Acute digestive disorders in children. Dyspepsia in a child what are these symptoms treatment Acute digestive disorders in infants

Dyspepsia in children is a fairly common disease characterized by a violation of the digestive process. Often, such an ailment is diagnosed in children in the first year of life, and the severity of the course directly depends on the amount of food consumed. This is due to the fact that the volume of food consumed does not always correspond to the capabilities of the gastrointestinal tract. There are several varieties of this syndrome in children - simple and toxic. In the first case, the functioning of the digestive tract is disrupted, in the second, a metabolic disorder is observed.

There are several reasons for the occurrence of such a disorder in babies - the immaturity of the organs of the digestive system, a sharp transition to artificial nutrition, the introduction of new products into the child's diet. But some experts believe that genetic predisposition or insufficient production of enzymes can serve as predisposing factors for the occurrence.

Such a disease in children is manifested by characteristic symptoms - severe pain in the abdomen, complaints of stomach fullness, early satiety, nausea and vomiting, diarrhea, which can be replaced by constipation, as well as the occurrence of heartburn and belching.

Diagnostic measures for dyspeptic syndrome include laboratory tests of feces and blood, as well as instrumental examinations, including ultrasound and endoscopy. All these procedures are necessary in order to find the cause of the disease. Treatment of the disease depends on the results of the diagnosis and the type of course. With simple dyspepsia, therapy consists in the abolition of the product that caused the disorder, and the administration of medications that reduce the manifestation of characteristic signs. In the toxic form, treatment in a medical facility is necessary, as plasma transfusions, intravenous medications and antibiotics may be necessary.

Etiology

There are several groups of factors that affect the appearance of dyspeptic syndrome. They depend on the age group of the child. Thus, the reasons for the formation of dyspepsia in young children are:

• irrational or irregular feeding of the baby;
• frequent overfeeding of the child;
• early and illiterate introduction of complementary foods to infants;
• introduction to the diet of foods or dishes that do not correspond to age;
• insufficient production of beneficial intestinal bacteria;
• non-compliance with the established diet by a woman during breastfeeding;
• defects in digestive enzymes is a hereditary disorder during which diseases associated with metabolism develop;
• overheating of the body of the child.

Causes of the onset and development of the syndrome in older children:

• malnutrition - the predominance of one or another group of nutrients, for example, only fats or carbohydrates;
• eating low-quality products;
• increased secretion of hydrochloric acid in the stomach during its inflammation - gastritis;
• taking certain medications, such as antibiotics or hormonal substances;
• prolonged exposure to stressful situations;
• acute intoxication - in case of food poisoning or infectious and purulent diseases;
• violation of the movement of food due to improper motility of the digestive tract.

A pronounced dyspeptic syndrome in a child requires immediate treatment, since a long-term illness can cause serious complications.

Varieties

Medicine knows two main types of the disease:

• simple form- characterized by damage only to the organs of the digestive system;
• toxic- represents a much greater danger, because metabolic disorders occur. Symptoms in this form are pronounced and disappear for a long time.

In addition, dyspeptic syndrome is divided depending on nutritional errors and causes. Thus, the disease is divided into:

• fermentation- It is formed on the basis of eating a large amount of carbohydrates. For example, kvass and beer, legumes and fruits, cabbage and bread;
• putrid- the predominance of protein in food, due to the use of a large amount of meat and eggs;
• fatty- excessive intake of fats in the body.

Classification of the disease as the characteristic symptoms of the syndrome appear in children:

• ulcerative- expressed by severe pain in the stomach, which disappear after eating. Therapy is carried out by taking medications;
• reflux-like- there is the appearance of belching, heartburn and bloating;
• dyskinetic- expressed by the occurrence of discomfort in the abdomen, which intensifies after eating, and increased gas emission;
• non-specific.

There are also several other classifications, but they are most typical for adults.

Symptoms

The clinical manifestation of dyspeptic syndrome in newborns and older children begins with the expression of a simple form of the disease, which is characterized by the following symptoms:

• constipation, which later gives way to diarrhea. The frequency of emptying can be more than five times a day;
• the presence of mucus and characteristic lumps in the feces, which may have a white, yellow or green tint;
• an increase in the volume of the abdomen;
• increased gas separation;
• fast saturation;
• decrease or complete lack of appetite;
• the occurrence of intestinal colic;
• belching.

The duration of this form of the disease is approximately one week. If treatment is not started during this time, a more severe form of the disease develops - toxic. In this case, the expression of symptoms such as:

• a significant increase in body temperature, up to a feverish state;
• persistent nausea and frequent vomiting;
• diarrhea - the frequency of emptying reaches twenty times a day;
• severe dehydration;
• sinking of a large fontanel in newborns;
• significant weight loss;
• decreased manifestation of reflexes;
• lack of interest in new toys or people;
• convulsions.

The toxic form of the syndrome can cause impaired consciousness, the development of a coma and the death of young children.

Diagnostics

Diagnosis of dyspepsia in children includes a whole range of tools, and consists of an examination by a pediatrician and a pediatric gastroenterologist, laboratory tests and instrumental examinations.

First of all, the doctor needs to get acquainted with the medical history of the patient and his immediate family. This is necessary in order to exclude or confirm the genetic factors for the onset of the disease. After that, the specialist needs to find out the first time, intensity and duration of symptoms. Then a thorough examination is carried out.

Instrumental diagnostic methods include:

• acidity test;
• EGDS is a procedure during which a specialist examines the inner surface of the organs of the digestive system using a special tool. In this case, a mandatory biopsy is necessary;
• determination of acidity in the stomach;
• respiratory diagnostics - necessary to detect the bacterium Helicobacter pylori;
• Ultrasound of the abdominal organs;
• colonoscopy;
• radiography with the use of a contrast agent;
• determination of motility of the stomach and intestines;
• manometry - carried out to assess the motor function of the esophagus;
• probing - gastric or duodenal.

In addition, additional consultations of a pediatric neurologist and psychologist are necessary, since such a disease is often accompanied by disorders of the nervous system.

Treatment

After the detection of the characteristic symptoms of the disease and the diagnosis, drug and non-drug therapy is used to treat the disease in children.

