Among the most common gastrointestinal diseases in infants are astroesophageal reflux, dyspepsia, diarrhea and enterocolitis. Some of them are directly related to the imperfection of the digestive system, others are provoked by hereditary factors or intrauterine malfunctions. But there are also diseases of the digestive system in young children (for example, dystrophy or paratrophy) that appear due to poor nutrition.

Disease of the digestive system in young children - thrush

This is a fungal infection of the oral mucosa, often occurring in infants. The disease is registered in 4-5% of all newborns. Those most susceptible to thrush are premature babies, newborns with weakened immune systems, infants who receive insufficient hygienic care, and babies who, for one reason or another, take antibiotics.

Cause of the disease. This disease of the digestive system in young children is caused by a fungus of the genus Candida. Frequent regurgitation provokes the development of fungus.

Signs of the disease. Dotted white deposits appear on the mucous membrane of the mouth and cheeks, reminiscent of curdled milk. Sometimes these points merge with each other, forming a continuous film of white-gray color. With massive damage, these plaques spread to the mucous membrane of the esophagus, stomach and respiratory tract.

Treatment. In mild cases, it is sufficient to irrigate the mucous membrane with a 2% solution of sodium bicarbonate or a 10-20% solution of borax in glycerin. It is possible to use 1-2% solutions of aniline dyes (methyl violet, gentian violet, methylene blue), a solution of nystatin in milk or water (500 thousand units/ml). The mucous membrane is treated every 3-4 hours, alternating the agents used.

In severe cases, in addition to local treatment of this gastrointestinal disease in young children, the child is given oral nystatin 75 thousand units/kg 3 times a day for 3-5 days or levorin 25 mg/kg 3-4 times a day for for the same period.

Malformation of the gastrointestinal tract of newborns pyloric stenosis

Pyloric stenosis- a malformation of the upper muscular sphincter of the stomach, associated with excessive development of its muscles and narrowing of the entrance to the stomach. Boys get sick more often.

Causes of the disease. The disease occurs as a result of disruption of the innervation of the stomach.

Signs of the disease. The first signs of this malformation of the gastrointestinal tract of newborns appear at the 2-3rd week of life, rarely earlier. It appears as a strong fountain 15 minutes after eating. Over time, the child’s weight drops sharply, even to the point of dystrophy, and anemia and dehydration develop. Little urine and feces are produced, and constipation occurs.

The duration of the disease is from 4 weeks to 2-3 months.

For diagnostic purposes, ultrasound, fibrogastroscopy, and X-ray gastrography are performed.

Treatment. Treatment is surgical. In the postoperative period, dosed feeding is carried out with the addition of glucose and salt-containing solutions.

Gastrointestinal disease in young children: neonatal reflux

Gastroesophageal reflux in newborns is the involuntary reflux of gastric contents into the esophagus with increased tone of the lower and middle esophageal sphincters.

Causes of the disease. This gastrointestinal pathology in newborns often occurs against the background of encephalopathy, congenital hiatal hernia, and constant overeating.

Signs of the disease. After feeding, the newborn spits up profusely, after which he vomits. The child is excited and restless.

Treatment. They switch to feeding with a thick milk formula in an upright position. After eating, the child should remain in an upright position for another 5-10 minutes. The last feeding is carried out 2-3 hours before bedtime. To treat this digestive problem in newborns, antacid medications are prescribed: Almagel 0.5 teaspoon per dose before meals, Maalox 5 ml suspension per dose before meals.

Pathology of the gastrointestinal tract in newborns: dyspepsia

Simple dyspepsia (functional dyspepsia)- functional disorders of the gastrointestinal tract, manifested by impaired digestion of food, without pronounced changes in the gastrointestinal tract.

Causes of the disease. The cause of this digestive disorder in young children is errors in diet, overfeeding or underfeeding the baby.

Signs of the disease. Children experience regurgitation. If the stomach is predominantly involved in the process, normal vomiting occurs after feeding; if the intestines are predominantly involved, it occurs in the form of chopped eggs. In the latter case, an increase in stool frequency up to 6-10 times a day is also typical. The child may experience painful colic that goes away after the gas passes.

Treatment. Treatment is based on eliminating the causes of dyspepsia.

In mild cases, 1-2 feedings are skipped and liquid is given instead (tea, rehydron, glucosolan, 5% glucose solution).

In the case of artificial feeding for this disease of the digestive system in young children, a water-tea diet is prescribed for 8-10 hours. The amount of fluid is calculated based on the child's weight. The liquid is given in small portions. After the water-tea diet, the amount of food is distributed among feedings and amounts to 1/3 of the total daily requirement. In the following days, 100-200 ml per day is added, gradually recovering to the normal volume by the 4th day. For loose stools, smecta is prescribed.

Digestive disorders in young children: diarrhea and milk intolerance

Antibiotic-induced diarrhea is a digestive disorder in young children who have been taking antibacterial drugs for a long time.

Signs of the disease. The disease is characterized by vomiting, lack of appetite, and frequent, profuse, watery stools with mucus.

Treatment. After discontinuation of antibiotics, diarrhea is treated.

Cow's milk protein intolerance can occur at any age and can occur after consuming cow's milk-based products.

Causes of the disease. The child does not have an enzyme that breaks down milk proteins, or the body is very allergic to milk components.

Signs of the disease. The disease begins from the first days of using cow's milk or mixtures prepared on its basis. The greater the volume of milk entering the body, the more clearly intolerance manifests itself. With this gastrointestinal disease, the newborn is restless, and since he experiences constant abdominal pain (colic), he screams loudly. Characterized by flatulence, watery, foamy stools with cloudy mucus. In severe cases, the baby vomits immediately after feeding. Possible bloating and various skin rashes.

Children lose weight sharply, their growth and development are delayed, and psychoneurological disorders appear.

Treatment. Natural feeding is the best way to protect a child from this pathology, and in the absence of breast milk and the appearance of intolerance, they switch to special formulas such as NAN N.A. These are hypoallergenic formulas containing whey protein, which is different from standard cow's milk protein.

NAN N.A 1 is prescribed in the first half of life, in the second half of the year NAN N.A 2 is indicated, which has a higher content of iron, zinc and iodine and meets all the needs of children from 6 months of age.

Digestive disorders in newborns: celiac disease in infants

Celiac disease occurs as a result of impaired digestion of the protein of cereals - gluten.

Causes of the disease. The pathology is genetic in nature.

Signs of the disease. The disease is detected in the first two years of life when eating white wheat and black rye bread, as well as dishes made from wheat and rye flour (i.e., products containing rye, wheat, oats, barley).

Typically, this gastrointestinal disorder in newborns manifests itself when complementary feeding with cereals is introduced. The child develops vomiting, rumbling in the intestines, flatulence, and the abdomen becomes enlarged. The stool becomes lighter, thicker, foamy, and sometimes foul-smelling, which indicates a lack of absorption of fat. There is a stop in growth and weight, mental development slows down.

Treatment. The baby is prescribed a gluten-free diet with the complete exclusion of products containing flour and cereal grains. Dishes containing flour, pates, minced cutlet products, sausages, boiled sausages, sauces, and cereal soups are prohibited. During the diet for this digestive problem in infants, dishes made from buckwheat, rice, soy, vegetables, and fruits are allowed. In the diet, the amount of products containing milk is increased, cottage cheese, cheese, eggs, fish, and poultry are additionally given. For fats, corn and sunflower oils are preferable; for sweets, jams, compotes, jams, and honey are preferable.

Gastrointestinal disorders in newborns: enterocolitis

Necrotizing ulcerative enterocolitis It occurs in children of the first year of life as an independent pathology or intestinal damage can accompany other ailments.

Causes of the disease. Most often, independent enterocolitis develops in children infected with one or another microorganism in the womb; the process develops secondarily against the background of dysbacteriosis, long-term use of antibiotics, sepsis, etc.

Signs of the disease. There are no typical manifestations of the disease. The child becomes lethargic, eats poorly, after feeding he has constant regurgitation, vomiting often occurs, sometimes with an admixture of bile. With this digestive disorder in newborns, the stool is watery, and the feces acquire a greenish tint. Over time, the abdomen swells, and the venous network becomes clearly visible on its skin.

If left untreated, the disease can lead to the death of the baby due to perforation of the intestinal wall by ulcers.

Treatment. It is recommended to feed the child only with mother's milk; if breastfeeding is impossible, he is transferred to acidic formulas. Lactobacterin or bifidumbacterin are used as medications, 3-9 biodoses per day. If the baby is severely tormented by vomiting, his stomach is washed with a 2% sodium bicarbonate solution before each feeding. Vitamins B1, B6, B12, P, PP, C must be administered. UHF is performed on the solar plexus area.

Digestive problems in newborns: malnutrition disorders in infants

Chronic eating disorders most often occur in young children and are characterized by:

• lack of body weight, lag behind growth norms (hypotrophy);
• uniform lag in weight gain and height;
• excess body weight and height, predominance of body weight over height.

Dystrophy is a digestive disorder in infants, characterized by pathologically low body weight.

Causes of the disease. There are nutritional causes of the disease - qualitative and quantitative malnutrition, lack of vitamins. This digestive disorder in infants can occur with long-term infectious and non-infectious diseases, defects in care, due to constitutional reasons, and with prematurity.

