Infantile colic. Infant colic: causes, symptoms, treatment. If you suspect a serious illness

1. Dietary disorders in a nursing mother. The baby experiences colic if the mother eats cabbage or other vegetables or abuses flour products and coffee.
2. Overfeeding.
3. Violation of feeding technique.

   After feeding, hold your baby upright. The baby will regurgitate the excess air that it swallowed during sucking.

4. Inappropriate mixture. Children's intestines cannot process some components of the formula, so it is necessary to change it.

   You also need to choose the right nipple for your bottle. The AVENT company produces nipples with bottles that specifically remove excess air.

5. During the first month of life, the baby’s digestive system is not yet adapted to the environment. It begins to become populated with many bacteria that are beneficial for digestion. The motility of the large and small intestines is not yet fully formed. Therefore, colic in newborn babies is an integral part of their life.
6. Spasms of intestinal smooth muscles.
7. There is a stereotype that colic occurs more often in boys. This is wrong. Colic in girls, just like in boys, occurs with the same frequency and does not depend on the nation and the nature of feeding.

Intestinal colic in newborns begins at one week of age and goes away by 4 months. In premature newborns, colic occurs 1 to 2 weeks later.

Intestinal colic occurs in 70% of children, so it is a mistake to think that everyone has it.

How can you tell if your baby has colic?

All children behave differently - they clench their fists, close their eyes tightly. But the main symptom is strong crying, pulling the legs towards the stomach.

The child begins to behave restlessly after eating. Worried about tight stools or even... Bloating. These signs will help you understand that this is intestinal colic in a newborn.

Colic in most cases torments children in the evenings. This is due to fluctuations in hormones in human milk and an increase in its fat content in the evening.

How to help a child with colic?

Gas and colic in newborns can be alleviated certain events.

1. Give it to the baby.
2. Place your baby on his stomach more often. This will help form proper bowel function. It is better to do this 30 minutes before feeding.
3. Colic in a baby can be relieved by placing a warm towel or a heating pad with warm water on his stomach.
4. Tummy massage for a newborn. With a warm hand, lightly stroke clockwise, preferably before and after your next meal.
5. Every mother should understand how to breastfeed correctly. Indeed, when the baby’s lips do not close completely around the areola, the child swallows excess air, which leads to the accumulation of gases.
6. The manifestations of colic in infants can be reduced by walking in the fresh air or rocking.
7. Gas outlet pipe. Place the child on his side, pressing his legs to his stomach. Be sure to lubricate the tip of the tube and carefully insert it into the anus.

   If there is an accumulation of gases in the intestine itself, this method will not help, unless the gases have accumulated at the base of the anus.

8. Medicines to help with colic.

Can relieve gas symptoms the following groups of drugs:

• reducing the level of gas formation (Espumizan baby, Bobotik,);
• agents that remove gases from the intestines (activated carbon, Smecta);
• restoring intestinal microflora (Linex, Bifiform).

Simethicone solution. Given before or after.

When artificial feeding is added to the bottle. Dosage for children under one year of age: 25 drops (per day). Shake before use.

Bobotik - simethicone emulsion

It is a suspension with a fairly pleasant taste. Reduces the surface tension of gas bubbles. Taken according to the instructions in the age-specific dosage. Drops can be diluted with water. After the symptoms disappear, the medicine is discontinued.

Plantex - a magical remedy for colic

The basis of the medicine is fennel. Its action is similar to dill. The contents of the sachet are dissolved in 100 ml of water. You can give it to your baby from the first days of life.

When does colic go away in newborns? - this is not a disease. Their best healers are time, patience and the above tips, thanks to which it will be easier for the child to endure this condition.

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"Consilium Medicum. Pediatrics" No. 4, 2014

I.N.Zakharova 1 , G.V. Yatsyk 2 , T.E. Borovik 2 , V.A. Skvortsova 2 , N.G. Zvonkova 2 , Yu.A.Dmitrieva 1 , N.G.Sugyan 1, E.N.Kasatkina 3, E.B.Machneva 1

1 GBOU DPO RMAPO Russian Ministry of Health, Moscow;
2 Federal State Budgetary Institution Scientific Center for Children's Health of the Russian Academy of Sciences;
3 GBUZ Tushino Children's City Hospital of the Moscow Department of Health

Functional disorders of the digestive system are a large group of conditions that are widespread in early childhood. According to the generally accepted definition, functional disorders of the gastrointestinal tract (GIT) include various combinations of persistent or recurring symptoms that cannot be explained by structural or biochemical disorders. With functional disorders of the gastrointestinal tract, motor function, digestion and absorption of nutrients, as well as the composition of the intestinal microflora and the activity of the immune system may change. The causes of functional disorders often lie outside the affected organ and are caused by a violation of the nervous and humoral regulation of the digestive tract.

In accordance with the III Rome Criteria of 2006, functional disorders of the gastrointestinal tract in infants and children of the second year of life include:

• G1. Regurgitation in babies.
• G2. Rumination syndrome in infants.
• G3. Cyclic vomiting syndrome.
• G4. Infantile intestinal colic.
• G5. Functional diarrhea.
• G6. Painful and difficult bowel movements (dyschezia) in infants.
• G7. Functional constipation.

