Constipation in children. Diet and exercises for a child with constipation.

Types of laxatives

Natural plant-based laxatives are divided into several groups:

• mechanical;
• stimulating.

Osmotic drugs are also released. The latter are not based on plant components, but are quite widely used in gastroenterological and coloproctological practice.

Mechanical products contain plant fiber. Fiber increases the volume of intestinal contents, increasing the amount of fluid in it, making stool softer. Plant fiber is also found in food products, for example in plums.

Stimulant drugs act on the muscular system of the intestine, provoking its contractions. This leads to the act of defecation even in the presence of a mechanical obstacle in the form of dense feces. Such remedies include preparations based on senna leaves and castor oil. Stimulants begin to work very quickly, and their use may be accompanied by bloating, abdominal pain and cramping.

Osmotic drugs increase the amount of fluid in the intestines. They are also characterized by a rapid effect and provoke multiple loose stools. As a rule, the use of such drugs is advisable before coloproctological examinations, operations and examinations.

Herbal laxatives are preferred for home use. For the most part, they act more gently, many of them are not addictive.

Foods High in Iron

Our body cannot synthesize iron; it only processes this element, extracting it from worn-out red blood cells. “Fresh” iron comes from food. However, even if you eat foods containing iron, this does not mean that you have enough. The thing is that there are two types of iron.

Iron can be heme (divalent) or non-heme (trivalent). The first is found in products of animal origin and is easily digestible (about 25%), the second is part of plants and is absorbed by only 8–10% maximum[3]. This is why vegans and vegetarians often lack this element, even if they eat foods rich in iron.

And yet, it is the right diet that is considered the main way to prevent iron deficiency. Iron is found in significant doses in the following foods:

Animal products:

• pork liver - 29 mg (hereinafter the figure is given per 100 g of product);
• hard cheese - 19 mg;
• beef liver - 9 mg;
• egg yolk - 6 mg;
• beef tongue - 5 mg;
• turkey - 4 mg;
• beef - 2.8 mg;
• chicken - 2.5 mg;
• mackerel - 2.5 mg;
• pork - 1.6 mg;
• herring - 1 mg;
• cottage cheese - 0.4 mg.

Products of plant origin:

• beans - 72 mg;
• hazelnuts - 51 mg;
• oat flakes - 45 mg;
• fresh forest mushrooms - 35 mg;
• millet - 31 mg;
• peas - 20 mg;
• seaweed - 16 mg;
• prunes - 13 mg;
• dried apricots - 12 mg;
• buckwheat - 8 mg;
• tofu - 5.5 mg;
• peaches - 4.1 mg.

Although the iron content of some plant foods is high, the non-heme form of iron is poorly absorbed. Therefore, it is important for those following a plant-based diet to check their iron levels and, if necessary, take dietary supplements that contain this element.

Our body perceives iron best from meat (on average 20% is absorbed), a little worse from fish and seafood (about 11%), legumes (7%) and nuts (6%). Only 1-3% of iron is absorbed from fruits, vegetables and cereals.

To improve the absorption of iron, it is also important to receive the right amounts of vitamins and minerals, which play the role of catalysts and help this element to be absorbed. These include:

• Vitamin C. Iron is almost not absorbed without ascorbic acid, so the menu must include foods rich in ascorbic acid - berries, oranges and grapefruits, cabbage, red peppers.
• Vitamin A. If a person lacks vitamin A, then iron will not be absorbed and used to “build” new red blood cells. Many orange and yellow fruits and vegetables are rich in vitamin A - it is this substance that gives them their cheerful colors. To replenish vitamin A reserves, you need to eat more dried apricots, carrots and pumpkin. However, it's important to know that fats are needed for this vitamin to be absorbed, so don't ignore sources of retinol like butter, fish oil, and egg yolks.
• Folic acid (vitamin B9). It helps absorb iron and normalizes the digestive tract, and healthy digestion is extremely important for the absorption of this element. Sources of folic acid are eggs, soybeans, yeast, green leafy vegetables, dill, eggplant, tomatoes, chicken liver.
• Copper. Sources of copper are offal, fish and seafood (shrimp, oysters, etc.), cabbage.