With mixed and artificial feeding, especially with unadapted formulas, quantitative nutritional disorders occur and the level of metabolism decreases.

Intrauterine malnutrition occurs as a result of impaired development of the fetus, slowing down its physical development.

Signs of the disease. For malnutrition of the first degree fatty tissue in the groin, abdomen, and under the arms becomes thinner. Weight loss is 10-15%.

With malnutrition II degrees Subcutaneous fat tissue disappears on the torso and limbs, and its amount on the face decreases. Weight loss is 20-30%.

For III degree malnutrition (atrophy) subcutaneous fat disappears on the face, weight loss is over 30%. The skin turns grey, the face takes on an senile expression with a reproachful look. Anxiety gives way to apathy. The oral mucosa turns red, the muscles lose their tone, and the body temperature is below normal. The child's food endurance decreases, regurgitation and vomiting appear, stool may be normal or constipation alternates with diarrhea.

With congenital (intrauterine) malnutrition, newborns experience weight deficiency; decreased tissue elasticity; paleness and flaking of the skin; multiple functional disorders; long-term physiological jaundice.

Treatment. Treatment of malnutrition is carried out taking into account the reasons that caused it, as well as the severity of the disease and the age of the child.

In a child with any degree of malnutrition, the daily amount of food should be equal to 1/5 of his body weight. At the beginning of treatment, 1/3 or 1/2 of the daily amount of food is prescribed. Within 5-10 days, the volume is adjusted to 1/5 of body weight. The best nutrition is mother's milk or adapted age-specific formulas.

Nutrition up to the daily amount is supplemented with tea, vegetable broth, rehydron, oralit. The number of feedings increases by one. During this period, the child should receive 80-100 kcal per 1 kg of body weight per day. This stage of diet therapy is called minimal nutrition, when the volume of food is brought to 2/3 of the required amount, enlites and protein milk are added. When feeding with human milk, low-fat cottage cheese is added, and the amount of drink is reduced by the corresponding volume.

At the next stage of intermediate nutrition, an increase in the amount of protein, fat and carbohydrates consumed is required; The daily allowance consists of 2/3 main food and 1/3 corrective food. This period lasts up to 3 weeks.

The period of recovery from dystrophy is called optimal nutrition. The child is transferred to physiological nutrition appropriate for his age.

As a medicinal treatment, infusion therapy (albumin, etc.) is carried out, and donor gamma globulin is administered. Enzyme therapy is prescribed during the period of intermediate nutrition for 2-3 weeks (pancreatin, abomin, etc.). Active treatment of dysbiosis is carried out, complex vitamin preparations are indicated.

In severe cases, anabolic hormones (Nerobol, Retabolil) are used in age-specific doses.

Paratrophy is a digestive disorder in infants, characterized by excess body weight.

Causes of the disease. Excess body weight appears as a result of overfeeding or with excess protein or carbohydrate nutrition, as well as when a pregnant woman eats excess carbohydrates.

Signs of the disease. There are 3 degrees of paratrophy.

• I degree - weight exceeds the age norm by 10-20%.
• II degree - weight exceeds the age norm by 20-30%.
• III degree - weight exceeds the age norm by 30-40%.

In any case, the disease is accompanied by disturbances in protein, fat and carbohydrate metabolism.

Protein nutritional disorders occur when cottage cheese or protein mixtures are excessively introduced into the baby’s diet in the 2nd half of life. The stool becomes dry, white, and contains a large amount of calcium. Gradually, the appetite decreases, the child begins to lose weight, and anemia occurs.

With excessive carbohydrate nutrition with a lack of protein, excess fat deposition and water retention in the body occur. This usually reduces the elasticity of the tissue. The child looks obese. Indicators of physical development by weight are usually above average.

Treatment. In case of paratrophy in the first months of life, it is recommended to eliminate night feeding and streamline other meals. Children with carbohydrate overfeeding are limited in easily digestible carbohydrates. For protein eating disorders, protein-enriched mixtures should not be used. Complementary foods are introduced in the form of vegetable puree; enzymes and vitamins B1, B2, B6, B12 are additionally used.

Monitoring of height and weight indicators in children with dystrophies is carried out once every 2 weeks, and nutrition is calculated.

Massage, gymnastics, and long walks in the fresh air are prescribed.

In older children, the need for carbohydrates is satisfied through vegetable dishes, fruits, vegetable oils; proteins and vitamins are additionally introduced into the diet.

This article has been read 14,358 times.

Dyspepsia in young patients is expressed by disruption of the digestive system. In simple terms, functional dyspepsia in children is common “indigestion.” In newborns and babies under the age of one year, the main causes of digestive disorders are the immaturity of the gastrointestinal tract system and nutritional disruptions (introduction of something new into the diet, a sharp transition to artificial feeding, lack of variety in diet, etc.). In addition to these factors, dyspepsia may be preceded by a genetic predisposition and insufficient production of digestive enzymes.

The main reasons for the development of dyspepsia are errors in feeding the child. A disturbed diet plays a special role - for example, if the mother feeds the baby more often than necessary, this contributes to regurgitation, and too much food in the baby can cause vomiting.

Children who are formula-fed or formula-fed are more susceptible to digestive disorders than those who are fed breast milk. Selecting formulas over a long period of time, or feeding a low-quality formula will ultimately lead to dyspepsia. In addition, when using formula, overfeeding is possible - after all, it is easier to suck from a bottle than from the mother's breast.

Acute digestive disorders in young children can be caused by the following reasons.

• Overeating.
• Insufficient enzymatic activity.
• The quantitative and qualitative characteristics of a baby’s food do not correspond to the performance of its digestive tract.
• Introduction of new food that is too early for the child to consume due to his age.

In older children, digestive disorders can also be caused by a number of factors.

• Excessive consumption of foods harmful to the body (fried, fatty, smoked, salty).
• Hormonal imbalance.

Overeating can cause dyspepsia in children

Concomitant diseases are the following.

In children, there are functional, toxic and parenteral dyspepsia.

In turn, functional (or nutritional) dyspepsia is a digestive disorder resulting from poor nutrition.

Functional dyspepsia is divided into five types.

• Fermentative dyspepsia in children is caused by fermentation processes from the abuse of foods high in carbohydrates. As a result, fermentation bacteria multiply in the colon.
• Putrefactive - the intestinal loops are inhabited by putrefactive microbes as a result of oversaturation with foods rich in proteins.
• Fatty – characterized by excessive consumption of fatty foods.
• Toxic dyspepsia is formed as a consequence of ineffective treatment of functional dyspepsia, and the main source of the problem here is the causative agents of intestinal infections - salmonella, E. coli, shigella and other less dangerous microorganisms.
• Parenteral is secondary in nature and is a complication after any previous illness (for example, pneumonia).

Based on the types of digestive disorders, the following symptoms are distinguished.

• Weight loss due to lack of appetite.
• Nausea, vomiting.
• Restless sleep.
• Flatulence (before and after one year).
• Acute pain in the epigastric region, accompanied by colic.
• Frequent loose stools mixed with mucus and lumps of undigested food.

Nausea is one of the symptoms of an upset stomach in a child.

Fermentative dyspepsia, just like putrefactive dyspepsia, is characterized by a specific stool odor.

Newborns are susceptible to temporary dyspepsia on the 3rd to 5th day of birth. It lasts several days while the body adapts to the external environment and goes away on its own.

The toxic form of the disorder is marked by the appearance of severe signs of the disease - symptoms of meningitis, fever, sudden weight loss, muscle atrophy, as well as the presence of seizures and loss of consciousness may be present. The skin is pale or bluish in color.

With ineffective or long-term treatment of dyspepsia, the child may develop dystrophy due to impaired metabolism. Rickets and allergies during the course of dyspepsia can lead to pyelonephritis, otitis, and pneumonia.

Be careful, young children are at high risk of developing volvulus, a serious gastrointestinal problem.

How to diagnose

At the first signs of a disorder, you should contact a pediatrician who will examine the child and, if necessary, prescribe a consultation with a pediatric gastroenterologist. You may need consultation and treatment from a pediatric neurologist and psychologist for problems with the nervous system.

The diagnosis is based on the results of instrumental and laboratory studies.

Instrumental examination methods include all of the following.

• X-ray of the stomach and subsequent examination of the intestines.
• Carrying out duodenal or gastric intubation.
• Endoscopic examination of the stomach and duodenum.
• Ultrasound of the abdominal cavity.
• Measuring the acidity of gastric contents using a special test.

Laboratory diagnostics includes the following basic tests:

• Biochemistry analysis of blood from a vein.
• Examination of blood and urine for the enzymatic activity of the pancreas.
• Examination of stool for the presence of bacteria, worms (all information on worms in a child).
• Carrying out a coprogram to diagnose the performance of the digestive organs.

To diagnose dyspepsia in a child, an abdominal ultrasound is performed.

Treatment

There is no need to worry if there is a single case of vomiting or diarrhea – you just need to adjust the baby’s diet. For example, a new product should be introduced gradually, given in small quantities and the subsequent reaction to the new product monitored. It should be noted that signs of a digestive system disorder may be observed if the child is overheated in the sun.