In infants, especially in the first 6 months of life, conditions such as regurgitation, intestinal colic and functional constipation are common. In more than 1/2 of children they are observed in different combinations, less often - as one isolated symptom. Since the causes leading to functional disorders affect various processes in the gastrointestinal tract, the combination of symptoms in one child seems quite natural. Thus, after hypoxia, vegetative visceral disorders may occur with changes in motility of the hyper- or hypotonic type and disturbances in the activity of regulatory peptides, leading simultaneously to regurgitation (as a result of spasm or gaping of the sphincters), colic (disturbances in gastrointestinal motility with increased gas formation) and constipation (hypotonic or due to intestinal spasm).

The term "colic" comes from the Greek. "colicos", which means "pain in the intestine". They are one of the most common reasons for parents with children in their first months to visit a pediatrician.

Intestinal colic syndrome refers to episodes of painful crying and restlessness of the child, which take at least 3 hours a day and occur at least 3 times a week. The most typical time for intestinal colic is the evening hours. Crying attacks arise and end suddenly, without any external provoking reasons. According to modern data, the prevalence of infant intestinal colic among children in the first months of life ranges from 5 to 19%, although some researchers indicate that intestinal colic is much more common. Significant differences in epidemiological data are apparently associated with the lack of uniform approaches and criteria for assessing this condition.

It is generally accepted that intestinal colic first appears in the 2-3rd week of a child’s life, intensifies in the 2nd month and decreases after 3 months. According to J. Paradise (1996), intestinal colic develops in infants at the age of 2.6 ± 1.8 weeks. At 1.5 months of age, the incidence of intestinal colic is 62%, at 3 months of age - 34%. The author showed that the severity and frequency of intestinal colic decrease with age (at the age of 1-3 months they occur in 29% of children, at 4-6 months - in 7-11%).

A. Douwes indicates that intestinal colic occurs in 25% of full-term newborns under the age of 1 month who are breastfed and in 31% - on artificial feeding. Already in 1960, T. Brazelton noted that the duration of colic is maximum at the age of 6 weeks, they persist until 12 weeks with a gradual decrease in the duration of the child’s restlessness. Later in 1962, the same researcher published data on the duration of crying of a healthy child depending on age.

So, at the age of 2 weeks, a child cries on average 1 hour 45 minutes, at the age of 6 weeks - 2 hours 45 minutes, and at the age of 12 weeks - less than 1 hour. The peak time of day when a child cries intensely is

The mechanisms of development of intestinal colic remain not fully understood, but numerous studies have made it possible to advance the understanding of this problem and draw certain conclusions:

• - infant colic is most common among first-born children in the family;
• - colic occurs more often in children born to mothers over 30 years of age and with higher education;
• - mothers of children with colic are characterized by increased anxiety and a tendency to depression;
• - the diets of mothers whose children have colic more often contain cow's milk, broccoli, cauliflower and white cabbage, onions and chocolate;
• - intestinal colic is more common among breastfed children;
• - in children with colic, the blood content of motilin and serotonin, which stimulate the activity of the gastrointestinal tract, is increased, and cholecystokinin (CCK), which regulates the perception of pain, is decreased;
• - babies with colic have increased intestinal permeability;
• - the level of calprotectin, which reflects the inflammatory process in the intestines, is increased in children with colic;
• - children with colic are characterized by dysbiotic changes in the intestines, accompanied by an increase in the content of Escherichia coli, Klebsiella and a decrease in the number of lactobacilli.

Thus, the occurrence of intestinal colic is promoted by various factors from both the mother and the child, including inadequate nutrition (Table 1).

Based on currently available data, it is possible to identify important causes of colic, which is necessary to develop tactics for their relief.

Normally, a small amount of air enters the stomach during swallowing. Its physiological role is to stimulate gastric motility (part of the air passes in transit through the pylorus into the intestine). Gases are produced by intestinal bacteria, but if motility is imperfect, their elimination is impaired. There is another mechanism that plays a significant role in pathological conditions. It is associated with a decrease in the absorption of gases by the intestinal wall as a result of accelerated passage of food or a widespread inflammatory process in the intestinal mucosa. The mechanisms that move gas through the digestive tube are not well understood. It is known that in the colon, feces are transported 30-100 times slower than liquid or gas. It should be noted that stretching or spasm of any part of the digestive tract due to increased gas formation can cause a range of sensations from mild discomfort to pain.

Violation of feeding technique contributes to excessive swallowing of large amounts of air (aerophagia). In infants, aerophagia occurs, for example, when sucking on an empty nipple or a breast with a small amount of milk and can cause anxiety in the child. Symptoms indicating aerophagia in infants include crying during feeding, bloating, refusal to eat, and after feeding - regurgitation or, less commonly, vomiting. Moderate aerophagia is often observed in children in the first months of life due to the immaturity of the nervous regulation of the swallowing process. To a greater extent, aerophagia is characteristic of premature infants, as well as children who are immature at the time of birth.

Morphofunctional immaturity of the digestive tract, accompanied by immaturity of the enzymatic system, disturbances of intestinal microbiocenosis, leads to incomplete breakdown of fats and carbohydrates, which contributes to excessive gas formation. Age-related features of the anatomical and physiological structure of the gastrointestinal tract in young children are presented in Table. 2.