Non-drug treatment consists of:

• restriction of food intake - for six hours to give only liquid. In the future, follow the rules of nutrition according to the age group of the child;
• the implementation of massage movements on the abdomen, clockwise;
• walk with the baby after he has eaten. For twenty minutes, provide him with a vertical position;
• exclusion of excessively tight swaddling;
• dietary regulation in older children and adolescents;
• complete elimination of overeating.

Drug treatment of dyspepsia consists in taking medications aimed at eliminating the signs of the disease. Patients are often prescribed - painkillers, proton pump blockers, drugs to reduce acidity, enzyme substances that normalize the digestion process. In addition, it is necessary to visit a psychotherapist and take psychotropic drugs.

Severe forms of dyspepsia in children are eliminated in a medical institution. In such cases, therapy includes plasma transfusion, the introduction of plasma replacement or saline solutions. You may need intravenous injections of drugs aimed at eliminating the symptoms and the disease that caused this ailment.

Prevention

Preventive measures for such a disorder are to follow simple rules:

• maintaining a rational and balanced diet, according to the age of the child;
• complete exclusion of overeating, eating low-quality foods and fast food;
• maintaining a healthy lifestyle - for teenagers;
• regular performance of moderate physical activity;
• hygiene before eating;
• regular visits to the pediatrician, at least once a year.

In most cases, dyspepsia in children has a favorable prognosis, ends in complete recovery and does not entail complications. But with untimely treatment, the prognosis is not so comforting. A toxic form of the disease can develop, which can lead to coma or death.

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Hepatomegaly in children is a condition in which the liver becomes enlarged. This is not a disease, but a kind of symptom that indicates that pathology is progressing in the child's body. In no case should it be ignored, since the causes of manifestation can be very serious. For example, hepatomegaly usually accompanies viral hepatitis, heart failure, hepatoma, blood cancer and other ailments. With an increase in the size of the child's liver, it is immediately necessary to show a specialist.

Acute dyspepsia is an acute indigestion in young children, manifested by an increase in defecation and a change (often liquefaction) of the stool (without or with signs of impaired digestion of food 1), vomiting or regurgitation, flatulence, etc.

Acute dyspepsia is widespread among young children and, with inadequate treatment of the patient, can be very difficult, even fatal. At the same time, with the timely implementation of relatively simple therapeutic measures, the prognosis of diarrhea in most cases is quite favorable. The tendency to develop dyspepsia at an early age is due, on the one hand, to large nutritional loads on the gastrointestinal tract, and, on the other hand, to the incompleteness of the morpho-functional formation of the digestive organs at this age, the anatomical and physiological characteristics of the child.

The functional activity of the digestive tract of a child of the first year of life is quite sufficient for breastfeeding conditions and appropriate child care. However, the reserve capacity of digestion at this age is very limited and easily decompensated with any feeding errors and violations of the child's living conditions. Lack of breastfeeding is an important factor in the increased susceptibility to dyspeptic disorders and infections of the gastrointestinal tract.

Classification

By etiology 1 functional 2 infectious (internal, paraenteral, dysbacteriosis) 3 hereditary-constitutional

According to clinical manifestations, acute gasteroenteritis, ost enteritis, ost enterocolitis, ost gasteroenterocolitis.

According to the degree of severity 1 lungs without toxicosis without exsicosis 2 medium st strand with toxicosis, with exsicosis of 1-2 degrees. 3 severe with toxicosis, with exsicosis of 2-3 degrees.

By presence of complications without complications, with complications meningoencephalic syndrome, convulsive syndrome, hemorrhagic syndrome, paralytic ileus (1,2,3 step)

Dehydration (exicosis) in children is primarily facilitated by a very high need and intensive exchange of fluid and electrolytes. Due to the low sensitivity of the kidney tubules to the action of antidiuretic hormone, the concentration ability of the kidneys of an infant is significantly lower than in older children, and does not increase even with dehydration. In connection with the same circumstance, the ability to save electrolytes is also reduced in young children. Dehydration in young children is more severe than in older children. This is due to the limited possibilities of centralization of blood circulation with a decrease in the volume of circulating blood. Electrolyte disturbances and hypoxia lead to a violation of the acid-base state, which complicates and intensifies (due to compensatory dyspnea) dehydration.

In most cases (70%), dehydration in children with dyspepsia develops as a result of a proportional loss of water and salts (isotonic type). Sometimes (in 10%), with abundant and repeated vomiting, the loss of salts is especially large. This leads to hypoosmolarity of the extracellular fluid and its movement into the cells (hypotonic type of dehydration). In children with profuse watery diarrhea, fever and shortness of breath, fluid loss dominates the loss of salts and hypertensive dehydration develops, characterized by the release of fluid from the cells into the intercellular space. Dehydration and the associated increase in the concentration of toxins in body fluids is one of the factors in the development of intestinal toxicosis. Especially quickly toxicosis develops in young children. There are a number of preconditions for this. In connection with the needs of growth, the nutritional load per 1 kg of the child's weight is very high. The process of digestion is accompanied by a much more significant load on the detoxification system of the liver than in adults. The detoxification function of the kidneys is less developed in young children compared to older children. An additional load on the liver and kidneys of a child in the first months of life occurs during artificial feeding as a result of the penetration into the blood of products of incomplete breakdown of food substrates (poly- and oligopeptides, disaccharides and medium-chain fatty acids). Due to the intense functioning of the detoxification systems of a young child, their reserve capabilities are very limited and quickly decompensated.

Instability of intestinal biocenosis in children receiving artificial feeding and deprived of breast milk factors stabilizing bifidoflora often leads to dysbacteriosis with the reproduction of conditionally pathogenic microorganisms and the formation of a large amount of toxic substances (indole, skatole, ammonia, hydrogen sulfide, etc.). This occurs in case of a mismatch between the nutritional load and the enzymatic capabilities of the digestive tract (with overfeeding, incorrect introduction of complementary foods), as well as with defects in child care. But toxicosis in children is especially pronounced in intestinal infections.

