Constipation in infants is a special form of intestinal pathologies, which is associated with an increase in the intervals between acts of defecation or with systematic insufficient emptying of the gastrointestinal tract in infants (it is generally accepted to consider infant age from 1 month to 1 year of life). This problem occurs in 20-40% of all newborns.. In most cases, parents conduct a course of therapeutic measures at home..

Constipation in infants is manifested, in addition to the absence of stools, by intestinal colic. Peculiarities of digestion in infants. Infancy is associated with a number of features that cause constipation:.

Specific dietary pattern (extremely limited diet, predominantly milk). For this reason, in babies of the first months of life, the frequency of stools can be from 5 to 7 times a day, provided that they are exclusively breastfed.. As complementary foods are introduced, the stool becomes thicker and rarer, which reduces the number of bowel movements (approximately 1-3 times a day by the year).

Underdevelopment of some parts of the gastrointestinal tract and weakness of the enzyme system (only lactulose works at an optimal level).

During the period of transition from breastfeeding to good nutrition, the so-called functional constipation occurs, which does not require therapeutic measures (it is a natural reaction of the body).

Weak waves of peristalsis due to the imperfection of the work of the sympathetic and parasympathetic nervous system. In this regard, there is a division of constipation into hypertonic and hypotonic types (the latter is more severe).

With persistent stool retention in young children, a mandatory consultation of a pediatrician and a pediatric surgeon is indicated.. In the absence of positive dynamics within 2-3 weeks of conservative therapy, hospitalization is required for the purpose of conducting, in particular, contrast irrigography (it helps to identify anatomical disorders in the intestine in 80% of cases).

Causes The most common causes of constipation in infants are shown in the table.

Group of diseases.

Example.

Characteristic.

Disturbances of nervous regulation.

Hirschsprung disease, birth injury of the spine.

What matters is the lesion at the level of the central nervous system (lumbar spinal cord) and the violation of local innervation directly in the intestinal wall (areas of agangliosis).

This group also includes the absence of urge to defecate with focal lesions of the brain..

Infectious and inflammatory processes in the intestines.

Necrotizing enterocolitis, severe forms of enterovirus infection.

As a result, areas of hypoganglionism may occur, which leads to a decrease in the overall sensitivity of the receptor apparatus of the intestine..

Alimentary violations.

Malabsorption.

These are the following factors:.

The timing of the introduction of complementary foods (should be no earlier than 6 months);

type of products introduced (it is better to start with dairy-free cereals);

the amount of nutrition introduced (calculated using special formulas that take into account the age of the child).

This group includes nutritional errors on the part of the mother..

Pathologies of the endocrine system.

Hypothyroidism, hyperparathyroidism, adrenal insufficiency.

Motility disorders are associated with hypo- or hyperfunction of the glands.

Violation of the musculoskeletal system.

Hernias of the anterior abdominal wall.

There is a divergence of muscles and a redistribution of pressure in the abdominal cavity.

Congenital malformations.

Rectal atresia, ectopic anus, incomplete rotation of the intestine in utero, Ledd's syndrome.

The problem is caused by mechanical obstruction of the intestine; often requires surgery.

Anorectal pathology.

anal fissures.

In addition to the anatomical violation of the integrity of the intestine, a psychological block occurs due to the binding of pain and defecation at a subconscious level..

Medical impact.

Iron preparations, anticonvulsants.

They can affect both the motility of the intestine itself and the density of fecal masses..

Diseases of the lower gastrointestinal tract.

Intussusception, strangulation ileus.

This group includes all variants of intestinal obstruction, regardless of the cause.. Often, such constipation is acute and may occur as a result of a pronounced infectious process (rotavirus infection).

Violation of the enzyme systems.

Enzyme deficiency of the pancreas, enzyme deficiency of the liver.

Can be established no earlier than by the end of the first year of life (relative stabilization of the bowels and the establishment of a normal diet).

Benign and malignant tumors of the abdominal cavity and retroperitoneal space.

Neuroblastoma.

Often, formations are determined in utero and do not have time to give a clinical picture of constipation (an emergency operation is performed).

Idiopathic form of constipation.

It occurs relatively rarely in children (often there is a clear morphological substrate of the disease). It is permissible to expose this type of constipation only after a thorough examination and exclusion of other diseases..

Often, stool retention in infants occurs as a comorbidity caused by a number of reasons, which is important to understand when drawing up a treatment regimen..

Diagnostic criteria For the diagnosis of constipation in an infant, the duration of observable defecation disorders must be at least 1-2 months.

According to the Paris Consensus, constipation is exhibited in the presence of 2 or more of the following signs:.

bowel movements less than 3 times a week;

uncontrolled bowel movements more than once a week;

large amount of feces;

palpable feces in the colon or rectum;

pain and delay in defecation.

In accordance with the Rome III criteria, in children under four years of age, 2 or more of the following signs must be detected in order to establish a diagnosis:.

less than 2 bowel movements per week;

1 episode of fecal incontinence per week, subject to the acquisition of toilet skills;

periods of prolonged stool retention and containment of the defecation process itself;

pain during bowel movements (feces have a hard dense consistency);

incomplete emptying and the presence of a large amount of fecal matter in the rectum;

indications of a history of large-diameter stools.

Both of the above clinical classifications do not take into account the division of children by age (newborn period, chest or infant). Children up to 4 years of age are combined into one scheme, which makes it somewhat difficult to diagnose constipation in infants..

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