The basic principles of treatment can be represented by the following actions:

• Correction of the child's nutrition.
• Optimization of the drinking regime.
• Traditional methods of therapy.
• Abdominal massage.
• Drug therapy.

If you experience frequent diarrhea (more than 10 times a day) and vomiting, you should definitely seek medical help. This condition can portend not only functional disorders of the digestive organs in children, but also be expressed by the appearance of an intestinal infection (dysentery).

Treatment of nutritional dyspepsia

The principles of treatment for this type of dyspepsia are:

• normalization of nutrition;
• increased drinking regime;
• use of folk remedies;
• drug treatment.

Treatment of nutritional dyspepsia suggests that the volume of food needs to be replenished with a volume of liquid. That is, during an exacerbation, give the child as much fluid as possible. If the child is breastfed, then it is worth stopping complementary foods and leaving only breastfeeding.

To cure dyspepsia in a child, it is necessary to strengthen his drinking regime.

Treatment of nutritional disorders is usually carried out at home. When normalizing nutrition, it is important to know what will help the baby heal as quickly as possible. The mother's daily action plan is presented below.

First day

• Leave the baby without mother's milk for up to 12 hours.
• During the absence of milk, replace feeding with baby tea with sugar.
• The maximum amount of tea should not exceed 300 ml.
• After 12 hours, breastfeed.
• The dose of milk after a break is no more than 100 ml.

Second day

• Feeding with mother's milk 5 times a day.
• The maximum volume per feeding is 100 ml.
• If the child needs more food, then add baby tea.

From the third to the fifth day

• The amount of milk per feeding increases to 175 ml.
• Weigh your baby regularly.
• If the stool is abnormal, then replace mother's milk with protein milk in a volume of 100 ml.

What to do if the mother has no milk

When artificial feeding, food unloading is carried out, the principle of which is to cancel 2-3 feedings. Feeding is replaced with drinking. If feeding formula, dilute it half with water. This therapy is carried out until vomiting and diarrhea stop. The mother's daily behavior plan is presented below.

When artificial feeding, food is unloaded and sometimes the mixture is replaced with water.

First day

• For the first 12 hours, eat only tea.
• Maximum tea volume 300 ml.
• After 12 hours, use the rice water.
• The frequency of feeding with decoction is 4 times.
• The maximum dose of decoction is 150 ml per feeding.

Second day

• The number of feedings per day is no more than 6 times.
• Feed with rice water four times out of six.
• A single dose of decoction is no more than 150 ml.
• Add kefir the remaining two times.
• Kefir dose 150 ml.

Third day

• The frequency of feedings is 5 times.
• Feed with rice water two times out of five.
• Three times out of five use kefir or protein milk.
• The dose of decoction or kefir is 125 ml per feeding.
• You can add 5 grams of sugar to kefir or milk.

Fourth day

• The frequency of feeding the baby is 7 times.
• Apply protein milk or kefir five times.
• Feed twice with rice water.
• The dose for any feeding is 150 ml.

From the fifth day, the frequency of feedings is returned to what it was before dyspepsia. The rice water is kept for another day or two. Then they switch to classic mixtures, preferably fermented milk. You can add sugar up to 10 grams to the broth.

Traditional medicine helps well in the treatment of nutritional dyspepsia. For example, chamomile decoctions have an anti-inflammatory effect, and tea brewed from blueberry leaves is an indispensable remedy for diarrhea.

Eubiotics (“Bifidumbacterin”) will help eliminate dysbacteriosis and normalize microflora. For colic, antispasmodics are used - “Papaverine” or “Drotaverine”.

You can normalize the intestinal microflora with the help of “Bifidumbacterin”

Treatment of toxic dyspepsia

In case of toxic dyspepsia, the child is hospitalized urgently. To eliminate acute symptoms of dyspepsia, it is advisable to prescribe antibiotics, saline solutions (Acesol, Disol, Trisol, Ringer's solution), as well as a 5% glucose solution. If a secondary infection cannot be excluded, treatment with antibiotics is carried out.

So, the main points of treatment of the toxic form of the disorder:.

• Hospitalization.
• Replenishment of lost fluid.
• Use of eubiotics.
• Correction of pathological flora with antibiotics.

Lost fluid is replenished with 50 ml of drink every half hour after vomiting or defecation.

How massage can help

Massage plays an important role in the treatment of digestive disorders in children. Abdominal massage helps greatly with flatulence and colic. To carry it out, the child is placed on his back and the tummy is massaged in a clockwise direction with light stroking and a gradual increase in pressure. Performing this massage for 5 minutes will help relieve spasms and relax the muscles.

In addition to massage, applying a warm diaper or heating pad to the epigastric area will help relieve the pain of colic. In this case, the drugs used are “Espumizan”, “Bobotik” or “Plantex”.

Parenteral dyspepsia is eliminated by excluding the associated disease.

Conclusion

Thus, dyspepsia always requires a careful assessment of the risk of the child's further condition. With the development of serious painful symptoms, especially in infants, immediate therapeutic measures are indicated. A simple and effective method for timely recognition of problems dangerous to a child’s health is to contact a specialist in a timely manner.

More often observed in infants. The main prerequisites for their occurrence are functional and morphological immaturity, imperfection of regulatory mechanisms, and insufficient enzymatic activity of gastric and intestinal juices. Artificial feeding and early introduction of complementary foods into the diet, reducing the reactivity of the child’s body contribute to the development of these diseases or cause quantitative and qualitative deviations in the baby’s nutrition; non-compliance with the infant's feeding regimen, poor care for him, acute infectious and non-infectious diseases. All this leads to disruption of complete digestion and absorption, resulting in indigestion (dyspepsia). There are three forms of dyspepsia: simple, toxic and parenteral (as such diseases are not registered).

Simple dyspepsia

Simple dyspepsia is an acute digestive disorder, manifested by stool and metabolic disorders. The general condition of the child does not change, the need for nutrition does not decrease.

Pathogenesis of simple dyspepsia

Functional disorders of the stomach and intestines, digestive disorders, colonization of the small intestine with colonic microbial flora.

Clinical manifestations of simple dyspepsia

Vomiting is not typical, maybe 1-2 times a day, stools - 6-8 times, watery. In healthy children, bowel movements occur 1-3 times a day; stool has a jelly-like consistency, is yellow in color, has a sour odor, and contains a small amount of mucus mixed with it. With dyspepsia, stool takes on the appearance of chopped eggs, is liquid, yellowish or greenish in color, and contains white lumps, which are calcareous and magnesium soaps of fatty acids. Sometimes threads of transparent glassy mucus are observed in it. Appetite is reduced, the child is restless. The tongue is dry, there is bloating and rumbling in the abdomen, and the discharge of smelly gas. The skin is pale pink, body temperature is normal, sometimes low-grade. Blood tests reveal a tendency towards acidosis, a decrease in the alkaline reserve, the level of potassium, sodium, and calcium.

Treatment of simple dyspepsia

Water-tea break for 6-8 hours (150 - 170 ml/kg body weight per day). Gastric lavage with 1% sodium bicarbonate solution. After this, the child needs to be given 1 teaspoon of castor oil, rinse the intestines with boiled water (37-38 ° C) or a solution of 3-5% starch. They give salt solutions to drink (isotonic sodium chloride solution, Ringer-Locke, Darrow solutions), 5-10% glucose solution, dill water, infusion of St. John's wort, chamomile flowers, boiled water, tea. After the water-tea break, the amount of food is reduced by 1/3 - 1/2 compared to the norm. Enzymes (gastric juice - 1/2-1 teaspoon 15 minutes before going, 3-4 times a day; abomin - 1/3 tablet 2-3 times with meals; festal - 1/4 tablet 2-3 times during meals) is prescribed for 5-7 days. For flatulence, dill water, infusions of chamomile flowers, St. John's wort, and caraway are recommended.

Toxic dyspepsia

Toxic dyspepsia is a severe form of digestive disorders, accompanied by changes in all types of metabolism, dysfunction of various systems and organs. This disease is often a further development of simple dyspepsia as a result of the action of unfavorable exogenous and endogenous factors or improperly administered therapy, but it can also occur independently. In the first stages of digestive disturbances, more pronounced than with simple dyspepsia, the amount of incomplete decomposition products that accumulate in the body is higher. Thus, conditions are created for the penetration of microbial flora into the upper parts of the small intestine and even into the stomach, where it participates in the bacterial breakdown of food. Many aphysiological products are formed, which sharply irritate the mucous membrane of the digestive tract and penetrate through it into the blood. Frequent bowel movements and vomiting lead to significant loss of fluid and electrolytes, resulting in dehydration. Hemodynamics are disrupted, which is especially pronounced at the level of capillaries. Metabolic acidosis develops.

Toxic dyspepsia clinics

Toxic dyspepsia is manifested by persistent vomiting, which is observed not only after eating, but drinking and on an empty stomach. Stools are frequent - up to 10-20 times a day, at first liquid, foamy, watery and due to the presence of gases emitted in a stream. Body temperature often rises to 39-40 ° C, but not for long (1-3 days). In 1-3 days, the patient’s body weight can decrease by 0.5-1.5 kg. As a result of vomiting and diarrhea, exicosis develops: the skin is pale, dry, with a yellowish tint, loses elasticity, wrinkles are easily formed and poorly smoothed out, the fontanelle sinks; facial features become sharpened, eyes are sunken, eyes are dull, mucous membranes are dry and red; other “injections of scleral vessels, sometimes cracks, sclerema of the skin and subcutaneous tissue on the back, buttocks, and limbs are noted.