Natural laxatives

Many natural products can be used as a natural laxative. So, to eliminate constipation, the fruits of joster are used, but it is important to be careful: some may experience nausea, dizziness, and weakness while taking it.

Aloe juice with honey is also used as a folk recipe to combat constipation. The effect often occurs only after a few days, so for long-term chronic constipation it is better to take a reliable drug. And such a recipe is suitable for the prevention of intestinal dysfunction, of course, in the absence of allergies to the components.

Cumin is commonly used to treat atonic constipation. Supplement the main course of therapy with seeds.

It is important to remember that even seemingly harmless folk remedies should not be taken without the consent of a doctor. They can provoke an allergic reaction, as well as blur the symptoms of an existing gastrointestinal disease, which will complicate the diagnosis of chronic constipation. Most herbal products are marketed without prior evaluation of their effectiveness and safety.

Main causes of functional constipation

• Pain
• Fever
• Dehydration
• Incorrect diet for a nursing mother
• Insufficient drinking regime of a bottle-fed child
• Insufficient drinking regime of a breastfed child during the introduction of complementary foods
• Early transfer of a child to artificial feeding
• Quickly transfer your baby from one formula to another (in less than 7 days)
• Poor nutrition of the child (for a long time the child receives food with a large amount of proteins, fats and insufficient dietary fiber, abuse of drinks containing a large amount of astringents - tea, coffee, cocoa)
• Excessive use of baby hygiene products or development of an allergic skin reaction in the perianal area
• Consequences of perinatal damage to the nervous system
• Rickets, vitamin D deficiency
• Anemia
• Thyroid gland dysfunction (insufficiency - hypothyroidism)
• Food allergies, primarily allergies to cow's milk protein
• Forced potty training, period of adaptation to new conditions (nursery, kindergarten)
• Hypodynamia – sedentary lifestyle
• Mental trauma or stress
• Systematic suppression of the urge to have a bowel movement, associated, for example, with the start of attending kindergarten, school, etc.
• Taking certain medications
• Constipation in family members

Frequency of defects in children of different ages

In addition to the frequency of stool, you should pay attention to its character. For a more objective assessment, the “Bristol Stool Form Scale” is convenient, since it is the form of stool, and not the frequency of stool, that is more consistent with the time of intestinal transit.

Bristol Stool Shape Scale

In accordance with this scale, 3 and 4 stool shape is regarded as normal, and 1 and 2 indicate slow transit (constipation). Quite often in practice there are situations when a child’s frequency of bowel movements is within normal limits, but the stool is dense, fragmented, and in scanty quantities. These signs indicate incomplete bowel movement and are considered manifestations of constipation.

The consistency of stool in newborns and infants should be mushy. From 6 months to 1.5 - 2 years, feces can be either formed or mushy. From the age of two, the chair must be decorated.

Herbal preparations

Laxative herbal infusions are available for free sale in pharmacies and stores that sell dietary supplements. Depending on the specific product, its action can be aimed at softening feces, activating the work of the muscular system and peristalsis, and replenishing water reserves.

The composition of the fees varies. Many products include flaxseed. It is believed that it improves intestinal motility and helps improve its evacuation function. Indeed, flax seeds contain a lot of fiber, which has a beneficial effect on the functioning of the digestive system.

Senna leaves have a pronounced laxative effect due to their effect on intestinal receptors. But you shouldn’t get carried away with such a natural component - addiction develops, and subsequently it will be more difficult to deal with constipation. It is also important to remember that regular consumption of senna tea is likely to provoke multiple bowel movements, rather than a one-time bowel movement.

Buckthorn is also often included in laxative herbal teas. It acts gently, helps soften and remove stool. The effect is observed no earlier than 12 hours after application, so buckthorn is not suitable as an urgent measure.

Rye and oat bran will help relieve constipation, but work best as a preventive measure. A large amount of fiber improves intestinal function. Bran often causes painful cramps and increased gas production in the intestines, so if you are prone to such symptoms, it is better to talk to your doctor.