From the first days of life, the child begins to receive breast milk (or infant formula). The amount of food gradually increases, the volume of the stomach increases, the enzymatic and motor functions of the gastrointestinal tract are activated, the formation of intestinal microbiocenosis occurs, etc. These processes are influenced by a large number of factors, so newborns should be considered as a group at increased risk for the development of functional disorders, especially in the presence of prematurity, morphofunctional immaturity, intrauterine hypoxia or asphyxia during childbirth, a long period of total parenteral nutrition, and early artificial feeding.

The functioning of the digestive system, the interaction of motility, secretion and absorption in the intestine is regulated by a complex system of nervous and humoral mechanisms. There are three main mechanisms of regulation of the digestive apparatus: central reflex, humoral and local. The central reflex influence is more pronounced in the upper part of the digestive tract. As one moves away from the oral cavity, its participation decreases, at the same time the role of humoral mechanisms increases. Their most pronounced influence is on the activity of the stomach, duodenum (duodenum), pancreas, bile formation and bile excretion. In the small and especially large intestine, predominantly local regulatory mechanisms manifest themselves (due to mechanical and chemical stimulation).

In some cases, the development of infant intestinal colic is facilitated by the immaturity of the nervous and endocrine systems involved in the regulation of the gastrointestinal tract (intestinal self-regulation disorders). The main role in the nervous regulation of gastrointestinal functions is played by the enteric nervous system, which is part of the central nervous system (CNS) and consists of many (about 100 million) neurons. The neurons of the enteric nervous system are grouped in ganglia, connected by intertwining nerve processes into two main plexuses - mesenteric (Meissner) and submucosal (Auerbach). When the intestinal smooth muscles are stretched, afferent neurons are stimulated, which perceive the signal and transmit excitation to the interneurons of the autonomic nervous system involved in the regulation of motility and secretion. The intestinal nervous system communicates with the central nervous system through the motor and sensory sympathetic and parasympathetic pathways. Vegetovisceral disorders of varying degrees occur in more than 1/2 of children in the first year of life, but most often they are observed in premature infants. It is known that at a gestational age of less than 32 weeks, an uneven distribution of neurons along the circumference of the intestine is observed. At the same time, signs of morphofunctional immaturity of intestinal regulatory systems are also found in full-term children. The maturation of the intestinal nervous system continues until the child is 12-18 months old. Often, vegetative-visceral disorders of central origin are accompanied by syndromes of hyperexcitability and intracranial hypertension, and as the symptoms of perinatal damage to the central nervous system are eliminated, regression of visceral disorders is noted.

It should be noted that individual characteristics play a large role in the occurrence of intestinal colic in infants - an increase or decrease in the threshold of pain sensitivity, as well as sensitivity to stretching of the intestinal wall.

Gastrointestinal hormones, a group of biologically active peptides produced by endocrine cells and neurons of the gastrointestinal tract and pancreas, are of great importance for the humoral regulation of digestive functions. These hormones have a regulatory effect on secretory functions, absorption, motility, blood supply to the gastrointestinal tract and trophic processes in it, and also have a number of general effects on metabolism.

Gastrointestinal hormones differ from hormones in their classical sense in a number of characteristics, primarily in that the cells secreting them are not united into clearly defined glandular structures, but are located diffusely in different parts of the gastrointestinal tract. Based on the similarity of amino acid composition and amino acid sequence, gastrointestinal hormones are divided into 3 families:

• - gastrin (gastrin, CCK);
• - secretin (glucagon, enteroglucagon, vasoactive intestinal polypeptide, gastroinhibitory peptide, etc.);
• - pancreatic polypeptide (pancreatic peptide and neuropeptide Y).

Some gastrointestinal hormones, such as gastrin-releasing hormone, somatostatin, motilin, neurotensin, etc., do not belong to any of the listed families. The half-life for all gastrointestinal hormones is measured in minutes.

Gastrin is synthesized by G-cells located in the mucous membrane of the antrum of the stomach and the crypts and villi of the Brunner glands of the duodenum. The release of gastrin is stimulated by food intake and distension of the stomach. Inhibition of the secretion of this hormone occurs when the gastric contents become acidic. The main physiological effects of gastrin are stimulation of the secretion of hydrochloric acid and pepsin, as well as regulation of the trophism of the stomach, duodenum and pancreas. Gastrin and pentagastrin increase the tone of the lower esophageal sphincter, enhancing the barrier function of this barrier for gastroesophageal reflux.

Secretin is a peptide hormone produced by S-cells in the mucous membrane of the small intestine and involved in the regulation of the secretory activity of the pancreas. The main physiological effect of secretin is an increase in the volume of the liquid part of the pancreatic secretion, the concentration and amount of bicarbonates in it.

CCK is a neuropeptide hormone produced by I-cells of the duodenal mucosa and the proximal jejunum. The leading effects of CCK are active enhancement of gallbladder motility and significant stimulation of pancreatic secretion. Relaxation of the sphincter of Oddi, synchronous with the contraction of the gallbladder, promotes the flow of bile into the duodenum. Pancreatic enzymes stimulated by endogenous or exogenous CCK are also released here, creating optimal conditions for the breakdown of various food components. Currently, the role of CCK, which has a sedative effect, in the genesis of intestinal colic in children has been proven. It is believed that a reduced concentration of CCK, which regulates the feeling of satiety and the perception of pain, may cause higher excitability in children with intestinal colic.