At the onset of the disease, the nervous system reacts with excitement, and as toxicosis increases, an inhibition phase begins (lethargy, adynamia, loss of interest in the environment, stereotypical movements, catatonia). The face is like a mask, the gaze seems to stop, directed at one point; there is no reaction to painful stimuli (injections), there are no tendon and corneal reflexes. Convulsions appear.

With toxic dyspepsia, varying degrees of changes in the cardiovascular system are observed, blood circulation is impaired. Due to spasm of the capillaries, the skin becomes pale, then (when stasis develops) cyanotic, with a marbled tint or dark red spots on the back of the body and limbs. The pulse quickens, its filling worsens; Muffled heart sounds and systolic murmur appear. Blood pressure is initially normal or elevated, then decreases sharply. Pulmonary emphysema develops; breathing quickens, it is loud, deep, without pauses (the breathing of a “hunted animal”). The abdomen is swollen, the liver is enlarged, its functions are impaired. Less commonly, the spleen enlarges. Changes in the urinary system are characterized by oliguria, proteinuria up to 1%; Acetone, traces of sugar, and single red blood cells may appear. The results of a general blood test indicate thickening of the blood, an increase in the amount of hemoglobin, red blood cells, leukocytes, and an increase in hematocrit. As a rule, toxic dyspepsia is accompanied by dehydration. Isotonic type, flooding is characterized by a uniform loss of water and salts, a moderate decrease in body weight (not exceeding 5%), moderate severity of the disease, agitation or lethargy in behavior, tachycardia, muffled heart sounds, normal or elevated blood pressure, decreased appetite and diuresis.

For water deficiency type of dehydration Characterized by hyperthermia, agitation, and thirst. In this case, the loss of water is greater than that of electrolytes, and therefore hypernatremia and cellular dehydration occur. Patients are restless, excited; consciousness is impaired; Tonic convulsions may occur. Sharply expressed clinical manifestations of exicosis: dryness of the mucous membranes and sclera, retraction of the large fontanelle, decreased salivation, diuresis, sweating; expressive phenomena of blood coagulation. Tachycardia, weak pulse, weakened heart sounds, and increased blood pressure occur. Loss of body weight reaches 10% of the original. Hydrophilic test accelerated.

The course of dehydration and salt deficiency is severe, in which there is a loss of electrolytes with the development of extracellular dehydration and hyponatremia. The decrease in body weight reaches 15%, so exicosis is especially pronounced. The skin is pale, dry, its turgor is reduced. Sometimes sclerema develops, the large fontanelle and eyeballs sink in, and facial features become sharpened, becoming similar to a mask. The voice becomes hoarse or disappears (aphonia), the child cries without tears. Thirst is insignificant or absent, sweating and salivation are not reduced. Stupor or coma, muscle hypotension, intestinal paresis develop; tendon reflexes are reduced or absent. With this type of dehydration, hemodynamic disorders more often occur: cyanotic skin tone, rapid pulse, weak filling, weakened heart sounds, reduced blood pressure. Salt deficiency exicosis is characterized by acute renal failure (oliguria, anuria), pronounced blood coagulation (hematocrit increases to 60-70% instead of 35-40% as normal), hypoproteinemia, hypoalbuminemia, hypergammaglobulinemia.

With toxic syndrome, hypokalemia sometimes develops, which is characterized by the following clinical manifestations: depression, indifference, persistent depression, muscle hypotension to paresis and paralysis, decreased reflexes; heart failure, expansion of the borders of the heart, rapid pulse, low blood pressure; prolongation of the Q-T interval, decreased S-T segment, flat, wide T wave on the ECG; intestinal paresis to paralytic obstruction; often increased breathing, impaired renal concentration function.

Treatment of toxic dyspepsia

Treatment is carried out in a hospital. The child’s body weight is monitored daily and records of liquids and food taken by her are kept. Diet therapy consists of prescribing a water-tea break (for 10-18 hours), dosed feeding with expressed breast milk, and in its absence, with “Malyutka” and “Vitalakt” mixtures. The liquid should be administered through the mouth, in case of vomiting - in drops, cooled to room temperature. After a water-tea break, the child is given expressed breast milk - first 10 ml, increasing by 10 ml daily and feedings at intervals of 2 hours. With a food volume of 60 - 80 ml, the intervals between meals are increased to 2.5 - C hours. Rehydration therapy consists of intravenous drip administration of fluids (10% glucose solution, plasma, rheopolyglucin, polyglucin, etc.). The volume of fluid to compensate for dehydration depends on the degree and amounts to 5-15%, respectively, to a decrease in body weight. Different solutions are prescribed in different ratios depending on the type of dehydration: for the isotonic type - 1:1 (isotonic sodium chloride solution or Ringer-Locke solution and 10% glucose solution), for water deficiency - 1 part of saline solutions and 2-3 parts of glucose solution . Children with salt deficiency type of dehydration are given 4 parts of saline solution, 2 parts of glucose solution and 1 part of 1.3% sodium bicarbonate solution.

The clinical manifestation of hypokalemia is an indication for the administration of potassium preparations into a vein. For intestinal paresis, solutions of proserin or pituitrin are prescribed. Suppression of the function of the adrenal cortex gives rise to the use of hormones (hydrocortisone, prednisolone, etc.). Sometimes they resort to parenteral feeding (prolonged vomiting, refusal to eat, sudden loss of body weight). Amino acids and energy preparations (from carbohydrates and fats) are recommended.

Parenteral dyspepsia

Parenteral dyspepsia is not an independent disease; it is caused by acute respiratory infection, pneumonia, otitis, and pyelonephritis. In young children, it can occur as a reaction of the body to an illness. During a disease in which parenteral dyspepsia develops, toxic substances are formed in the intestines that negatively affect the mucous membrane. As a result, the enzymatic activity of gastric juice decreases, which, in turn, disrupts intracavitary and parietal digestion.

The average medical worker must remember that the occurrence of dyspeptic symptoms against the background of another disease complicates the child’s condition and it requires even more diligent care and treatment. The so-called psrichidpa dyspepsia of newborns is a reaction of the body’s irrigtosuppressive mechanisms to new nutritional conditions (placental changes to oral) and the penetration of microbial flora in sterile intestines. It is characterized by frequent bowel movements without symptoms of toxicosis. Sometimes there is some bloating of the abdomen, which, apparently, explains some of the child's anxiety, but this condition does not require treatment.

Acute digestive disorders are a common pathology in young children. Usually this is accompanied by diarrhea (diarrhea), which lasts no more than 5-8 days and may be accompanied by loss of fluid and electrolytes, and malnutrition. The occurrence of acute digestive disorders in a child at an early age is predisposed by the functioning of the gastrointestinal tract, such as a decrease in the mucus-forming function of the intestine, the content of secretory Ig A, a low supply of transport systems that regulate the reabsorption of sodium and chlorine, the child’s physiological mood for overhydration, low barrier intestinal function, reduced detoxification function of the liver.

The cause of acute gastrointestinal disorders in most cases is a bacterial or viral infection. The bacteria can cause diarrhea due to the secretion of an exotoxin when they enter the intestinal mucosa. Depending on whether or not the pathogen has penetrated the mucous membrane, the infection can be invasive (Shigella and Salmonella) or non-invasive (some strains of Colibacillus and Vibrio cholera). The cause of the disease can also be opportunistic microorganisms (staphylococcus), which in low concentrations are part of the normal microflora of the colon of a healthy child. In 70% of cases, rotaviruses are the causative agents of diarrhea. The cause of acute digestive disorders may be an incorrect diet (overfeeding, unbalanced diet) or food intolerance. In the latter case, the disease becomes chronic. Usually, with acute viral gastroenteritis, complete restoration of the intestinal epithelium occurs 7-10 days after the end of virus excretion, although in children under one year of age this process can take up to 6-12 weeks.

Currently, disturbances in the absorption and secretory functions of the digestive tract that occur during acute diarrhea have been quite well studied. It is known that four main mechanisms are important in the pathogenesis of diarrhea: intestinal hypersecretion, increased osmotic pressure in the intestinal cavity, impaired transit of intestinal contents and intestinal hyperexudation, which leads to loss of water and salts. This is often accompanied by impaired fat absorption, inhibition of lactase synthesis and the development of secondary lactase deficiency.

The severity of clinical manifestations in acute digestive disorders depends on the etiology of the disease. In the absence of timely treatment, dehydration develops, which determines the severity of the disease. Therefore, in the treatment of acute diarrhea in young children, the main attention should be paid to the fight against dehydration and therapeutic nutrition. The main objectives of diet therapy for acute diarrhea are to replenish fluid loss, replace the loss of electrolytes, reduce the intake of lactose and fats into the body, ensure the body's energy needs, prevent metabolic disorders associated with malnutrition and protein catabolism in the child's body. Previously practiced long-term restrictions in the diet of a sick child, fasting diets during illness are now considered inappropriate. Observations show that children endure long-term food restrictions much more difficult than adults, since the growing child’s body experiences a higher need for basic nutrients than the mature body of an adult. In a child, all metabolic processes occur with great tension, which requires significant energy consumption. In addition, it is noted that during illness these processes are often activated. Therefore, in case of acute intestinal infections, long-term quantitative and qualitative restrictions in the nutrition of a young child are inappropriate. This approach is possible only at the very beginning of the disease, after which in a fairly short time (usually within 1-4 days) it is necessary to switch to a nutritious diet appropriate to the age and physical development of the child.