With intestinal toxicosis, a number of syndromes always appear: signs of infectious inflammation, a syndrome of neurological disorders, a syndrome of peripheral vascular insufficiency. The targets of toxins are not only the intestinal epithelium, but also the liver, vascular endothelium, peripheral neurons, the brain, and less often other organs and systems. With intestinal toxicosis in children, due to the rapid action of toxins on the central nervous system, neurological disorders - anxiety, capriciousness, refusal to eat - appear even before the development of signs of dehydration. Irritative signs are quickly replaced by a soporous state - lethargy, lethargy appear, the child loses interest in the environment. Later, stupor, lethargy, and coma may develop.

Quite quickly, the functions of internal organs are violated: liver, CCC. Anaerobic glycolysis is excessively activated with the development of hyperlactatemia and metabolic acidosis. Vascular permeability increases with the development of blood clotting syndrome and disseminated intravascular coagulation, microcirculation is disturbed, and tissue hypoxia develops. Severe intestinal toxicosis should be considered as an infectious-toxic shock.

Simple (alimentary) dyspepsia is an acute indigestion in infants, caused by alimentary errors and manifested by dysfunction of the digestive tract without a significant disturbance of well-being.

Etiology. Pathogenesis. Simple dyspepsia mainly develops as a result of a mismatch between the quantity and quality of food and the capabilities of the child's digestive tract. Due to the characteristics of mother's milk, dyspepsia in breastfed children is observed only with gross violations, while with artificial feeding, additional stress on the child's digestive system, acute dysfunctions of the gastrointestinal tract occur much more often. The cause of dysfunction can be. rapid transfer to artificial feeding, rapid introduction of a new formula or complementary foods for a child, overfeeding, nutrition of food that is inappropriate for age, non-compliance with the rules for storing and preparing mixtures, etc. with carbohydrate overfeeding) and putrefactive processes (with protein overfeeding) with the formation of toxic substances, increased peristalsis and impaired splitting and absorption of food substrates.

Clinic. The main symptoms of simple dyspepsia are: regurgitation, vomiting, diarrhea, slowing down in weight gain. The stool becomes more frequent up to 5-8 times a day, heterogeneous yellow-green with white lumps (soaps of fatty acids with salts of calcium, magnesium and other alkaline earth minerals), watery (partially absorbed into the diaper), often with mucus, an unpleasant odor. The general condition of the child is disturbed unsharply (capriciousness, periodically anxiety, which decreases after the passage of stool and gases). Body temperature is normal. Dehydration is irrelevant. On examination, you can find a moderately furred tongue, a swollen rumbling belly, visible peristalsis of the intestines, sometimes diaper rash around the anus or on the buttocks. The nature of the stool depends on the cause that caused dyspepsia. If the child is overfed with carbohydrates, then the stool is frothy, watery, mostly green, has a sour smell and low pH, there is a large amount of iodophilic flora in the coprogram. With protein overfeeding, the stools are not plentiful, have a loose, crumbly appearance, the stool contains white lumps, has a grayish tint, an unpleasant putrefactive odor, an alkaline reaction, there is a lot of detritus in the coprogram. With fatty overfeeding, the stool is shiny, sometimes discolored. In the coprogram - an abundance of neutral fat and fatty acids. During bacteriological culture of feces, pathogenic flora is not detected.

Treatment. First of all, it is necessary to identify and eliminate the causative factor. For 4-6 hours, the child is prescribed food unloading. During this period, formula-fed babies are not fed, but compensate for the amount of food with liquid. It has been established that the absorption of water in the gastrointestinal tract depends on the linked transport of sodium and glucose through the mucous membrane.

Therefore, it is advisable to prescribe glucose-salt solutions. Of the official solutions, 1 rehydron (citroglucosolan) is used, containing sodium chloride - 3.5 g, sodium citrate - 2.9 g, potassium chloride - 202.5 g, glucose - 2010 (15) g, or glucosolan (oralite) - sodium chloride - 3.5 g, sodium bicarbonate - 2.1 g, potassium chloride - 201.5 g, glucose - 20 g. In the absence of standard solutions for oral rehydration, they can be prepared from improvised means: table salt (1 teaspoon), drinking soda (1/2 teaspoon) and sugar (1/2 tablespoon) per liter of chilled boiled water. Rehydration can also be carried out with raisin broth (300-400 g of washed raisins are boiled in a liter of water for 15 minutes, filtered through gauze). For rehydration, Ringer's solution can be used mixed with 5% glucose solution in a 1:1 ratio. During the period of food unloading, the child needs to drink 30-50 ml / kg of the solution, giving it fractionally every 10-15 minutes in small portions. In addition, in order to compensate for the current loss of fluid and salts, immediately after each bowel movement and 30 minutes after each regurgitation or vomiting, the child should additionally drink 30-50 ml of glucose-salt solution.

After 6 hours, maximum 8 hours, the baby begins to feed. At the same time, they use the mixture and the feeding regimen in which the child did not have dysfunction of the digestive tract. Usually on the first day of treatment, the mixture for each feeding is given in half, supplemented (or diluted) to the full volume with water. Signs of improvement are: cessation of vomiting, normalization of urination and a tendency to reduce stool, more calm and active behavior of the child. In the next 2-3 days, the volume of feeding with the mixture is gradually brought to normal, depending on the nature of the stool. After that, if the child received complementary foods before the disease, the same complementary foods are given again on the 2nd-3rd day. % tea, water). In addition, until the disappearance of dyspeptic disorders, supportive compensation for fluid losses with stool and vomiting is continued.

Nutritional unloading of breastfed children consists in the temporary cancellation of complementary foods. With a sufficient amount of mother's milk, it is recommended to replace complementary foods with breast milk in the amount of physiological norms. With a shortage of breast milk - replacement of complementary foods with a mixture in half with the addition of liquid and a gradual increase in the amount of the mixture to the full volume of feeding, followed by (2-3 days) return of complementary foods. The volume of rehydration is mainly determined by the current losses of fluid and salts. Medical treatment for simple dyspepsia is usually not necessary. To reduce flatulence and intestinal colic, bifidumbacterin is prescribed 2.5-5.0 doses 3 times a day for 30 minutes before feeding, as well as decoctions of herbs with astringent and anti-inflammatory effects: rhizome of cinquefoil, burnet, serpentine, bird cherry, blueberries, alder seedlings; anti-inflammatory - chamomile flowers, St. John's wort, mint; carminative - dill grass, cumin fruits, medicinal dawn root, centaury stems, chamomile.