Pancreatic polypeptide - secreted by the PP cells of the islets of Langerhans of the pancreas. The vast majority of cells that synthesize pancreatic polypeptide are located in the head of the pancreas. The pancreatic polypeptide is an antagonist of CCK in its action. In physiological concentrations, it suppresses the secretion of pancreatic juice and relaxes the smooth muscles of the gallbladder.

Motilin is a polypeptide hormone secreted by enterochromaffin cells of the mucous membrane of the duodenum and jejunum. It stimulates peristaltic contractions of the smooth muscles of the wall of the stomach and intestines. Motilin is an essential neurotransmitter that regulates gastrointestinal motility through the direct effect of the polypeptide on stimulatory receptors on muscle cells. Motilin increases the tone of the lower esophageal sphincter, accelerates gastric emptying and enhances the contractile activity of the colon. In humans, the release of motilin is stimulated by fats, and glucose inhibits the release of the hormone. L. Lot et al. (1987) showed that the level of vasoactive intestinal peptide and gastrin is increased in children with various gastrointestinal disorders (but not in intestinal colic). The authors reported increased basal motilin levels in colicky infants and hypothesized its role in their occurrence.

Recently, there is also evidence of increased levels of ghrelin (a peptide hormone secreted by P/D cells of the gastric fundic mucosa) in the blood serum of children with intestinal colic compared to healthy children. It is assumed that this hormone is involved in impaired intestinal motility and increases appetite. It can be considered a mediator between the gut and the brain.

Most authors believe that infant intestinal colic is caused by the immaturity of the nervous and endocrine regulation of intestinal activity, as well as the anatomical features of the structure of the gastrointestinal tract in young children (long mesentery, pendulum-like movements of the intestines), leading to impaired motor skills. Children with intestinal colic are characterized by slow gastric emptying, while intestinal transit is not impaired in most cases.

One of the options for the development of intestinal colic is due to dyskinetic phenomena in the colon. This type of colic is most often observed during or after eating. The occurrence of intestinal colic may be associated with gastroileal and gastrocecal reflexes, which were described back in 1909 by G.Holzknecht and S.Jonas. The essence of the reflexes is that during the first 10 minutes after eating, a periodic increase in the motor activity of the colon is observed. Peristaltic waves reach the rectum, causing the urge to defecate. The general mechanisms of regulation of motility and secretion, especially of the small intestine, suggest that motility disorders may be accompanied by secondary disorders of intestinal secretion.

The occurrence of intestinal colic may be influenced by changes in the composition of the intestinal microbiota. An imbalance of intestinal microflora is a risk factor for increased gas formation. Gas is one of the main products of bacterial fermentation of carbohydrates and proteins that enter the large intestine as a result of their excess consumption or insufficient digestion. In case of lactase deficiency, increased gas formation is associated with the formation of hydrogen during bacterial fermentation of unsplit lactose. At the same time, not only increased gas formation and disruption of its passage play a role in the pathogenesis of colic, but also the qualitative composition of the gas. In breastfed children, this is hydrogen, which is released during the fermentation of lactose in breast milk. In children who are bottle-fed or receiving complementary foods - methane gas. Methane is also produced by strict anaerobes during the digestion of protein and carbohydrates. Ammonia and hydrogen sulfide produced by proteolytic anaerobic microflora have potential cytotoxicity.

Conducted by F.Savino et al. (2004) studies revealed differences in the content of lactobacilli in children with and without colic. Thus, Lactobacillus brevis and Lactococcus lactis were found in children with intestinal colic, while in healthy children Lactobacillus acidophilus predominated in the microbiota. L. brevis and L. lactis are thought to be involved in the pathogenesis of intestinal colic by increasing flatulence. A significant increase in the content of Escherichia coli in the intestinal microflora in children with intestinal colic compared to healthy infants was also established.

An analysis of the state of intestinal microbiocenosis in infants with intestinal colic was carried out at the Department of Pediatrics of the Russian Medical Academy of Postgraduate Education. Normocenosis was found in only 5% of children. The majority of children (86.7%) had intestinal dysbiosis of 2nd and 3rd degree. Moreover, grade 3 dysbiotic intestinal disorders (52.8%) were more typical for breastfed children. When analyzing the composition of the intestinal microflora in children with intestinal colic, a significant decrease in the content of representatives of obligate microflora was found. These changes were more pronounced during breastfeeding. In 55.5% of breastfed children and in 29.2% of bottle-fed children, a low content of bifidobacteria was detected (<107). Обращает на себя внимание большой процент детей, у которых обнаружились кишечная палочка с гемолизирующими свойствами (40%) и гемолизирующие формы стафилококка (35-37%).

The regulation of gastrointestinal motility is multilevel and, in addition to the central nervous system and peripheral nervous system, is carried out at the local level directly in the intestine. The microflora of the gastrointestinal tract makes a significant contribution to the local regulation of motility, both through the formation of feces and through the production of various metabolites, including short-chain fatty acids (SCFA).