Considering the fact that the absorption of breast milk in acute diarrhea is rarely impaired (only in 4% of patients), breastfed children should continue to be breastfed, while maintaining the physiological rhythm of feeding 6-7 times a day (depending on age ). On the first day, depending on the baby’s appetite, the amount of food can be reduced by no more than 50-75% of the age-appropriate amount of food, and then within 2-3 days it should be increased to the age norm. Alternating between taking rehydration solutions and breastfeeding usually reduces stool frequency and improves stool consistency.

For children who are bottle-fed, a fasting diet is prescribed for 6-8 hours. At this time, highly specialized rice-based products can be used: water and salt balance restorer, BIO-rice broth, carrot-rice broth ORS-200 (HiPP, Austria). Subsequently, the child is given milk formula in half the volume of the usual portion, followed by restoration to normal. A special therapeutic mixture for acute intestinal disorders is Humana LP (Humana, Germany), which contains dietary fiber from bananas, which has a high ability to bind excess water in the intestines and helps reduce fluid loss during diarrhea. When passing through the intestines, dietary fiber forms a fibrous or amorphous matrix of a “molecular sieve” type, the physicochemical properties of which determine the ability to retain water, cation exchange and adsorption properties, and sensitivity to bacterial fermentation in the colon. The presence of hydroxyl and carboxyl groups in dietary fibers contributes, in addition to hydration, to ion-exchange swelling. Degradation of dietary fiber occurs under the influence of intestinal microflora. Pectin and most of the hemicelluloses that make up banana dietary fiber are completely destroyed, lignin and, to a lesser extent, cellulose are resistant to bacterial attack and pass into feces. The predominant anaerobic bacteria in the colon are saccharolytics and are capable of digesting many types of non-starch polysaccharides. During fermentation, the most important products are released - short-chain fatty acids: monocarboxylic (acetic, propionic, butyric, etc.), dicarboxylic (succinic), hydroxy acids (lactic), amino acids. Short fatty acids and other metabolites of dietary banana fibers have a number of positive local and systemic effects on the macroorganism: supply of substrates for lipo- and neoglucogenesis, maintenance of ion exchange, antibacterial effect, activation of local immunity and blocking the adhesion of pathogens, maintenance and differentiation of the epithelium, and much more. etc. It is important to note that this mixture does not contain lactose, which is of particular importance in the development of secondary lactase deficiency. Since fat absorption is impaired in acute intestinal infections, the fat content in the Humana LP mixture is low and is represented mainly by easily digestible polyunsaturated fatty acids and triglycerides with medium-chain fatty acid residues. Gluten is not included in the mixture, since its early administration to children with intestinal infection contributes to the clinical manifestation of celiac disease in the presence of a predisposition to this disease. The high protein content in the Humana LP mixture reduces the degree of intestinal disorders and ensures the normal course of recovery processes in the body during the recovery period after an infectious disease.

For acute diarrhea, children can also be given fermented milk mixtures. The ability of these products to stimulate the immune response in infants, as well as the bactericidal effect of lactic acid, underlie the therapeutic effect of fermented milk mixtures for intestinal infections. As for the stimulating effect of these products on the immune response, its mechanism obviously includes activation of the production of immune response regulators, in particular interleukins and interferon g, in combination with an increase in the local response of enterocytes. Along with anti-infective and probiotic effects, fermented milk products have a beneficial effect on intestinal motility. Undoubtedly, the advantages of fermented milk products are also the high digestibility of milk protein and the reduced level of lactose associated with the partial breakdown of these substances under the influence of lactic acid microorganisms during the fermentation process. For acute intestinal infections in young children, fermented milk products such as Acidolact, Agu-1, Agu-2, Adalakt, BIFI kefir, Bifilin, Biolact with lysozyme, Bifilin-M, Biokefir, Narine can be used.

As digestion is restored and the activity of the gastrointestinal tract normalizes, they gradually return to the child’s normal feeding regimen. For children under 3-4 months of age with diarrhea of ​​infectious origin, in order to prevent food allergies to cow's milk proteins, hypoallergenic mixtures with a low degree of hydrolysis are recommended: Humana GA-1 (Humana, Germany), HiPP-GA-1 (HiPP, Austria ), Friesopep-1 (Friesland Newtrition, the Netherlands). This cautious approach is determined by the risk of an allergy to cow's milk proteins associated with damage to the intestinal mucosa. Given this danger, products containing protein hydrolysates are prescribed for up to 2-3 weeks, even if the disease was mild. If the course of diarrhea was severe, formulas based on partially hydrolyzed proteins continue to be given to the child until 4-5 months of age, after which they switch to feeding formulas of the second age group: Samper Baby 2, Humana 2, Humana Baby Fit, Frisomel, Enfamil 2. If a child has an allergy to cow's milk and soy proteins, dietary foods containing highly hydrolyzed proteins are introduced into the diet: Alfare (Nestlé), Pepti Junior (Nutrizia), Tutteli Peptidi (Valio).

Lactose-free formulas are recommended for children aged 3 to 6 months, even if the diarrhea is mild. In these cases, you can use mixtures of Frisosoy (Friesland Nutrition, the Netherlands), Humana LP (Humana), AL 110 (Nestlé), Nutrilon low-lactose (Nutritsia), Soya-Sam (Samper). Children over 7 months are prescribed low-lactose milk Nutritek (Russia). For mild cases of lactase deficiency, it is possible to use fermented milk mixtures. For children with secondary lactase deficiency, low-lactose nutrition is indicated for 3-4 months. The criteria for the effectiveness of the therapy are the elimination of clinical manifestations, including normalization of stool character and stable weight gain. After this, a gradual expansion of the diet is possible. In children over 6 months of age, precautions regarding the use of medicinal mixtures remain relevant, but to a lesser extent.

After complete rehydration and restoration of appetite, the child should be given well-cooked, pureed, easily digestible food: rice, cereals, very ripe bananas (fresh or boiled, whole or chopped in a mixer), potatoes, apples (fresh grated or baked), fruit puree in jars (apple, banana, pear). It is necessary to return to a balanced diet as soon as possible.

Literature

1. Ardatskaya M. D. Metabolic effects of dietary fiber, Russian Journal of GGC, No. 4. volume 11, pp. 91-102.
2. Feeding children in the first year of life. A manual for doctors and students of pediatric faculties of medical universities; Ed. Samsygina G. A. M., 2001. P. 67.
3. Kon I. Ya. Specialized medical nutrition products: characteristics and use in young children // Children's Doctor. 2000. No. 3. P. 43-47.
4. Kuvaeva I. B., Ladodo K. S. Microecological and immune disorders in children. M.: Medicine, 1991. P. 270.
5. Specialized food products for children with various pathologies. Catalog; Ed. Ladodo K. S., Sazhikova G. Yu. (ed.). M., 2000. 200 p.
6. Shenderov B. A. Medical microbial ecology and functional nutrition. M., 1998. P. 285.
7. Brown K. H. et al. Use of the non-human milk in the dietary management of young children with acute diarrhea: a metaanalysis of clinical trials//Pediatrics. 1994. Vol. 94. P. 17-26.
8. Snyder J. D., Molla A. M., Cash R. A. Home-based therapy for diarrhea//J. Pediatr. Gastroenterol. Nutr. 1990. No. 11. P. 438-447.

Diseases of the digestive system and nutritional disorders occupy one of the first places in frequency among all diseases of early childhood, especially in the 1st year of life. The frequency, as well as the severity of the lesion, is determined by the anatomical and physiological characteristics of the gastrointestinal tract, nervous system, and metabolic state in young children.

It should, however, be borne in mind that with proper feeding and care of the child, and favorable environmental conditions, these diseases in young children are extremely rare.

The term “nutrition” should be considered as a physiological concept, which includes a set of processes occurring in the body that lead to the construction of new tissues and support basic metabolism: food intake, digestion, absorption from the intestines, cellular and tissue metabolism (assimilation and dissimilation) . Violation of one of these processes entails an eating disorder.

Proper nutrition is especially important in early childhood due to increased growth, which is a biological feature of this age period.

Eating disorders can occur acutely with acute digestive disorders and are referred to as dyspepsia - diseases similar in their main symptom - acute diarrhea. In other cases, nutritional disorders develop gradually, depending on a number of endogenous and exogenous factors; they are called chronic nutritional disorders, or malnutrition.

Diseases of the gastrointestinal tract are a common pathology, especially in young children. Their prevalence in our country has been significantly reduced thanks to the introduction of rational nutrition and other preventive measures into practice.

At the VIII All-Union Congress of Children's Doctors (1962), a classification of diseases of the gastrointestinal tract in young children was adopted, which has found wide application.