Modern aspects of the treatment of constipation in children

The diet of patients with constipation should include a sufficient amount of liquid - water, fruit juices, which are consumed on an empty stomach, during meals or in the intervals between meals

The medical literature contains data indicating that 40-60% of adult patients and 90% of sick children with clinical symptoms characteristic of gastrointestinal pathology suffer from functional diseases. Of these, constipation is the most serious problem. Recently, the incidence of functional constipation in children has been increasing, so proper correction of this pathology is very important.

Constipation is conventionally divided into functional and organic. Functional constipation, depending on the etiopathogenesis, is divided into nutritional, dyskinetic, psychoneurogenic, endocrine, inflammatory (against the background of colitis).

Treatment of children with constipation should be comprehensive, and diet therapy is of great importance. In the early stages of the disease, a proper diet, regulating intestinal activity, in many cases leads to normalization of stool without the additional use of medications.

The degree of disturbances in intestinal secretion in intestinal diseases is largely determined by the range of products and the nature of their culinary processing. Based on their effect on motor function, nutrients are divided into three groups: those that enhance motor function, those that slow down peristalsis, and those that are indifferent.

The most pronounced laxative effect is possessed by: black bread; raw vegetables and fruits; dried fruits; white bread with an increased amount of bran (medicinal varieties of white bread - “Zdorovye”, “Barvikhinsky”); legumes; oatmeal, buckwheat, barley, meat with a large amount of connective tissue, pickles, soft drinks saturated with carbon dioxide (mineral water, lemonade, fruit drinks); very sweet dishes (for example, jelly and compotes from cranberries, gooseberries).

The laxative effect of fermented milk drinks varies depending on the method of their preparation and storage conditions. Fermented milk drinks with acidity above 90-100° according to Turner have a laxative effect. In addition, fermented milk products must be freshly prepared, since the laxative effect lasts only during the first day. Milk in its pure form and in large quantities in dishes is usually poorly tolerated, causing diarrhea and flatulence in patients with constipation, so most authors recommend eliminating or reducing its amount for constipation.

Plant fibers and organic acids serve as mechanical and chemical irritants. Therefore, for constipation, dried fruits, dates, figs, fresh fruit, vegetable and berry juices are recommended. Some dried fruits, especially figs and prunes, promote swelling and increase the volume of intestinal contents. For any form of constipation, you can include prunes (10-20-30 pieces) in your diet daily. It is poured with a small amount of water overnight, eaten in the morning and evening, along with the resulting infusion.

Fiber and cell membranes are the main stimulants of intestinal secretion. The cell membranes of raw vegetables and fruits are less digestible. The membranes of plant cells contain carbohydrates and proteins that are slowly and incompletely processed by digestive enzymes. In turn, undigested food falls under the active activity of microbes, under the influence of which acids and gases are formed that enhance the peristalsis of the large intestine. Small gas bubbles make the intestinal contents looser. Rubbing and especially homogenizing products significantly reduces their mechanical effect on the mucous membrane of the gastrointestinal tract.

Depending on the nature of disorders of intestinal motor function in the diet, the amount of food regulators of peristalsis changes and in each case it is calculated individually, taking into account other symptoms of the disease. A number of authors recommend that when strengthening the motor function of the colon, at the first stage, exclude foods containing large amounts of fiber. Minced meat and fish, vegetables and fruits without peel, in the form of puree, are allowed. For hypomotor disorders, on the contrary, a large amount of fiber, cool liquid on an empty stomach, and vegetable oil are indicated.

The diet of patients with constipation should include a sufficient amount of liquid - water, fruit juices, which are consumed on an empty stomach, during meals or in the intervals between meals. Not only the volume of feces, but also the water content in the stool also depends on the presence of vegetables rich in cellulose and hemicellulose in the menu. It is important to note that even with relatively small fluctuations in the percentage of water, the consistency of the fecal matter changes. So, stool is liquid if it contains 90% water, mushy - 85%, soft-dense - 80%; Normal stool contains 78% water. Difficulty in the passage of intestinal contents occurs when the amount of water is reduced to 50%, and its passage through the intestines stops at 20% water content. Therefore, patients with constipation are advised to drink as much as possible during the day.