3. Dispensary observation of children in the first year of life must be carried out with the utmost care. Primary medical patronage for a healthy newborn child must be carried out within the first three days after the child is discharged from the maternity hospital.

Subsequently, the child during the first month should be examined by a nurse weekly. The second medical patronage for a newborn is carried out at three weeks. Subsequently, monthly examinations of a child of the first year of life are carried out at appointments in a children's clinic (consultations), in their absence, in a specially designated room of the medical center of the unit, the children's department of the OMedB or the hospital.

When conducting patronage for a newborn child, it is necessary to assess the condition of the skin, umbilical wound, the severity of reflexes of newborns, and sucking activity. During subsequent contacts of the doctor with the child of the first year of life, it is necessary to characterize the dynamics of his physical and neuropsychic development, the adequacy of nutrition, and make timely adjustments taking into account the individual characteristics of the child. Based on this information, the doctor is obliged to give the mother recommendations on organizing the daily routine and nutrition, and caring for the baby. It should be persistently formed in the mind of a nursing woman, a deep conviction that natural feeding of a child is the only optimal type of nutrition for a child in the first year of life. With an objective need to transfer a child to mixed or artificial feeding, the doctor must decide on the most rational type of food. In the case of hypogalactia in a nursing woman, one should not rush to introduce supplementary feeding; all measures must be taken to restore lactation. The issues of feeding children in the first year of life should be constantly in the center of attention of the garrison pediatrician. Focusing on the prevalence of artificial feeding on the territory of the deployment of the unit, the doctor must control the volume of supplies of dry milk formulas to the institutions of the military trade. In the absence of such ongoing work, there may be cases of receipt of mixtures with an expired shelf life or not in demand. One of the ways to provide children with fresh cow's milk and vegetables is the rational use of subsidiary farms available in some parts.

The term "dyspepsia" means indigestion.

simple dyspepsia- acute indigestion of a functional nature, characterized by vomiting and diarrhea without a significant violation of the general condition of the child.

Etiology. Dietary factors play an important role in the occurrence of simple dyspepsia. Digestive dysfunction can occur as a result of the increased demands placed on the body by improper feeding of the child. Most often, dyspepsia develops with improper mixed or artificial feeding. Excessive introduction of the total amount of food, its incorrect qualitative composition, insufficient amount of vitamins can lead to indigestion.
With breastfeeding, dyspepsia develops less frequently and its cause is a violation of the diet - non-observance of time intervals between feedings, improper introduction of complementary foods.

In the occurrence of dyspepsia, the reactivity of the child's body is of great importance. In children with reduced reactivity - premature, patients with rickets, dystrophy, exudative diathesis - dyspepsia can develop when they receive a full meal, but with defects in care, especially when overheated.

An important place in the development of dyspepsia is occupied by an infectious factor, most often pathogenic strains of Escherichia coli. Penetration of infection into the gastrointestinal tract of a child is possible through the mouth and food (if baby food is stored improperly) and water, less often through nipples, toys, and care items.

Pathogenesis. Dyspepsia in young children develops as a result of a mismatch between the requirements of the body (the volume and composition of food) and the ability to digest this food with a normal amount of digestive tract enzymes.

When overfeeding a child, as well as feeding him food that does not correspond to age, there is a functional overstrain and depletion of the digestive glands, a decrease in the amount of digestive juices and their enzymatic strength. As a result, the normal course of the digestive process is disturbed. Food that is not sufficiently processed with enzymes enters the intestines, which is more easily fermented.

All this changes the composition of the intestinal chyme and creates conditions that increase the pathogenic properties of the permanent intestinal microflora (primarily E. coli). Under these conditions, not only the reproduction of Escherichia coli takes place, but also its ascent from the large intestine and the lower sections of the small intestine up to the stomach, and its participation in the process of digestion. Bacterial digestion of food is accompanied by the formation of a large amount of gases, acetic acid and lower fatty acids, indole, skatole, etc.

Irritation of the receptors of the gastric and intestinal mucosa with abundant or age-inappropriate food, altered chyme composition, and bacterial breakdown products of food leads to a change in the excitability of the cerebral cortex and the appearance of defense impulses. Vomiting, increased peristalsis, diarrhea, flatulence are a protective response from the gastrointestinal tract. There is a restructuring of various links of metabolism. Neutralization of acids in the intestine is carried out by the intake of calcium, magnesium, sodium, potassium salts from the intercellular fluid and tissues of the body, which combine with fatty acids and form fatty acid soaps.

In the pathogenesis of alimentary dyspepsia, the leading role belongs to the functional disturbance of the activity of the stomach and intestines, which distorts the normal course of digestion, bacterial invasion is secondary.

clinical picture. Simple dyspepsia develops acutely. In the anamnesis, it is possible to identify violations of feeding the child. The disease begins with one or two vomiting immediately or 10-20 minutes after feeding. Stool 5-8 times a day, liquid, greenish-yellow in color with a slight admixture of mucus and lumps of white or yellow color, resembling chopped egg white in appearance. These lumps are soaps of fatty acids. The stools have a sour smell and give an acid reaction. Their greenish color is due to the accelerated transition of hydrobilirubin to biliverdin in the acidic environment of the intestine.

There is bloating, rumbling in the intestines, frequent passage of gases. The behavior of the child changes: periodically he becomes restless, often wakes up, cries. After passing gases, and often applying a warm heating pad, he calms down and does not show any signs of a violation of his condition - he plays, smiles, is interested in others. The temperature is often normal, in some children subfebrile. Appetite decreases.

On examination, a slight pallor of the skin is determined. Coated tongue. On the mucous membrane of the tongue, cheeks, soft palate, thrush sometimes develops. There is a slowdown in weight gain or a slight decrease in it. The abdomen is periodically swollen, sensitive to pressure.