CLASSIFICATION OF GASTROINTESTINAL DISEASES OF EARLY CHILDREN

I. Diseases of functional origin

A. Dyspepsia

1. Simple dyspepsia

2. Toxic dyspepsia

3. Parenteral dyspepsia (not registered as an independent disease) B. Dyskinesia and dysfunction

1. Pylorospasm

2. Atony of various parts of the stomach and intestines

3. Spastic constipation

4. Partial ileus

II. Diseases of infectious origin

1. Bacillary dysentery

2. Amoebic (amebiasis) dysentery

3. Salmonella

4. Intestinal co.chi infection

5. Intestinal form of staphylococcal, enterococcal and fungal infections

6. Viral diarrhea

7. Intestinal infection of unknown etiology

III. Malformations of the gastrointestinal tract

1. Pyloric stenosis, megaduodenum, megacolon

2. Atresia (esophagus, intestines, anus)

3. Diverticula and other malformations

Let us first focus on functional diseases.

Currently, dyspepsia (literal translation - indigestion) is much less common compared to the 30-50s, which is mainly due to advances in the field of feeding children. Most often, these diseases are observed in children 1 year of life, especially before 6 months of age.

The gastrointestinal tract of a young child is subject to great demands due to intensive growth and development. Per 1 kg of weight, a child receives relatively more food than an adult, and this causes high tension in the digestive system when the development of functional abilities is not yet complete. In addition, it must be taken into account that the metabolism of a young child is extremely labile. That is why nutritional factors play a big role in the occurrence of dyspepsia in infants.

During breastfeeding, dyspepsia develops much less frequently than during mixed and artificial feeding.

There are two main forms of acute dyspepsia: simple and toxic.

Simple dyspepsia

Simple dyspepsia (indigestion) most often develops with: 1) disordered feeding, non-compliance with the intervals between feedings; 2) inappropriate feeding - non-compliance with the correlative relationships between proteins, fats, carbohydrates when introducing complementary foods; 3) insufficient content of vitamins in food; 4) non-compliance with the water regime, especially in the hot season; 5) overheating and inappropriate clothing of the child for the high ambient temperature. All of these disorders are much more common with mixed and artificial feeding.

Clinic. The general condition of the child is little affected. In rare cases, low-grade fever is observed. At the beginning of the disease, regurgitation appears, and then there may be vomiting 1-2 times a day. These are protective reactions due to which some of the excess or insufficiently digested food is removed from the stomach. Stools become more frequent up to 6-8 times a day, sometimes more, it is liquid, yellowish or greenish in color with white lumps (calcareous salts, fatty acids, bacteria), with mucus in the form of transparent, glassy threads, an acidic reaction.

Abdominal bloating is observed due to flatulence, accompanied by the release of gases with an unpleasant odor. The child may be restless due to pain due to intestinal colic. The tongue is dry, covered with a white coating.

There is a slight decrease in body weight. The duration of the disease is 5-7 days, there are usually no complications. The course of simple dyspepsia depends mainly on timely and correctly administered treatment, and on the possibility of eliminating unfavorable environmental factors.

Treatment. A fasting break is prescribed in order to create functional rest in the gastrointestinal tract and eliminate the substrate for bacterial decomposition of food. For 6-8 hours, the child receives only liquids at the rate of 150-170 ml/kg per day. They give weak tea, rice water, sweetened water, 5% glucose solution, rosehip infusion, vegetable decoctions, isotonic sodium chloride solution and Ringer's solution. Drinks are given in small portions to avoid vomiting. After fasting, breastfeeding is prescribed with some limitation in the duration (7-10 minutes) of each feeding for 2-3 days. The missing amount of food is replenished by drinking. When artificially feeding children, especially those under 6 months of age, it is necessary to provide expressed breast milk. Only in the complete absence of human milk are sour formulas (VRMK, B-kefir) prescribed. In the first 2 days, give approximately half, and then ^3 of the usual amount

food for each feeding and the total volume is supplemented by the introduction of drink.

In the future, the amount of food is increased daily, taking into account the general condition of the child. After normalization of stool and appetite, they switch to age-appropriate food. Complementary foods are also introduced in small portions.

Among medications, vitamins of group B and C are prescribed, a solution of hydrochloric acid with pepsin (Acidi hydrochlorici diluti 1 ml, Pepsini 1.5, Aq. destill. 100 ml) 1 teaspoon 3 times a day before meals or gastric juice (Succus gastrici naturalis ) no "/2 teaspoon, dissolved in 5-10" ml of water, 3 times a day before meals. At the same time, concomitant diseases such as rickets, malnutrition, etc. are treated. It is also necessary to eliminate defects in care that contributed to the disease.

In the absence of parenteral foci of infection (otitis media, pneumonia, stomatitis), antibiotics or sulfa drugs should not be prescribed.

Toxic dyspepsia

Toxic dyspepsia, like simple dyspepsia, is caused in most cases by nutritional disorders and is a functional disease. However, there is a significant difference between simple and toxic dyspepsia: with simple dyspepsia, the functional activity of the gastrointestinal tract is disrupted, the general condition is disturbed relatively little, with toxic dyspepsia the whole body suffers, the nervous system is involved in the pathological process, metabolism is deeply disturbed - a “metabolic catastrophe” develops "

Toxic dyspepsia can develop from simple dyspepsia under the influence of a number of exogenous and endogenous factors (too short hunger break, too quick transition to regular food, insufficient fluid supply, irrational feeding, overheating, care errors, etc.). At the same time, some pediatricians believe that toxic dyspepsia (toxic syndrome) can occur with any disease in response to exposure to microbial toxins or non-physiological products of food decomposition.

Clinic. The clinical picture of toxic dyspepsia is similar to the manifestations of toxic syndrome that occurs with any intestinal infection in young children. The general condition of patients with toxic dyspepsia is always severe. Vomiting becomes frequent and uncontrollable, even from a spoonful of water. The stool is also frequent, watery, with a large radius of wetting the diaper, and does not contain feces. Symptoms of toxicosis and exicosis develop quickly and simultaneously

(dehydration). Initial excitement gives way to lethargy, adynamia, at times there is a blackout or loss of consciousness, stereotypical movements of the tongue and hands appear, a “conductor” or “fencer” pose appears, a mask-like appearance of the face, a stopped gaze directed into the distance, and rare blinking are noted. The conjunctival reflex and pupillary reaction to light weaken and fade away. Tendon and skin reflexes also weaken. The pallor of the skin due to spasm is replaced by cyanotic marbling (stasis) or purple spots on the back surface of the body and limbs. The pulse is frequent, weak, and sometimes difficult to determine. Heart sounds are significantly muffled, especially the first sound at the apex.

The breathing at the beginning is rapid, shallow, then becomes deep, without pauses (the breathing of a “hunted animal”).

Along with the manifestations of toxicosis, signs of dehydration of the child’s body appear. A decrease in body weight in 1-2 days can reach 500-800 g or even more. There is a drop in tissue turgor, the skin becomes dry and gathers into poorly straightened folds. Facial features are pointed. The large fontanelle is sunken, the eyes are sunken. Some pastiness and sclerema may be observed, especially on the extremities, which is an indicator of a deep metabolic and trophic disorder. The mucous membrane of the oral cavity becomes brightly colored, the sclera becomes dry.

With toxic dyspepsia, body temperature may rise to 38-39°C due to intoxication and dehydration of the body. However, usually the increase in temperature is short-lived (2-4 days); if it drags on, then you should think about infection.

Diuresis decreases sharply, and sometimes anuria may occur. Albuminuria (up to 1 g/l), cylindruria, and sometimes glucosuria are noted in the urine.

Blood thickening develops: the amount of hemoglobin, red blood cells, and white blood cells increases; ESR is usually low - 1-2 mm/h.

The course of toxic dyspepsia depends on the condition of the child’s body and on the timeliness of rational treatment. With proper treatment, toxicosis and exicosis are eliminated within 3-4 days from the start of treatment, complete recovery occurs in 2-3 weeks.

If a 24-hour fast-water break with daily fluid requirements does not lead to detoxification and if an elevated body temperature persists for several days, then you should think about intestinal infections (coliform infection, salmonellosis, etc.).

In addition, with toxic dyspepsia there is usually a parallelism between the degree of toxicosis and exicosis, with intestinal

In other infections, such parallelism is not observed; either toxicosis or exicosis prevails.

In previous years, the mortality rate for toxic dyspepsia was very high; currently, with timely hospitalization of a sick child and with timely, complete treatment, mortality is calculated in tenths of a percent.

Treatment. For toxic dyspepsia, treatment is carried out in a hospital. The fight against dehydration (rehydration) and toxicosis is carried out according to the general principles of treatment of toxic syndrome (see, “Dysentery and coli-infection”).

A fasting-water break is prescribed for 12-20 hours, and sometimes longer. Its duration depends on the severity of toxicosis and the child’s nutritional status. The principles of its implementation are the same as for simple dyspepsia, only liquids are given in teaspoons of 5-10 ml every 5-10 minutes. After a fast-water break, dosed feeding is prescribed. On the 1st day, the baby receives 100 ml of expressed human milk - 10 ml (two teaspoons) every 2 hours, a total of 10 times a day. The missing amount of food is replenished according to age by introducing fluids and infusions. When vomiting stops, already from the 2nd day of treatment, the child can be given vegetable decoctions (from cabbage, carrots, potatoes): they are rich in mineral salts, alkalis, microelements, have a pleasant taste and enhance the secretion of gastric juice. The amount of human milk is increased by 100-200 ml per day, and the volume of injected fluid is reduced accordingly. By the 3-5th day, the child should receive up to 500 ml of food. From this time, they begin to put him to the breast for a few minutes 1-2 times a day. When a single dose of food is increased to 50-60 ml, the intervals between meals are increased to 2"/2, and then to 3 and 3"/2 hours. Gradually, the child is transferred to a nutritious diet appropriate for his age.