As a result of numerous studies, it has been established that during the fermentation of carbohydrates (non-degradable starch, oligosaccharides, dietary fiber) with anaerobic bacteria and opportunistic flora (propionobacteria, bacteroides, fusobacteria, clostridia, peptostreptococci, coprococci, lactobacilli, eubacteria, etc.) SCFAs are formed. When breaking down carbohydrates - acetic (acetate), propionic (propionate) and butyric (butyrate) acids. Isobutyrate, isovalerate and 2-methylbutyrate are formed from amino acids (valine, leucine and isoleucine, respectively), which are also a significant source of SCFAs for humans. About 30% of proteins in the intestine are converted into SCFA, which are also formed during the breakdown of lipids and nucleic acids. A significant source of the initial substrates for fermentation is the organism itself, namely: mucus glycoproteins, the specific membrane of the epithelium - the glycocalyx, dead epithelial cells that have separated from the main layer and “residual” proteins. It has been established that SCFAs affect gastrointestinal motility. In low concentrations they have a stimulating effect on intestinal smooth muscle cells through the cholinergic reflex, and in high concentrations they inhibit colonic motility. They influence the motility of intestinal segments both locally and through the circulatory and nervous systems of the intestine, modulating physiological functions such as ileocolonic inhibition, protection against ileocecal reflux.

With functional disorders of the gastrointestinal tract, manifested by intestinal colic and diarrhea syndrome, there is a sharp decrease in the proportion of acetic acid and an increase in the amount of propionic and butyric acids, and these changes increase with the severity of the disorder in the intestinal microflora. Changes in acid profiles can be explained both by impaired intestinal motor function and by changes in the species composition of intestinal microflora producing different short-chain acids. It is known that microflora creates both an energy and raw material base for synthetic activity for colonocytes. Anaerobes should be considered as the main species that directly ensure the normal functioning of the epithelium. The existing changes in functional disorders of the gastrointestinal tract can be explained by stress (intrauterine hypoxia, morphofunctional immaturity, muscular dystonia, neuro-reflex excitability) effects on the intestinal epithelium. Under stress, the metabolism of colonocytes switches from the Krebs cycle to the anaerobic version of glycolysis and activation of hexose monophosphate shunting. This change in the metabolic strategy leads to a change in the trophic base of colonocytes, which cease to absorb and utilize SCFAs, primarily propionic and butyric acids. In addition, it is known that propionic acid affects the absorption of water in the intestine through cyclic adenosine monophosphate-dependent systems, which can also be one of the mechanisms for the development of diarrhea.

At the Department of Pediatrics of the State Budgetary Educational Institution of Further Education of the Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation, the spectrum of SCFA in children with intestinal colic was analyzed depending on the nature of feeding and the degree of microbiocenosis disturbance. The absolute content of SCFAs demonstrated an increase in their concentration as the degree of disturbances in the intestinal microbiocenosis increased, which was associated with quantitative and qualitative changes in the composition of microorganisms, their habitat and motility disorders. Analysis of SCFA profiles indicated a sharp decrease in the proportion of acetic acid, an increase in the proportions of propionic and butyric acids, and a deviation of the values ​​of anaerobic indices, reflecting the redox potential of the intraluminal environment, into the area of ​​sharply negative values ​​compared to the norm as microbiocenosis disturbances worsened.

It is known that acetic acid is a metabolite of obligate, saccharolytic microflora, and a decrease in its proportion indicates a decrease in the activity and number of lactic acid microorganisms (bifidobacteria and lactobacilli). An increase in the proportion of propionic and butyric acids indicates the activation of opportunistic microflora and strict anaerobes (bacteroides, eubacteria, fusobacteria, coprococci, etc.). When studying the correlation between the degree of disturbance of intestinal microbiocenosis and the level of acetic acid in feces in children, it was found that the correlation coefficient for breastfeeding was r = 0.922 and r = 0.707 for artificial feeding. Accordingly, changes in SCFA parameters reflect the nature and severity of changes in the qualitative composition of the microflora and can be used for screening assessment of its condition.

Thus, a vicious circle is formed: changes in intestinal motility lead to the formation and aggravation of changes in the qualitative composition of microorganisms, and this, in turn, through changes in the production of SCFA and other metabolites, aggravates and maintains disorders of the intestinal motor-evacuation function.

Infants with functional disorders of the gastrointestinal tract have immaturity of the digestive system, relative exocrine pancreatic insufficiency, disorders of bile formation and bile secretion. This interferes with the digestion of proteins and fats. Insufficient emulsification of fats in case of deficiency of bile acids in the duodenal lumen further impairs their breakdown. Altered pancreatic function, accompanied by a deficiency or decreased activity of pancreatic enzymes, as well as insufficient lactase activity in the small intestine lead to the accumulation of non-utilizable digestive substrates, which contributes to the development of rotting and fermentation and stimulates the proliferation of bacterial flora in it, due to which the breakdown of nutrients occurs. The result of this is a disruption of the microbiocenosis of the large intestine, the accumulation of gases in it (hydrogen sulfide, carbon dioxide, hydrogen, etc.), products of the breakdown of insufficiently hydrolyzed nutrients. On the other hand, bacterial breakdown products of insufficiently hydrolyzed nutrients (SCFA, indole, skatole, phenol, gases, etc.) and bacterial endotoxins enhance the peristalsis of the small and large intestines, which leads to accelerated passage of chyme and a decrease in the contact time of pancreatic enzymes with nutrients in the field of cavity and membrane digestion.