Diagnosis. In the diagnosis of dyspepsia, the clinic of the disease is of decisive importance. To exclude the infectious nature of dyspepsia, additional studies are carried out: scatological, bacteriological examination of feces.

In a coprological examination, a large amount of neutral fat, free fatty acids, soaps of lower fatty acids, single (5-6 in the field of view) leukocytes are determined in the feces. From the side of blood, urine deviations from the norm are not observed.
differential diagnosis. Simple nutritional dyspepsia should be distinguished from functional dyskinetic disorders in young children: regurgitation, vomiting, as well as atypical forms of acute diseases of the gastrointestinal tract caused by infectious factors.

In children of the first months of life, regurgitation or vomiting is often observed. At the same time, the general condition, normal stools are not disturbed, the child gains weight. Such regurgitation is not a symptom of dyspepsia, but is often due to the anatomical and physiological characteristics of the digestive organs.

In some babies, spitting up and vomiting is associated with indiscriminate feeding or sucking excess milk from the mother's breasts. Elimination of defects in the feeding technique, the vertical position of the child after feeding are sufficient to eliminate regurgitation and vomiting.

In some newborns, there is an increase in stool, its liquid consistency, sometimes a greenish color, i.e., dyspepsia with proper feeding of the child. They do not have regurgitation and vomiting, the general condition is not disturbed. Sometimes there is a slight bloating. Such disorders of bowel function in newborns are called physiological dyspepsia.

Restoration of bowel function with proper feeding, care, exclusion of the infectious factor, but without therapeutic measures confirm the presence of physiological dyspepsia. The greatest difficulties are observed in recognizing dyspepsia of an infectious nature in young children (especially dysentery) with a similarity of the clinic with simple dyspepsia.
Attention should be paid to the fact that with an infectious nature, the disease is accompanied by an increase in temperature, metabolism is disturbed faster and weight is reduced.

Important differential diagnostic value has the character of a chair. With dysentery, in contrast to simple dyspepsia, there is an increase in stool up to 15-20 or more times a day. The stools are scanty, green in color, with much mucus and sometimes streaked with blood. During the act of defecation, the child strains (tenesmus), becomes restless, his face turns red, while with simple dyspepsia, tenesmus is not observed. Unlike simple dyspepsia, with dysentery, diet therapy does not give a quick effect. In scatological examination, a large number of leukocytes and sometimes erythrocytes are found in the feces. Bacteriological examination in 90-95% of patients revealed dysenteric bacilli - the causative agents of the disease. An epidemiological history is important (dysentery of the child's parents, staff, etc.).

Mild form of dyspepsia , caused by pathogenic strains of Escherichia coli, resembles simple dyspepsia, but unlike it, it often begins more acutely with subfebrile or short-term high temperature, dyspeptic symptoms are more pronounced. The chair is frequent (10-15 times a day), watery, sometimes splashing, with the presence of mucus and greenery. The recovery period is longer.

Complications. Untimely and incorrect treatment of a patient with simple dyspepsia can lead to a profound metabolic disorder and, consequently, to the development of toxicosis syndrome. With a protracted course of dyspepsia, a chronic malnutrition is possible - dystrophy. Patients with dystrophy, rickets, exudative-catarrhal diathesis may develop pyelonephritis, otitis, etc.

TREATMENT

For the successful treatment of patients with dyspepsia, it is necessary to create good hygienic conditions in the room where the child is located, to ensure careful care of the skin and mucous membranes (bathing), and to protect from overheating.

For simple dyspepsia therapeutic measures should be aimed at eliminating the cause that caused it (etiological treatment) and restoring disturbed body functions (pathogenetic treatment).

The most effective and necessary method of treating children with simple dyspepsia is diet therapy, which is carried out taking into account the type of feeding and the nutritional status of the child.

If dyspepsia has developed in a breastfed child as a result of overfeeding, then it is enough to restore the normal feeding regimen, and the dyspepsia phenomena are eliminated. If before the disease the child was on mixed or artificial feeding and received mixtures rich in carbohydrates and fats, or food that was not appropriate for age, such nutrition should be canceled and a strict diet should be prescribed.

For simple dyspepsia water-tea diet for 6-12 hours. At this time, the child receives liquid in the form of sweetened tea, 5% glucose solution, Ringer's solution, isotonic sodium chloride solution. The liquid must be cooled and given to drink in small portions. The daily amount of fluid needed by the child should be at least 150 ml per 1 kg of weight.

After a water-tea break, the child begins to be fed with women's milk. Dosing of food during breastfeeding is achieved either by limiting the duration of each feeding, or by feeding with expressed milk.
After a water-tea diet, it is imperative to limit the duration of each feeding to 5 minutes. When feeding with expressed milk, a single amount of it is reduced to 70-80 ml. The number of feedings - 5-6 times a day, depending on the age of the child. The amount of food missing by age is replenished with liquids.

On the second day, the duration of each breastfeeding is extended to 7-8 minutes, the amount of expressed breast milk is up to 100 ml.
On the 3rd-4th day, the duration of each feeding and the amount of milk per feeding increase.

With such diet therapy, the symptoms of dyspepsia are completely eliminated by the 6-7th day, which allows you to switch to feeding according to age. By this time, you can return to complementary foods if the child received it before the illness.

In case of dyspepsia in children who are bottle-fed, diet therapy with breast expressed milk is highly desirable. If this is not possible, feeding the child should be carried out with therapeutic mixtures: kefir, protein milk, mixtures with cereal decoctions - B-kefir, B-kefir, etc.

Diet therapy with artificial feeding consists in the appointment of 50-70 ml of one of these mixtures on the first day after a 6-12-hour water-tea diet.

From the 2nd day, the amount of the mixture is increased to 70-100 ml. In the future, the daily amount of food is increased by 25-30 ml for each feeding. From the 3rd day, fruit juices are introduced, starting with 10 ml per day.
From 6-7 days, feeding of the child is allowed according to age.

For simple dyspepsia in children with dystrophy, the time of the water-tea diet is reduced to 6-8 hours. Then expressed breast milk or one of the therapeutic mixtures of 20-30 ml 8-10 times a day is prescribed. In the future, a single dose of food is increased by 5-10 ml daily, the missing amount is supplemented with liquids. As the patient's condition improves, the calorie content of food increases by adding proteins and fats.