If the child is bottle-fed, then it is necessary to provide him with donor milk, and only in its absence use acidic formulas. They are given in the same quantities and in the same sequence as expressed human milk.

Pylorospasm, pyloric stenosis

Pylorospasm refers to dyskinesia and develops in connection with spasms of the pyloric muscles. It is believed that this is due to the abundant supply of nerves to the pyloric part of the stomach.

Clinic. From the first days, frequent but mild vomiting appears. The amount of milk released during vomiting is less than the amount sucked by the child at the last feeding. On some days there may be no vomiting. The child becomes restless at times. The body weight curve flattens, gradually

hypotrophy gradually develops, constipation appears. The disease must be differentiated from pyloric stenosis.

Treatment. Reduce the amount of human milk per feeding and increase the frequency of feeding to 8-10 times a day. It is recommended to give a small amount (1-2 teaspoons) of 8-10% semolina porridge before feeding 2-3 times a day. The mother's food must be enriched with vitamins, especially group B. Vitamin b] is given to the child 0.005 g orally 2-3 times a day or administered intramuscularly (0.5-1 ml of a 2.5% solution once a day). Atropine is prescribed at a dilution of 1: 1000 (1-2 drops 4 times a day) or chlorpromazine (3-4 drops of a 2.5% solution per 1 kg of body weight per day in 3 divided doses). It is recommended to apply a patch of mustard plaster to the stomach area before feeding. To combat dehydration, saline solutions and 5% glucose solution are administered parenterally.

Pyloric stenosis- malformation of the gastrointestinal tract. The disease occurs predominantly in boys. The muscular layer of the pylorus is thickened, has a dense, cartilaginous consistency, and the lumen is narrowed.

Clinic. The disease develops gradually. Regurgitation, which appears in a child at the age of 2-3 weeks, turns into profuse vomiting in a fountain. In this case, the amount of vomit exceeds the amount of food taken before. Prolonged repeated vomiting leads to exhaustion and dehydration of the child's body. One of the striking symptoms is peristalsis of the stomach with its acquisition of an hourglass shape, which is visible when feeding a child or upon superficial palpation of the abdomen. A sick child experiences rare urination, constipation, and may experience dyspeptic, “hungry” stools. This condition should first of all be differentiated from pylorospasm.

Pylorospasm

1. Vomiting from birth

2. The frequency of vomiting varies from day to day.

3. The amount of milk released during vomiting is less than the amount of milk sucked

4. Constipation, but sometimes stool on its own

5. The number of urinations is reduced (about 10)

6. Skin is not very pale

7. The child is loud

8. Body weight does not change or decreases moderately

9. Body weight at admission is greater than at birth

Pyloric stenosis

1. Vomiting from 2-3 weeks of pregnancy

2. Frequency of vomiting is more constant

3. The amount of milk released during vomiting is greater than the amount of milk sucked

4. Constipation is almost always severe

5. The number of urinations is sharply reduced (about 6)

6. Severe pale skin

7. The child is calm

8. A sharp decrease in body weight

9. Body weight on admission is less than at birth

The diagnosis of pyloric stenosis is confirmed by x-ray examination. Barium gruel introduced into the stomach during pylorospasm ends up in the intestine after 4-5 hours, while with pyloric stenosis, barium remains in the stomach for 24 hours or longer, unless excreted through vomiting.

Treatment of pyloric stenosis is usually surgical.

In the complex treatment of toxic dyspepsia, careful individual care for the child is of great importance: wide access to fresh air, careful care of the skin and mucous membranes, moisturizing the sclera of the eyes by instilling sterile oil, clean linen, care items, etc.

When a child is removed from a state of toxicosis, enzymes (pepsin with hydrochloric acid, pancreatin), vitamins of the group are used to increase the body's resistance IN, apilak, etc.

Hypotrophy

The concept of “chronic eating disorders” or “dystrophy” includes pathological conditions characterized by either excess or decreased body weight compared to normal. The first forms are called “paratrophy”. The second forms, which are more common, are combined under the name “hypotrophy”; they are characterized by weight loss, decreased food tolerance and decreased immunity.

Hypotrophies are typical for young children (up to 2 years of age); in older children they occur only under extremely unfavorable conditions.

Children with malnutrition are especially susceptible to diseases. Quite often, malnutrition is the background against which all infectious and inflammatory processes occur more severely.

With an increase in the material and cultural level of the population, the implementation of systematic medical control over the feeding and development of children in the first years of life, and the organization of a wide network of dairy kitchens, the incidence of malnutrition among young children has significantly decreased. Currently, children with severe forms of malnutrition (grade III) are very rare, but mild and moderate malnutrition (grades I and II) continue to be common diseases among young children.

The causes of malnutrition in young children are numerous and varied; they can be divided into the following groups: 1) nutritional; 2) infectious; 3) related to unfavorable environmental conditions.

In previous years, defects in child feeding played a leading role in the etiology of malnutrition.

The most important among the nutritional causes of malnutrition is malnutrition when the correct ratio is violated

individual ingredients in food. Insufficient intake of proteins, fats, carbohydrates, mineral salts, and vitamins can lead to the development of malnutrition. The most important is protein deficiency, which adversely affects the growth and development of the body, leads to profound changes in metabolism, and causes disruption of the enzymatic functions of the liver and other organs.

Deficiency of vitamins (A, C, group B, etc.) can cause malnutrition, since they are regulators of all life processes; Their close connection with hormones and enzymes has been established.

Nutritional deficiencies can be of a different nature, but the cause of malnutrition during breastfeeding is most often malnutrition or partial starvation, which can occur when the mother has insufficient milk due to temporary or permanent hypogalactia. Sometimes a child receives an insufficient amount of milk either as a result of developmental defects (pyloric stenosis, cleft palate, cleft lip, congenital heart disease, Hirschsprung's disease, etc.), or as a result of defects in the mother's mammary gland (flat, inverted, cleft nipple , tight chest, etc.).

Less often, during breastfeeding, deviations of a qualitative nature can be observed, when the amount of mother's milk is sufficient, but it is defective in its composition, mainly in terms of fat and protein content.

In addition to malnutrition, indiscriminate feeding, early complementary feeding without medical indications, errors in feeding technique, etc. play a role in the occurrence of malnutrition.

Much more often, feeding defects (quantitative and qualitative) play an etiological role in the development of malnutrition in children who are mixed and mainly bottle-fed. Hypotrophy in such children most often develops with monotonous and long-term feeding of cow's milk and flour products. Hypotrophy can also occur in children receiving highly low-fat foods for a long time.

All nutritional factors are very significant in the development of malnutrition in the first half of life, but their role is also significant in the child’s future life.

Currently, thanks to the widespread implementation of preventive measures, chronic nutritional disorders of alimentary etiology are much less common. In recent years, the infectious factor has begun to play a major role in the development of this pathology in young children. Of greatest importance in the occurrence of malnutrition are frequently recurring acute respiratory infections and influenza, which often lead to complications in the lungs, ears and kidneys.

The constant presence of purulent foci in the child’s body leads to disruption of metabolic processes.

Hypotrophy very often develops in children due to infectious gastrointestinal diseases, especially chronic dysentery and coli infection.

The direct cause of malnutrition in children can be congenital enteropathies of various types, in particular cystic fibrosis of the pancreas, celiac disease, and tuberculosis.

The infectious factor plays a big role in the occurrence of malnutrition in children in the 2nd half of life, especially in the 2nd year of life. This is facilitated by the children’s great contact with others.

Poor living conditions (cramped, damp, poorly ventilated rooms), wrapping up, leading to overheating of the child, improper daily routine, insufficient use of air, lack of favorable conditions for sleep, pedagogical neglect and many other defects in the organization of the environment can cause the development of malnutrition. Combined with eating disorders, these factors usually contribute to frequent illnesses in the child. Malnutrition occurs especially easily in premature babies with the slightest disturbance in the organization of the environment.

In conclusion, it must be emphasized that all of the listed causes of malnutrition are so closely intertwined and mutually influence each other that it is sometimes difficult to determine what is primary and what is secondary.

Clinic. With the development of malnutrition, functional disturbances appear in the activity of systems and organs (primarily the gastrointestinal tract, nervous system), changes in metabolism, and a decrease in general and local resistance. There are malnutrition of I, II and III degrees.

With grade I malnutrition, the child’s general condition remains satisfactory and he does not give the impression of being sick, especially when the child is dressed or wrapped. However, an objective examination reveals signs of malnutrition. The subcutaneous fat layer becomes thinner on the abdomen and torso, so that the fold at the navel level reaches only 0.8 cm or less.