In many infants, intestinal colic is accompanied by diarrhea caused by intolerance to foods or components (usually lactose). The breakdown of disaccharides occurs under the influence of disaccharidase enzymes, which are produced in the brush border of the small intestine. Disaccharidases are synthesized in polysomes of intestinal villi and are membrane glycoproteins located superficially in microvilli. Each disaccharidase has a hydrophobic region, which serves as a membrane backbone, and an intraluminal hydrophilic region, which is the active part. Disaccharidases are divided into two classes: b-glycosidase (lactase) and a-glycosidase (sucrase-isomaltase, maltodextrin-coamylase, trehalase). The microvilli of enterocytes contain enzymes that break down oligo- and disaccharides into monosaccharides, which are absorbed. Normally, only a small amount of undigested carbohydrates reaches the colon. Excessive intake of lactose into the colon causes the accumulation of gases during fermentation, flatulence, bloating and pain. It should be noted that the subjective sensations of abdominal pain depend on individual sensitivity to intestinal distension by gases.

Lactase deficiency can be primary, when a decrease in enzyme activity occurs when the enterocyte is “safe,” and secondary, due to its damage. There are a number of factors that influence lactase activity: genetic, gestational age, age of the child, state of the autonomic nervous system, hormonal, protein growth factors that accelerate the division and maturation of enterocytes, cavity factors that have a trophic effect on the enterocyte (biogenic amines, SCFA, nucleotides, individual amino acids). The reasons leading to damage to the enterocyte include hypoxia, infectious, toxic, allergic and some others.

In children in the first months of life, partial lactase deficiency is often caused by both reduced enzyme activity due to the immaturity of the child and damage to the enterocyte due to hypoxia. At the Department of Pediatrics of the Russian Medical Academy of Postgraduate Education, the level of carbohydrate excretion was studied depending on the intensity of intestinal colic during breastfeeding and artificial feeding. For this purpose, the severity of intestinal colic syndrome was assessed using a 3-point system (Table 3).

In breastfed children, the intensity of intestinal colic turned out to be directly proportional to the level of total carbohydrate excretion in feces (1 point - 0.54±0.09 g/%; 2 points - 0.58±0.08 g/%; 3 points - 0.606± 0.25 g/%); R<0,001. Однако экскреция лактозы была достоверно повышена лишь при интенсивности кишечных колик, оцененной в 1 балл (0,233±0,04 г/%); р=0,002. При интенсивности кишечных колик, равной 2 и 3 баллам, увеличение уровня лактозы не имело статистической значимости. Эти данные еще раз подтверждают отсутствие четкого параллелизма между степенью выраженности клинических симптомов и уровнем экскреции лактозы. Наиболее значительная экскреция глюкозы и галактозы зарегистрирована при 2-й степени интенсивности кишечных колик, а выделение ксилозы увеличивалась от 1 к 3 баллам (табл. 4).

Against the background of artificial feeding, the total excretion of carbohydrates with feces also increased as the degree of intensity of intestinal colic increased, reaching 3 points when their severity was 0.473±0.25 g/% (Table 5).

At the same time, a significant increase in lactose excretion was also noted (0.383±0.26 g/%). At the same time, with intestinal colic rated at 2 points, lactose excretion was normal, and glucose excretion had no deviations with intestinal colic severity of 1 and 3 degrees.

The role of allergy to cow's milk proteins in the occurrence of intestinal colic, which can occur equally often in both breastfed and bottle-fed children, is currently being discussed. Their development is most often associated with cow's milk allergens - bovine serum immunoglobulin (Ig) G and b-lactoglobulin, present in breast milk. Intolerance to cow's milk proteins can occur through immune and non-immune pathways. In the first case, the occurrence of intestinal colic is associated with damage to the intestinal mucosa through the development of immunological reactions (see figure).

Pathogenesis of food allergy.

Allergic inflammation occurs, the process of digestion and absorption of substances is disrupted, which leads to increased gas formation and the appearance of mucus in the stool.

The development of sensitization may be facilitated by increased permeability of the intestinal wall, detected in children with intestinal colic.

Clinical case

A 1.5 month old girl was born to a young woman suffering from bronchial asthma and chronic gastritis. The pregnancy proceeded against the background of slight toxicosis in the first trimester. Delivery on time, independent. Body weight 3750, height 51 cm. Attached to the breast after birth, breastfed until 2 weeks of life, then mixed feeding (breast milk and fermented milk formula in a 1:1 ratio).

Complaints about the absence of independent stool from 2 weeks of age (stool after a gas tube), watery with mucus, severe intestinal colic during the day, regardless of feeding. In the first month I gained 1.2 kg. On examination: single pinpoint rashes on the face, dry skin on the outer surface of the forearms and shins. The stomach is swollen and growling.

In the coprogram there is moderate steatorrhea of ​​types 1 and 2, a lot of mucus, 8-10 leukocytes in the field of view. Fecal carbohydrates 1.8 mg%. Microbiological examination of stool: Escherichia coli with mild enzymatic properties 65%, lactobacilli 105.

The pediatrician at the clinic prescribed nutritional correction: breast milk and lactose-free formula, pancreatic enzymes. During therapy, the child's condition improved slightly; colic continued to bother him throughout the day. Independent stool 3-4 times a day, liquid with mucus. Another specialist looked at the child and drew attention to the presence of an abundance of mucus in the feces, manifestations of atopic dermatitis. Mothers are recommended to follow a strict dairy-free diet with the complete exclusion of all dairy products and supplementary feeding with a mixture based on casein hydrolysis. After 2 weeks, intestinal colic was completely relieved. The stool became mushy 3-4 times a day, yellow in color, and there was a small amount of mucus.