Drug therapy patients with simple dyspepsia consists in the appointment of enzymes - pepsin (0.05-0.1 g in 1-3% hydrochloric acid solution 2-3 times a day before meals); pancreatin (0.1-0.15 & 2-3 times a day after meals) or gastric juice, as well as thiamine - 0.002-0.003 g, riboflavin - 0.002-0.003 g, ascorbic acid 0.05-0.1 g, nicotinic acid - 0.003 g - 3 times a day, etc.

When the child is worried about flatulence, prescribe carbolene (0.5-1 g 2-3 times a day), to remove gases into the rectum, a gas outlet tube is inserted, carminative water is given. A warm compress or heating pad relieves abdominal pain.

With a protracted course of dyspepsia, especially in children with reduced nutrition, stimulating therapy is carried out: plasma transfusion (5-10 ml per 1 cell of weight after 3-5 days), massage, physiotherapy exercises.

Antibiotics and sulfa drugs are prescribed only when the infectious nature of the disease is confirmed.

Prevention. In the prevention of dyspepsia in children, proper nutrition is extremely important: compliance with the rules of breastfeeding children in the first year of life; gradual and timely introduction of physiological complementary foods; weaning a child from the breast in the cold season; with mixed and artificial feeding - the correct preparation, sterilization and storage of milk mixtures; overfeeding and one-sided feeding should also be avoided.

Along with the diet, it is necessary to improve hygienic care, avoid overheating of the child, and carry out hardening measures that increase the body's resistance.

In sanitary and educational work among mothers, the main attention should be paid to the promotion of natural feeding of the child, hygiene standards for caring for young children.

Forecast favorable. The presence of foci of infection in patients with reduced resistance, poor care and living conditions in patients with dystrophy, rickets, exudative-catarrhal diathesis significantly worsen the prognosis.

Dyspeptic syndrome in young children

simple form dyspepsia- this is an acute gastrointestinal pathology in children at an early age due to severe digestive disorders (in other words, this is indigestion of the stomach and intestines).

Almost all children can be affected by dyspepsia, but most often children with manifestations of rickets, malnutrition, allergies or hypovitaminosis, with acute infectious diseases of the digestive system or other systems and organs suffer from dyspepsia. With this pathology, the main and leading symptoms of the disease are gastrointestinal disorders, which will clearly indicate a disturbed digestive process.

At the same time, all the symptoms and all complaints fit perfectly into the manifestations of just a simple form of dyspepsia, with a violation of the stool, the appearance of its atypical color, white lumps in the stool and an abundance of mucus, which directly indicates a violation of the normal process of abdominal and intestinal digestion. With dyspepsia, metabolic products atypical for digestion begin to accumulate in the lumen of the digestive tube, from which the child's body immediately hurries to get rid of, showing symptoms of both vomiting and diarrhea. At the same time, in parallel with dyspeptic symptoms, the child also has symptoms of metabolic disorders - manifestations of vitamin and mineral deficiency, symptoms of rickets, protein deficiency. All this should make parents worried and consult a doctor for advice and adequate treatment.

Causes of dyspepsia

The most basic of the reasons for the development of dyspepsia (indigestion, as parents themselves often call it) are nutritional or alimentary factors. Children are tritely overfed with certain food components - proteins, fats or carbohydrates (sugars), and they also use foods that are completely unsuitable for their age in the child's diet - children under three years old are given sausage, lard, herring, barrel cucumbers, crayfish, etc.

Also, the reasons for the development of dyspepsia can be improperly selected amounts of food in an effort to feed your baby more and tastier. There may be disruptions with the introduction of new food components (complementary foods) immediately in large volumes or quickly in time, the introduction of products in violation of the recommended complementary feeding scheme - the introduction of juices at three to five months, the introduction of cow's milk up to a year, the introduction of dense food up to six months.

When breastfeeding, the causes of dyspepsia can be irrationally introduced supplementary feeds with a mixture when they are completely unnecessary, as well as the introduction of complementary foods not according to the recommended scheme - in the wrong sequence, at too fast a pace or too large a single volume.

One of the most common causes of dyspepsia in mixed-fed children and formula-fed babies is an improperly prepared formula (too thick), or violation of the conditions for its storage or preparation, violation of hygiene rules, violation of the shelf life of the mixture, especially in the warm season, when the mixture can turn sour or become contaminated by pathogenic microbes. Also in the summer, external influences can play a significant role in the development of dyspepsia - overheating of the child with dehydration, loss of electrolytes during sweating, a decrease in the activity of gastric juice or a violation of enzymatic activity.

What happens to digestion with dyspepsia

When a large amount of food is immediately introduced to a child or a child is fed with food that categorically does not correspond to his age category, then there will be a functional disorder and overstrain of the digestive tube and glands of the small intestine, a violation of the digestion of food in the cavity and its active and correct assimilation.

In addition, at the same time, the processes of both abdominal and parietal digestion suffer, since there is a relative deficit of secreted digestive juice and enzymatic activity decreases.

As a result of such actions, food will enter the intestinal cavity, which is only partially processed by enzymes, and fermentation and decay processes begin to activate inside the intestine, products of intermediate breakdown of food are formed, sometimes with a toxic effect. These intermediates can be toxic, irritating or allergic.

The intestinal wall begins to become irritated and inflamed, its integrity is disturbed, microerosion and cracks appear, the acidity of the contents decreases, it ferments, gives gas bubbles, loses its protective properties, which contributes to the upward spread of infection from the large intestine throughout the space of the small intestine, which causes microbial damage to the intestine and clinic of intestinal infection caused initially by opportunistic flora. As a result of the action of microbes on food slurry in conditions of a deficiency of protective factors (pancreatic secretion and bile), food masses are split, which results in the release of toxins and intermediate metabolic products by microbes - acetic acid, lactic acid, and various metabolites. They irritate the intestinal receptors and cause pain and spasms in the intestinal wall.