You can prescribe mineral waters: for constipation with increased contractile activity of the intestines, with the presence of spastic pain in the abdomen, it is recommended to take Essentuki No. 4; for intestinal hypomotility - more mineralized Essentuki water No. 17. Take 0.5-1 glass of mineral water two to three times a day on an empty stomach, 1-1.5 hours before meals, warm.

In infants, diet therapy has a number of features. As has already been noted by many authors, you cannot feed a child with milk, kefir and infant formula for a long time. From the second half of the year, dairy products should not exceed 700-750 ml per day, after a year 500 ml, in two or three years 300 ml. It is recommended to introduce fruit purees into the child’s diet from the age of five months: apple, apricot, peach, as well as juices. Fruit juices and purees have a positive effect on the secretory and motor functions of the digestive organs, increase appetite and have a beneficial effect on the intestinal microflora. For constipation, cabbage, beet juice, and prune puree should be prescribed (2 to 4 teaspoons per day, depending on age).

Principles of proper nutrition for infants:

• correct daily routine and nutrition for the mother,
• correct drinking regime for mother and child,
• physiologically complete, properly selected diet for the child,
• if tolerated poorly, reduce or completely eliminate milk from the diet.

We looked at the effectiveness of the Frisovo mixture, which was prescribed to children with regurgitation, constipation, and intestinal colic. It contains carob gluten, which has a mild laxative effect. Fiber binds water and increases the viscosity of intestinal contents, which in turn improves peristalsis. In most children, during the first week, stool returned to normal, bloating and abdominal pain decreased, and appetite improved. When bottle-feeding a child, you can completely replace all feedings with the Fries formula. For some children, diet therapy was insufficient. Recently, a dry, bland, adapted mixture “Semperbifidus” has appeared, which is also suitable for feeding children with constipation. The laxative effect of the mixture is provided by lactolactulose, which is part of it.

Diet correction is required for all types of constipation. But the effectiveness of diet therapy increases several times when it is enriched with biologically active additives (BAA). Therefore, it is necessary to help the patient correctly build a daily diet by introducing ballast substances into it, primarily those contained in food products. Ballast substances (fillers or swelling agents) are polysaccharides of plant origin that do not undergo enzymatic breakdown in the small intestine, and upon reaching the large intestine, they are partially broken down by bacteria, and partially swell due to the absorption of water.

At the end of the last century, people consumed approximately 100 g of ballast substances with food every day. Nowadays, this amount has decreased to an average of 15-20 g per day.

It was found that the use of wheat bran in a daily dose of 30 g increases the weight of feces by 56.3%, and the total transit time of intestinal contents through the colon is halved.

When taking bran, it is recommended to consume enough fluid to avoid hardening of the stool. 1 g of bran binds 18 g of water. It is recommended to take dietary fiber from 15 to 50 g per day. A large amount of dietary fiber leads to a decrease in the absorption of fats by 5-7%, proteins by 8-15%.

Practice shows that often after stopping bran, constipation recurs, hence the need to re-use it.

The use of mucous substances, the so-called mucilaginases, for constipation has also been practiced for a long time. These products consist of the same amount of fiber and polysaccharides that are not absorbed in the intestines. These substances are of plant origin, have a resinous consistency, and are insoluble. In water, they swell and turn into a mucous mass, which prevents the stool from thickening and at the same time increases its volume. Slimy substances include algae of marine origin. In our country, the most widely used seaweed (kelp), which is a brown algae rich in iodide, bromide and calcium salts, polysaccharides, and vitamin C. Laminaria is contraindicated in patients with idiosyncrasy to iodine and, with prolonged use, can cause the phenomenon of iodism.

Children under one year of age are prescribed special dry dietary supplements. Currently, dietary supplements containing live bifidobacteria and lysozyme have been introduced into industrial production. The enrichment of medical food products with lysozyme is based on its biostimulating, bacteriostatic, bifidogenic, antihistamine and other properties.