The color of the skin and visible mucous membranes may be normal or slightly pale. At the same time, the elasticity of the muscles and skin characteristic of a healthy child decreases somewhat. Body weight may be 10-20% less than normal; As for such parameters of physical development as height and chest circumference, they usually remain within normal limits. Sleep, appetite and stool are either preserved or slightly impaired,

With II degree malnutrition, body weight deficiency can reach 20-30%. At the same time, these children exhibit a slight (2-4 cm) growth retardation. The subcutaneous fat layer disappears on the trunk, limbs and decreases on the face. The skin loses its elasticity and easily folds on the inner thighs, shoulders and buttocks. The skin becomes pale or gray in color, becomes dry, flabby, and in some areas you can find pityriasis-like peeling and pigmentation. Hair becomes coarse and thin. Skin turgor decreases significantly, and in most cases muscle hypotension is observed. Body temperature loses its monothermicity; temperature ranges can reach 1 °C or more.

As a rule, appetite is significantly reduced, some children develop aversion to food, and when force-fed, vomiting. Dyspeptic disorders often occur.

The nervous system of such a child is unstable: excitement, anxiety, and causeless crying are replaced by lethargy, apathy, and adynamia. Most patients have restless sleep. There is a lag in the development of motor functions: children later begin to sit, stand, walk, and sometimes acquired motor skills are lost.

Quite often, children with grade II malnutrition experience infectious and inflammatory processes in the ears, lungs, and urinary tract, and it should be noted that all diseases proceed sluggishly and torpidly.

III degree malnutrition is characterized by a sharp decrease in the subcutaneous fat layer on the face and its complete disappearance on the torso and limbs. The child's face becomes small and acquires a triangular shape, an senile appearance. The body weight curve with grade III malnutrition continues to fall progressively. The child's body weight deficiency exceeds 30%. Growth retardation is also significant (4-6 cm or more). Such children have a characteristic appearance. The skin is pale gray, flabby, dry, in places with pityriasis-like peeling, hemorrhages, hanging in folds on the inner surface of the thighs, shoulders, and buttocks; collected in folds, it does not straighten out (Fig. 27). Visible mucous membranes are dry, bright red in color, easily vulnerable, thrush, stomatitis, and ulcerations often develop, which are difficult to treat therapeutically. The muscles become atrophic, their tone is increased. At first, these children are restless, irritable, whiny, and subsequently their lethargy, indifferent, apathetic attitude towards their surroundings increases, they sleep a lot, and do not show any feeling of hunger at all. Often all previously acquired motor skills are completely lost. In some cases, the formation of motor skills and speech development slow down sharply. Characterized by almost constantly decreased

Rice. 27. III degree hypotrophy in a 4 month old child.

body temperature. Breathing is disturbed - it is shallow, arrhythmic, slow, atelectasis often develops, pneumonia occurs, occurring atypically (without fever, cough, severe catarrhal phenomena). Heart sounds are muffled in most cases, the pulse weakens and slows down to 60-80 per minute. The extremities are usually cold to the touch.

The abdomen is retracted or swollen. Appetite sharply decreases, sometimes a complete aversion to food develops, and often regurgitation or even vomiting appears as a protective reflex. The stool is usually loose, rapid, and resembles dyspeptic stool; Constipation is less common. Diuresis in such children is in most cases reduced.

This degree of malnutrition is gradually accompanied by manifestations of vitamin deficiency (A, C, group B), however, sharp pronounced symptoms of rickets are not observed due to the retardation of growth processes.

Children with malnutrition are very susceptible to all kinds of diseases, which last a long time, are peculiar, difficult, and are often accompanied by complications. The most common diseases such as influenza, acute respiratory infection, pneumonia, otitis media, otoanthritis, occur in children with pronounced degrees of malnutrition atypically, often latently, for a long time, with short remissions and frequent outbreaks, without fever, without obvious clinical symptoms, no changes in peripheral blood. It is quite understandable that diagnosing infectious diseases in such children presents certain difficulties.

In the presence of any local focus during malnutrition, general septic and toxic conditions easily arise. At the same time, sepsis also occurs atypically, in some cases

teas without an increase in body temperature, without characteristic changes in the blood, without bacteriological confirmation.

A disease of any nature contributes to a further increase in malnutrition in the child.

The reduced reactivity of children with malnutrition is also manifested in their reduced tolerance to food. Often, a child with grade II and III malnutrition responds to a normal food load with a paradoxical reaction: instead of weight gain, there is a drop in weight, vomiting, frequent loose stools, and sometimes even toxicosis develops. This indicates decreased gastrointestinal resistance. Based on this, caution and consistency must be observed when prescribing a diet.

Over the past 10-15 years, the etiological structure of malnutrition in young children has undergone significant changes. Everywhere there is a significant reduction in the number of children with malnutrition due to irrational feeding and defects in care. The number of children with malnutrition that developed as a result of infectious diseases is also decreasing, but to a lesser extent. However, at the same time, the significance of harmful factors acting at various stages of development of the embryo and fetus and causing the occurrence of intrauterine malnutrition began to emerge more clearly.

Intrauterine malnutrition refers to acute and chronic intrauterine metabolic disorders that appear at birth or in the neonatal period. These metabolic disorders can develop with toxicosis of pregnancy, hypertension, anemia, heart disease, endocrine glands, tuberculosis and other maternal diseases. Environmental factors (poor nutrition of a pregnant woman, radioactive substances, X-rays, chemicals, some medications, etc.) can be harmful.

During a normal pregnancy, children with this pathology have reduced indicators of physical development. And this primarily concerns body weight, the deficit of which compared to normal values ​​can range from 200 to 900 g. Because of this, the subcutaneous fat layer may be insufficiently expressed or completely absent, depending on the degree of malnutrition.

Growth deficiency is also detected much less frequently, which is not so pronounced (from 1.5 to 3 cm) and occurs only with severe degrees of the disease.

Usually the skin has a pale pink color with a slight cyanotic tint, it is dry, thin, with translucent veins on the abdomen and chest, with abundant pityriasis-like peeling. These children, as a rule, have a large physiological loss of body weight (more than 10-15%), slow

restoration of the original mass, more pronounced and longer-lasting physiological jaundice, later falling off of the remnant of the umbilical cord and healing of the umbilical wound.

The prognosis for malnutrition depends on the severity of the disease, the age of the child and the presence of complications.

With grade I hypotrophy, with timely diagnosis and proper treatment, recovery occurs in a relatively short time. Second degree hypotrophy in modern conditions in the vast majority of cases proceeds favorably, however, treatment of these children usually requires at least 4-6 weeks. With grade III malnutrition, the prognosis is always serious.

Treatment. The entire complex of therapeutic measures for malnutrition should be based on the severity of the disease and the individual reactivity of the child. A large place in the treatment of malnutrition is given to organizing the environment and eliminating the causes that led to the development of the disease.

To bring a child out of the state of stage I malnutrition, it is enough to eliminate its cause and establish proper, vitamin-enriched nutrition for the child, taking into account his age. This is not enough for the treatment of hypotrophy II and especially III degree. In addition to eliminating the cause of the pathology, a set of therapeutic measures is necessary, among which proper nutrition takes the leading place. The two-phase power supply method is widely used. The first phase is careful feeding to establish the child’s tolerance for food, the second phase is enhanced nutrition, which should not only cover the vital need for food, but also restore depleted reserves.

Diet therapy for malnutrition in children is differentiated depending on its degree. With grade I malnutrition, the calorie content and volume of food can be either normal or slightly reduced for some time, depending on appetite. The correct ratio of individual food ingredients is necessary (up to 1 year, proteins, fats and carbohydrates should be in the ratio 1: 3: 6, after 1 year - 1: 1: 3-4) and enrichment with vitamins.

If a control calculation reveals a deficiency of one or another ingredient, it is necessary to correct the diet, providing the child with the amount of proteins, fats, and carbohydrates that corresponds to physiological standards.

The missing amount of protein can be replenished with regular cottage cheese, “Zdorovye” cottage cheese or protein preparations (“Enpit”, “Kazecit”). It is best to correct fat deficiency with fish oil, as well as cream and, in older age, butter. To replenish the missing amount of carbohydrates, sugar syrup, cereals, vegetables, and fruits are used.

In case of II degree malnutrition, 2/3 or 3 times the required daily caloric intake is prescribed for 5-7 days. They give human milk or acidic mixtures (acidophilus mixture, “Malyutka”, “Malysh”, kefir, etc.), and the number of feedings is increased to 7-8. During this period of limited nutrition, the missing amount of food is replenished with either 10% rice broth with 5% glucose solution or Ringer's solution (100-200 ml) with 5% glucose solution, or vegetable broth of cabbage, carrots, turnips, beets (rich in mineral salts ). When breastfeeding, the addition of cottage cheese is indicated, starting from 5 g per day with a gradual increase to 10 g 2-3 times a day, as well as B-kefir or kefir 1-3 teaspoons 3-5 times a day.

After 5-7 days, as the condition improves, the calorie content and volume of food are gradually adjusted to normal, while the amount of food ingredients and calorie content is calculated based on the child’s proper body weight.

For grade III malnutrition, the first 5-7 days give \ ^h or Uz daily caloric intake calculated for average body weight (actual body weight + 20% of this weight). The amount of food missing in volume is replenished with liquids (vegetable decoctions, 5% glucose solution, vitamin juices, tea). Prescribed only for women