A massive stream of impulses from the intestinal wall enters the cerebral cortex, which leads to an increase in the excitability of the zones responsible for the activation of protective reactions - there is an increase in intestinal peristalsis, which is felt as seething and transfusion in the stomach. Reactions such as diarrhea as a way of getting rid of toxins and microbes, and vomiting as a way of expelling potentially dangerous food entering the lumen of the digestive tube are manifested. From the space between the cells of the intestinal wall, calcium and sodium, potassium and magnesium ions enter the lumen of the intestine, which try to combine with irritating fatty acids and form insoluble salts that will calmly come out. As a result, salts of fatty acids and soaps are formed, which give special white lumps in the stool, resembling egg white or cottage cheese crumbs.

Clinical manifestations of dyspepsia

Usually the disease begins after errors in eating and is manifested by frequent stools of a different nature, from gruel to frank water with flakes, as well as vomiting, while the general condition of the child remains relatively satisfactory. Vomiting can be one to three times a day immediately after a meal or after about twenty to thirty minutes. May reduce appetite due to diarrhea and vomiting. At the same time, the stool can gradually become more frequent up to five or more times a day, it becomes very liquid with impurities of greenery and mucus, bile, with lumps of white or yellowish color. In this case, the temperature usually does not rise or, in very rare cases, it can become subfebrile (increases to 37.0-37.5 degrees). At the same time, the child periodically begins to act up and scream, to twist his legs strongly, as happens with intestinal colic.

At the same time, the stomach is moderately swollen, when probing it is soft and strongly growls, under the fingers one feels the transfusion of intestinal contents and the rolling of gas bubbles. When probing, the liver does not increase in size, and the tongue becomes lined with a gray or white coating. There may be abdominal pain that disrupts sleep and mood, weight gain is disturbed, and the weight curve is greatly flattened.

When conducting stool tests for scatology, the analysis reveals a large amount of neutral fats and free fatty acids, there will be some mucus, single leukocytes. At the same time, stool cultures for flora do not give a positive result.

Treatment methods for dyspepsia

First of all, since the body loses fluid due to diarrhea and vomiting, it is necessary to begin treatment by introducing additional portions of fluid into the body. For drinking, a child is given strong sweet tea with sugar or glucose, diluted by a third with Ringer's solution (this is a saline solution with sodium and potassium), the introduction of a carotene mixture (carrot-rice broth), oralit, rehydron can also be shown. These solutions are drunk 5-10 ml every 10-15 minutes, but the total volume of the carotene mixture for the child does not exceed 200 ml during the day. When soldering, the solutions must be alternated - once glucose is given, once - saline.

The child should be fed continuously until the loss of fluid with diarrhea and vomiting stops, the fluid should be at room temperature, the total volume of fluid for rehydration is approximately 100-150 ml per kilogram of body weight per day.

If the child is breastfed, breastfeeding is done frequently, but the time spent at the breast is reduced to three to five minutes, with severe vomiting it is recommended to take a short break in the attachment. If the feeding is mixed, it is worth leaving only breastfeeding, temporarily removing the mixture completely, supplementary feeding with the mixture should be started only as the condition improves and the signs of dehydration are eliminated and the absorption of breast milk is normal. For exclusive formula feeding, it is necessary to replace unleavened formulas with fermented milk and probiotic formulas, and reduce the volume of formulas by half, replacing part of the mixture with rehydration solutions (liquid).

As the condition improves and the stool normalizes, the child is gradually returned to the previous feeding regimen. Babies are gradually applied to the breast for more and more time, increasing the periods of stay at the breast to five to seven minutes or more. When feeding with mixtures, gradually increase the volume of the mixture by 20 ml daily. By about the third or fourth day, the volume of food is gradually increased to two-thirds of the age norm, and by the fifth or sixth day it is brought to the age norm. If, before the development of the disease, the child has already received complementary foods, you can start introducing them; for all days of therapy, do not forget about adequate replacement of fluid losses with solutions for soldering (glucose and saline).

In addition to soldering and nutritional correction, drug treatment of simple dyspepsia is carried out - enzyme preparations are prescribed - pepsin, pancreatin, creon, panzinorm, and others in age dosages with food. To improve metabolic processes in the body and activate intestinal secretion and motility, vitamin B complexes with thiamine, pyridoxine, riboflavin and nicotinic acid are prescribed, you can combine them with ascorbic acid. Vitamin preparations are used twice or thrice a day.

With the development of microbial processes in the intestine, an intestinal antiseptic - enterofuril can be prescribed, but this is done under the supervision of a doctor. With flatulence and gas formation, gas venting tubes, carminative preparations and drops, dill water, dry heat on the stomach are used.

At the time of diarrhea in a baby, it is necessary to observe special hygienic conditions - creating the correct temperature regime in the room to avoid overheating, airing, creating peace and quiet. To prevent diaper rash and irritation, strict hygiene measures are shown - it is important to wash the child after each stool, it is necessary to wash with a delicate liquid soap that does not dry or irritate the skin, does not irritate. To avoid irritation around the anus, it is worth using a protective diaper cream around the anus and on the skin folds between the buttocks and in the groin. For the duration of diarrhea, it is better not to use disposable diapers, but to use diapers or panties, as diapers cause additional skin irritation. When vomiting, it is necessary to keep the child's head on its side and remove the vomit from the mouth in order to avoid inhalation and the development of aspiration pneumonia in the future as a complication. It is important to wipe your mouth with a tissue or rinse with a spoonful of boiled water.

The prognosis for simple dyspepsia in children is favorable, almost all children recover quickly.

SIMPLE DYSPEPSIA is an acute indigestion of a functional nature, characterized by vomiting, diarrhea without significant disturbance of the general condition.

ETIOLOGY. In etiology, the leading factors are the alimentary factor, care defects (overheating, violation of the feeding regimen), as well as the infectious factor (most often E. coli). Predisposing factors are: early artificial and mixed feeding, rickets, exudative catarrhal diathesis, malnutrition, prematurity.

