intestine increases due to a change in the type of food);
• Milk teeth grow (by the second year - up to 20 teeth), therefore, the child is able to grind food on his own;
• The feces take on a form corresponding to type 3-4 according to the Bristol scale (the child's digestion is close to the physiological norms of an adult);
• The beginnings of the regulation of the act of defecation appear.

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

• During this period, a final change in the type of food occurs, milk can cause indigestion;

• The length of the intestine in a two-year-old child is six times its height, and in an adult, the intestine is only four times longer. It means that:

  • the passage of food in the intestines of a child takes a longer time than that of an adult;
  • protein and fatty foods are retained in the intestines longer, and therefore they should not form the basis of the child's diet;
  • plant food must necessarily include plant fiber that is not digested in the intestines;
  • it is necessary to regularly give the child to drink ordinary boiled water;
  • chopped food should be gradually eliminated from the main diet.
• For the first time, the child is independently able to chew food. Teach him to chew properly.
• It is advisable to completely abandon diapers at this age.

Constipation in children 3 years old

The third critical period from the point of view of the possible development of constipation in a child is the final formation of the reflex of delayed defecation and the beginning of socialization of the baby (kindergarten). At this time, there are no significant physiological changes in digestion, potentially affecting the nature of bowel movements. However, this segment of life is characterized by the psychological and intellectual development of a person. There are no universal recommendations for the prevention of constipation at the age of three, as there are no identical children.

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

• Formation of the correct diet and diet (normal stool in a child should not be associated with phobias);
• Refusal of diapers, the use of which smooths out the unpleasant sensations in the child after defecation, therefore, inhibits the development of a reflex to regulate the act of defecation.

If, despite a healthy diet, adherence to the daily regimen and a normal psychological climate in the family, the child continues to have constipation, perhaps their cause is medical problems. Then the only correct advice is to go to the clinic for a full examination and to a psychologist to determine the emotional causes of the disease.

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

• Fecal incontinence is a consequence of the thoughtless use of diapers in children after three years. Sometimes the problem lies in other reasons, which can only be dealt with by a doctor on the basis of careful research;
• Encopresis is a condition that results in persistent soiling of underwear and is mistaken for diarrhea. But this is always a consequence of constipation. In the ampulla of the rectum, during instrumental examinations, fecal seals are diagnosed;
• Psychological problems are always individual, it is unreasonable to limit yourself to online advice on what and how to tell a three-year-old child who is experiencing difficulties with defecation.

What to do if a child is constipated?

The first thing to do is to learn how to properly assess the situation. If the problem, in your opinion, threatens the life of the child, immediately contact the hospital. On the other hand, constipation may be imaginary. Its main feature is the absence of bowel movements against the background of the child's usual behavior, without colic (abdominal pain).

In this case, you should pay attention to the following circumstances:

• Insufficient weight gain in a child - perhaps the reason for the lack of defecation is underfeeding, and restless behavior is associated with hunger;
• Weight gain is normal - it is possible that breastfeeding is almost completely absorbed by the child (the tummy is not enlarged, there is no pain, the baby is developing well).

The second is to seek advice from a child's caregiver. An inexperienced mother is not always able to independently and adequately assess the situation. A professional pediatrician can help you understand the possible causes of constipation.

The third is to master the simplest therapeutic and prophylactic procedures (massage, the use of enemas, the introduction of laxatives, effective for the child, rectally or through the mouth). Do not try to carry out manipulations by correspondence instructions, ask a specialist to demonstrate their correct implementation.

Fourth, to learn how to identify signs of dangerous conditions that threaten the health of the child (acute abdomen syndrome, which characterizes various diseases of the child's gastrointestinal tract, accompanied by constipation). Find out where to go for help in this situation.

There are also many special foods that can help normalize stool in a child, see the article - What helps with constipation?

Treatment of constipation in children

Treatment of constipation in a child includes several aspects:

• Symptomatic treatment. Elimination of the main symptoms of pathology with laxatives of different groups used in pediatric practice, as well as enemas and physiotherapeutic procedures aimed at emptying the intestines;
• Etiotropic therapy. Eliminate the cause of constipation. This is the most difficult direction of treatment, it depends on many factors: the results of diagnosis, the state of the child's body, the etiology of the disease (congenital, acquired). Based on these data, treatment tactics are selected: therapeutic (treatment with medications and physiotherapy) or surgical (prompt elimination of defects that cause chronic or acute intestinal dysrhythmia);
• Pathogenetic therapy. Treatment is aimed at eliminating the pathogenetic symptoms that have developed during the course of the disease (intoxication, growth retardation, disorders of the cardiovascular system). The arsenal of medications and physiotherapeutic agents is huge, their choice is individual, and depends on the pathogenesis of the disease.

Diet for constipation in children

Appointment of dietary food for children is possible from about two to three years. Until that time, just include in the diet ordinary boiled water cooled to room temperature.

When the child is able to eat regular food, the diet will need to include meals prepared from the following foods:

• First meal. Soups with fish broth (hake, cod, navaga), soups with meat broth (beef, turkey), vegetable soups (zucchini, tomatoes, carrots, potatoes, beets, cabbage, pumpkin);
• Second courses. Cabbage rolls, meatballs (limit or exclude rice), fish and meat cutlets (beef), omelets;
• Side dishes. Buckwheat, barley and pearl barley porridge in fat-free meat broth, boiled pasta, vegetables (listed above);
• Beverages. Dried fruit compotes (dried apricots, raisins, prunes, figs), tea, vegetable and berry juices, fruit drinks;
• Dessert. Curd puddings, honey, marshmallow, marmalade;
• Bread from second grade flour with the addition of whole grains and bran, diet bread.

See the article - what you can and cannot eat for constipation

For constipation in children, the following foods should be limited: fatty meat and fish, smoked and spicy foods, raw whole milk, radishes, onions, garlic, rice, semolina, chocolate.

The author of the article: Sokolova Praskovya Fedorovna | Pediatrician

Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.