Fermented milk products are also widely used for constipation. The physiological role of lactic acid bacteria is diverse: they cause the fermentation of milk sugar with the formation of lactic acid, which is involved in calcium metabolism, the breakdown of casein and promotes the growth of bifidobacteria. Medical food products containing lactic acid bacteria have pronounced antagonistic properties towards pathogenic and opportunistic microorganisms. Fermented milk products such as biokefir, bifilin, curdled milk, biolact, bivit, bifidok, etc. are widely used. In addition, various starter cultures are recommended: “Evita”, “Narine”, “Vitaflor”, etc. The Semperbifidus mixture is also used , which promotes the growth of bifid flora and inhibits the growth of opportunistic flora, due to the presence of lactolactulose.

Diet therapy with dietary supplements is effective for alimentary constipation, but in other cases drug therapy is required.

The main place in the drug therapy of constipation is occupied by laxatives. According to the mechanism of action, laxatives differ from each other. Side effects of laxatives include: allergic reactions, diarrhea, vomiting, etc.

In clinical practice, products containing anthraglycosides are most often used - senna leaves, rhubarb, etc. The use of herbal laxatives (senna leaves, buckthorn) is associated with certain inconveniences, since the level of active glycosides in them is subject to fluctuations, their concentration cannot be accurately measured , and an overdose causes side effects. Therefore, tablet forms are often used (tisasem, senadexin, etc.).

It has been experimentally proven that long-term use of anthraglycosides causes dystrophic changes in the neuromuscular apparatus of the colon.

A number of laxatives include synthetic substances - phenolphthalein, bisacodyl, etc., the laxative effect of which is similar to anthraglycosides.

In practice, doctors often use bisacodyl suppositories - it is a contact laxative, acting directly on the mucous membrane of the rectum, stimulating the sensory endings of the nerve plexuses in the mucous membrane and submucosal layer. As a result, it accelerates and enhances the peristalsis of the colon, and also increases the release of water and electrolytes in the colon, which leads to softening of the stool. For proctosigmoiditis, irritating the mucous membrane of the rectum, the drug causes a painful sensation in children.

Preparations made from natural and semi-synthetic polysaccharides and cellulose derivatives are relatively harmless. These include normase (lactulose). Normaza, under the influence of intestinal bacteria in the colon, is digested with the formation of acetic and lactic acids, which promote the secretion of water in the intestines and accelerate the evacuation of contents, inhibit the growth of bacteroides and Escherichia. Prescribed from 5 to 30 ml, depending on age, once a day on an empty stomach in the form of syrup. For colitis, the use of normase with hilak-forte is effective.

Herbal medicine provides significant assistance in the complex treatment of patients with constipation. The biologically active substances contained in herbs in their natural proportions, with long-term use, can be more effective than their individual ingredients in preparations. Medicinal plants must be prescribed individually, taking into account their therapeutic effect.

Plants that have a laxative effect include: anise (fruit), laxative joster (fruit), centaury (herb), alder buckthorn (bark), lemon balm (leaves), dandelion, mountain ash (fruit), licorice. (roots), field steelhead (roots), horse sorrel (fruits).

Herbs are prescribed in the form of infusions, decoctions, and various laxative teas. We use medicinal plants for therapeutic and prophylactic purposes. During an exacerbation, laxative herbs are combined with herbs that have antispasmodic, analgesic and anti-inflammatory effects (calendula, chamomile, millennial, common juniper). In addition, we recommend herbal medicine in the spring-autumn period, when relapses of constipation are observed (preventive courses of herbal medicine are carried out during periods of seasonal exacerbation with breaks). For the same purpose, you can use the so-called “jester compote”: 1 tbsp. l. joster, 30 g of raisins, 10 g of prunes, pour 400 ml of water, boil for 20 minutes, filter and take 1/4-1/2 cup orally at night.

Thus, treatment of constipation should be carried out taking into account the causative factors and must be comprehensive.

Note!