Colic often depends on the child's temperament. However, temperamental characteristics cannot always explain most of a child’s persistent worries. There is an opinion that colic is the result of an unfavorable family climate created by inexperienced and anxious parents. The interaction in the parent-child system is disrupted, which has a growing interest in the emergence of pronounced anxiety in the child. The baby reacts to the depressed and irritable mood of the parents with anxiety, which in turn increases the stressful situation for the parents. Thus, a vicious circle arises.

The negative emotional mood of the child’s mother has a particular impact, especially in the postpartum period. Thus, in a survey of 1015 mothers and their children, T. Vik et al. (2009) showed that infant colic and duration of child fussiness were associated with levels of maternal depression. Thus, the presence of colic in a child at 2 months of age contributes to the development of a high level of depression in the mother by 4 months of age.

Smoking by the mother during pregnancy and after childbirth increases the risk of colic in the baby. Studies have shown that the association of smoking with intestinal colic is associated with an increase in the concentration of motilin in the blood plasma of a smoker. A high concentration of motilin causes dysregulation of the gastrointestinal tract, leading to the development of colic.

There is evidence that social status, education, and maternal work also influence the incidence of infant intestinal colic. It has been shown that the risk of developing intestinal colic in infants increases if the mother experienced physical inactivity and engaged in mental work during pregnancy, which is associated with the development of fetal hypoxia with subsequent immaturity of the child’s systems.

The characteristics of the nervous system and the child’s temperament matter. A 4-year observation of children who had intestinal colic at an early age showed greater emotional lability in the observed group of children compared to their peers. In older children, intestinal colic can transform into functional abdominal pain, irritable bowel syndrome.

Knowledge of the pathogenesis of infant intestinal colic is important for their further treatment. Currently, the treatment of colic is largely associated with the impact on predisposing factors and the causes of their occurrence. The list of medications used for infant intestinal colic is minimal; these include Sab Simplex, which contains the active ingredient simethicone. Stretching or spasm of any part of the digestive tract due to increased gas formation in an infant leads to pain and discomfort. Simethicone reduces the surface tension at the interface, complicates the formation and promotes the destruction of gas bubbles in the intestinal contents. The gases released during this process can be absorbed by the intestinal walls or excreted through peristalsis.

Due to physical and chemical inertness, Sab Simplex is not absorbed and is excreted unchanged after passing through the gastrointestinal tract. The drug removes foam physically without entering into chemical reactions. That is why the drug is safe and approved for use from the first days of a baby’s life. In table 6 presents a comparative description of drugs used to reduce gas formation in the intestines of infants.

20 years of global experience has shown the effectiveness and safety of Sub Simplex. In addition, the drug is easy to use (a bottle with a dropper dispenser) and economical (the bottle lasts for 10 days of use). Sub Simplex has a pleasant raspberry taste, which children like and makes the drug easy to take even for the youngest patients. Due to its properties, safety and ease of use, simethicone can be prescribed to children from the first days of life to relieve colic, which will greatly facilitate the task of their successful correction. The drug does not contain carbohydrates, so it can also be used in patients with diabetes. One of the safety indicators of Sab Simplex is that its use is allowed for women during pregnancy and breastfeeding.

Thus, an analysis of existing scientific data convincingly demonstrates that the pathogenesis of infant intestinal colic continues to be a subject of debate and research. At the same time, understanding the complex mechanisms of development of functional disorders is the key to their effective treatment.

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Colic (abdominal pain) in an infant is a common problem associated with the characteristics of its digestive system.

Preventing colic in a baby

If the mother is breastfeeding, she must strictly adhere to the diet recommended by the doctor, limiting the consumption of whole cow's milk, spicy foods, chocolate, coffee, onions, bananas, grapes and cabbage. Very often, colic in a baby is accompanied by increased gas production. In this case, the mother should completely exclude from the diet sweets that enhance fermentation processes in the intestines, smoked foods and hot seasonings.

If the child is on, the formula for him must be selected individually, following the advice of the observing pediatrician.

Another cause of colic in a baby can be a violation of the feeding regime and technique. It is important to remember that the next feeding should not occur earlier than after 2-3 hours. Otherwise, the child’s body will not cope with digesting food. To prevent the baby from swallowing air during feeding, he should be kept in a semi-upright position. Also, choose bottles with special valves, which also help reduce the amount of air you swallow. After eating, it is recommended to hold the baby vertically for 10-15 minutes.

The emotional state of the baby can also adversely affect the digestion process, so feeding should take place in a calm and familiar environment for the child.

Help with colic

• Give your baby a light massage. Before you begin, rub your palms together to warm them up. Stroke your baby's tummy, moving clockwise. The following exercise can help a child with bloating: place the baby on his back and alternately bend his legs, pulling them towards his chest.
• To ease the pain, place a warm diaper on your baby's tummy. You can also hold your baby close to you and walk around the room with him.
• Another proven method for colic is to regularly lay the baby on his stomach. Try to do this more often, this way the baby’s abdominal muscles are trained, which has a beneficial effect on peristalsis.
• Also, to relieve the baby’s pain, the pediatrician may recommend installing a gas tube. Before the procedure, wash your hands, put on a diaper (preferably a disposable one), then lay the baby on his back. Lubricate the rounded end of the gas outlet tube with Vaseline oil, then carefully and slowly insert 3-4 cm into the child’s rectum. You can cover the baby with a blanket and wait 5-10 minutes. After the passage of gases and feces, the baby should be washed. The procedure can be repeated no earlier than after 3-4 hours.
• It is important to remember that before using medications to relieve painful symptoms in a child, you should consult with your pediatrician.