PATHOGENESIS. When overfeeding or feeding food that is not appropriate for age due to lack of enzymatic activity and low acidity of gastric juice in young children, the food is not processed enough in the stomach, which causes an overstrain of the stomach function. Insufficiently prepared food enters the small intestine. The normal course of digestion is disturbed. Since the intestines have an alkaline environment, bacteria begin to multiply intensively in the food bolus, and the pathogenic properties of the constant intestinal microflora increase.

Bacterial breakdown by putrefaction and fermentation in the intestine promotes the formation of toxic products (indole, skatole, acetic acid) and gases (Fig. 8).

Irritation of the receptors of the mucous membrane of the stomach and intestines with toxic products leads to the appearance of protective reactions in the form of regurgitation, vomiting, increased intestinal motility, increased secretion of mucus by the intestinal glands and diarrhea. Fatty acids, which were formed as a result of improper breakdown of fat in the intestines, are neutralized by the intake of calcium, magnesium, sodium, and potassium salts from the intercellular fluid and tissues of the body. These salts react with fatty acids to form fatty acid soaps.

CLINICAL MANIFESTATIONS. The disease begins acutely. Appetite decreases, lethargy appears, sleep is disturbed. The main symptoms are single or double vomiting and loose green stools with mucus and white lumps. Chair 5-8 times a day. The stools have a sour smell. Green stool is due to the accelerated transition of hydrobilirubin to biliverdin in an acidic environment, and white lumps are soaps formed as a result of the neutralization of fatty acids with calcium, magnesium, sodium, and potassium salts.

In addition, periodically the child has intestinal colic due to gases accumulated in the intestines, after which the child calms down. Body temperature is often normal, but sometimes subfebrile can be observed.

When viewed outside an attack of intestinal colic, the child's condition is relatively satisfactory. There is some pallor of the skin, coated tongue, sometimes thrush on the oral mucosa. The abdomen is swollen, rumbling on palpation, diaper rash in the anus (feces are acidic, which causes skin irritation).

The diagnosis is not difficult. Correctly collected anamnesis (violation of the diet, overfeeding, overheating, etc.), epidemiological history (lack of contact with patients with diarrhea), as well as the clinical picture, make it possible to correctly diagnose. But it is necessary to differentiate with such diseases as dysentery, intussusception, appendicitis. Therefore, first of all, it is necessary to exclude those diseases that require urgent surgical care.

TREATMENT. Includes bowel lavage, the appointment of a water-tea diet for 6-8 hours (using rehydron, oralit, saline sodium chloride solution, 2% glucose solution, boiled water, tea in the amount of 150 ml per 1 kg of body weight per day), diet therapy.

Usually on the 1st day, 70-80 ml of women's milk is prescribed while maintaining the feeding regimen or applied to the breast for 3-4 minutes (usually a child sucks out 20 ml in 1 minute). In the absence of women's milk, adapted sour-milk mixtures or kefir are used in a 2: 1 dilution with rice water. Every day the amount increases, and by the 5th day the volume of food should reach the volume that the child consumed before the illness. From the 6th day from the onset of the disease, complementary foods can be introduced if the child received it, but introduced gradually. Grated apple and juices are prescribed from the 6-7th day.

For oral rehydration in acute digestive disorders in infants, the Austrian company "HIPP" produces a medicinal product - carrot-rice broth "HIPP ORS 200". The main ingredients of this product are carrot, rice, glucose, salt, sodium citrate, potassium citrate, citric acid. Carrot-rice water "HIPP ORS 200" is a homogenized, sterile, ready-to-eat food. 100 ml of the product contains 0.3 g of protein; 0.1 g fat; 4.2 g carbohydrates; 120 mg sodium; 98 mg potassium; 145 mg chloride; 135 mg citrate; energy value - 19 kcal / 100 ml; osmolarity - 240 mOsm / l.

The pectin substances contained in HIPP ORS 200 have the ability to adsorb microbial toxins, gases, products of incomplete hydrolysis and fermentation of nutrients. Rice mucus and starch, due to the enveloping action, contribute to the regeneration of the intestinal mucosa and the restoration of digestion processes.

The recommended amount of "HIPP ORS 200" with a mild degree of dehydration is 35-50 ml per 1 kg of the child's body weight per day, with an average degree - 50-100 ml per 1 kg per day. Repeated vomiting in infants is not a contraindication for the use of HIPP ORS 200 therapeutic nutrition. A prerequisite for the use of "HIPP ORS 200" for vomiting is its use in small amounts at short intervals, for example, every 10 minutes, 1-2 teaspoons of "HIPP ORS 200".

Be sure to use enzyme therapy. Usually hydrochloric acid with pepsin is used. Creon (pancreatin with minimal activity of lipase, amylase and proteases) has a good therapeutic effect, which ensures the digestion of food ingredients, facilitates their absorption, stimulates the release of the digestive tract's own enzymes, improves its functional state and normalizes digestion processes. The drug is prescribed 1 capsule 3-4 times a day with meals with a small amount of water. You can mix the contents of the capsule with a small amount of applesauce, drink juice or warm tea. With insufficient effectiveness, you can increase the daily dose to 6-12 capsules.

It is recommended to prescribe likrease. Newborns are prescribed 1 - 2 capsules per day (maximum dose - 4 capsules per day). Capsules can be previously opened and diluted in milk. Children under 5 years old are prescribed 2-4 capsules per day, from 5 to 10 years old - 4-6 capsules, over 10 years old - 6-8 capsules per day.

You can also use festal, mezim forte, pancreatin, digestal and other enzyme preparations, but since their children's forms are absent, the dosage of drugs should be approached carefully.

Antibacterial drugs are prescribed only if an infectious etiology is suspected or confirmed: furazolidone (10 mg / kg per day 4 times a day after meals), polymyxin (100,000 IU / kg per day 4 times a day).

Symptomatic treatment includes, with severe flatulence, the removal of gases through a gas outlet tube, the appointment of white clay (0.25 g 3 times a day), carbolen (0.25 g 3 times a day), smecta (1 sachet per day in 50 ml of boiled water, give during the day). With intestinal colic, a compress is used on the stomach, therapeutic enemas with valerian (1 drop of valerian for a month of a child's life), a 1% solution of bromine with valerian is prescribed. Subsequently, eubiotics are indicated to restore normal intestinal microflora.