• Functional constipation is divided into nutritional, dyskinetic, psychoneurogenic, endocrine and inflammatory
• The diet has a number of features depending on the form of constipation, the presence of inflammation and the nature of the disorders
• Phytotherapy is included in the complex therapy of constipation
• Drug treatment is prescribed when diet therapy is ineffective

Tablets and suppositories based on herbal ingredients

Some drug and supplement manufacturers make herbal laxative tablets. The main advantage is ease of use. However, first of all, you should be guided by the composition of the drug.

Candles with natural ingredients, such as chestnut seed, are convenient for one-time use and provide immediate relief. But this form of funds has strict contraindications. For example, for proctological diseases, the use of suppositories is strictly prohibited.

Also, remember the limitations for any laxatives: intestinal obstructions, tumors and other serious illnesses require urgent medical attention. Otherwise, there is a risk of serious complications.

Products with a laxative effect

Some food products are also classified as herbal laxatives. By adding them to your diet, you can consolidate the effect of the drugs, prevent constipation, or in some cases cope with it yourself. Such products include:

• Olive oil. The fatty acids in the composition stimulate intestinal motility and protect the mucous membranes from injury by dense feces.
• Figs, prunes and dried apricots, as well as beets. The high fiber content in these products helps normalize bowel movements.
• Sauerkraut. Indirectly helps to get rid of constipation due to the content of bacteria beneficial to the intestines and the restoration of normal microflora.
• Fresh dairy products. Stimulates intestinal function and helps maintain the balance of beneficial bacteria.

The products listed are suitable for one-time use or permanent use. These products should be included in your daily diet in consultation with your doctor.

Does diet help with constipation?

Everyone knows that a diet for constipation should include many foods rich in fiber, and these are vegetables and fruits. But not everyone knows how much and what kind of fruits and vegetables a child needs.

Yes, for most children, to normalize stool, it is enough to simply establish a drinking regime and regularly feed the child fruits and vegetables in accordance with age. But not for everyone.

Some people need to enrich their diet with products with a laxative effect. These include: plums, beets, prunes, raisins, figs, dates, dried apricots, legumes, nuts. They should be present in the diet of a child prone to constipation. You need to include them in your diet gradually. For some, it will be enough to consume one of the listed products daily, while others will need to include several in their diet.

Porridges made from cereals with a shell (buckwheat, oatmeal, pearl barley, wheat) and wholemeal bread are also useful.

Fermented milk products (kefir, yogurt, fermented baked milk, biolact) are best consumed before bed. 1 glass per day is enough. You can increase your daily kefir consumption to 2 glasses per day.

Refined rice, blueberries, pears, sweets and baked goods, flour products made from premium flour, strong tea, and animal fats have a fixing effect. It is better for children prone to constipation to abstain or significantly limit their use.

I recommend trying several recipes for constipation that I and my patients have tested:

— Take equal quantities of dried fruits: figs, dates, dried apricots, prunes, wash well, pour over boiling water, remove seeds, grind through a meat grinder or grind in a blender. Take 1-2 teaspoons daily in the morning on an empty stomach (30 minutes before meals), with 1 glass of water with lemon. Children under 3 years old - 1/2 glass of water.

This recipe can be used by children from 1 year old, but be sure to first test how the child tolerates each dried fruit individually, and then prepare the mixture.

— Sour milk + prunes at night: wash 10-20 prunes well, brew with boiling water for 5-10 minutes, you can make a puree for a small child. Eat before bed, washed down with 1 glass of kefir, biolact, fermented baked milk, yogurt.

Wheat bran is a very useful product because... contain approximately 50% fiber, as well as many vitamins and microelements. You can buy them at the pharmacy. Wheat bran can be included in the diet of children after 1 year as a remedy for constipation. Start with a daily amount of 1 teaspoon, gradually, every 2-3 days, increasing the dose until regular bowel movements are achieved. The maximum dose for children is up to 2 tablespoons per day. The daily dose of bran is brewed with a small amount of boiling water. Leave it covered for 30-40 minutes, then excess water is drained, and the swollen bran is added to the child’s food, most often to porridge. You can also add them to kefir, cottage cheese, vegetable and fruit purees. You can add the entire daily dose of bran to one serving of food; you can divide it evenly into breakfast, lunch and dinner.