Constipation in a baby

With natural feeding, the number of bowel movements in a newborn, as a rule, coincides with the frequency of feedings. In a bottle-fed baby, constipation is the absence of bowel movements for 24 hours.

Often, parents begin treating their child on their own and make many mistakes, which can contribute to the deterioration of the child’s condition. It is important to remember that successful treatment of constipation in a newborn depends on timely contact with a specialist who will make the correct diagnosis. After the examination, the doctor will give recommendations on changes in diet and prescribe medications depending on the cause of constipation, because it can be caused by any disease that needs to be treated first. Cleansing enemas are also prescribed by your pediatrician.

Elena Aleksandrovna Chistozvonova, pediatrician, candidate of medical sciences, deputy chief physician for neonatology of the Perinatal Medical Center, member of the expert council of Johnson’s Baby

Infantile colic- a common behavioral syndrome in children aged 2 weeks to 4 months, characterized by bouts of excessively intense and prolonged crying. Colic usually appears in the evening, without any apparent reason. The child, who was previously completely healthy, suddenly begins to cry inconsolably, pressing his legs to his stomach, which becomes tense and swollen. Only 5% of children have colic caused by some organic disease; in most cases, their course is benign, and after 4 months they disappear without a trace.

The most common criterion for diagnosing colic is formulated by Wessel (1954): “Colic is attacks of crying in a healthy child, lasting more than 3 hours in a row, more than 3 days a week, any of the last 3 weeks.”

Colic occurs in 10-30% of children worldwide, regardless of gender. The causes of their occurrence have been poorly studied and not well understood, and treatment methods are limited and ineffective. Probiotics are a promising new treatment option, while alternative medicine (herbal teas, fennel, massage, etc.) has no proven effectiveness and in some cases can be harmful.

As a result, colic remains a common cause of family discomfort and stress in young mothers, and is also the main reason for seeking medical care for infants under 4 months. Due to the ineffectiveness of treatment for colic, the main method remains to convince parents of the safety of this phenomenon and adopt a wait-and-see approach.

Symptoms of colic in babies

Increased physical and psychological sensitivity of the child

Another version of the occurrence of colic in infants is the increased sensitivity of some of them to irritating environmental factors (too cold or hot, wet diaper, bright light, change of weather, etc.). This sensitivity is aggravated in the child by an emotionally traumatic feeling of loss. mother's womb. Thus, from the point of view of supporters of this version, colic is a phenomenon that has not only a physiological, but also a psychological nature. Indirect confirmation of this is the fact that colic in some infants can be alleviated by methods that have nothing to do with the impact on the gastrointestinal tract: rocking in a sling or in a special vibrating cradle, carrying in the arms, certain sound effects.

Emotional instability of the mother (during breastfeeding)

It has been proven that during emotional disorders and stress that a woman experiences (including as a result of postpartum depression), the composition of her milk changes under the influence of hormones. It is possible that these hormones provoke attacks of colic in infants.

Features of the sucking process

Incorrect attachment of the baby during breastfeeding is also considered one of the reasons for the development of infant colic, since the baby swallows too much air (which causes pain in the stomach). Alternatively, the flow rate of mother's milk is too high (this is due to the physiological characteristics of individual women), which is why the baby choke during sucking and, again, may swallow air.

Infant migraine

It is also possible that colic in babies is the result of “infant migraine”. However, this point of view has not yet been proven.

Lactose intolerance to breast milk

This is another version that has been unreasonably popularized in recent years. In fact, lactose intolerance in breast milk can indeed be the cause of pain in the gastrointestinal tract, but this phenomenon is quite rare and requires a lot of special tests to diagnose it. In many cases, when mothers notice a connection between attacks of colic in babies and the feeding process and conclude that they are lactose intolerant and need to transfer the child to artificial feeding, these conclusions are unfounded.

This category includes lactase deficiency (lack of the enzyme lactase, which is necessary to break down the sugar lactose). Diagnosed by a high content of carbohydrates in the stool. Lactase can be given along with breast milk, or there are lactose-free formulas.

Treatment of infant colic

Since the exact cause of colic in babies is not established, each family has to develop its own strategy for treating colic, and do this based on “trial and error.” In general, pediatricians give the following recommendations.

If the suspected cause of the child’s anxiety is digestive problems and increased gas production

In this case, it is worth trying in various ways to speed up the passage of gases and, if possible, prevent the appearance of new ones. To do this, you can give the child an abdominal massage and special gymnastics (press the legs bent at the knees to the child’s stomach, properly pressing on the stomach); After feeding, it is recommended to carry the baby vertically for 10-15 minutes so that he burps air. Some doctors recommend placing the baby on his stomach as often as possible during this period.

If the baby is breastfed, the mother can try adjusting her diet. The effectiveness of this measure for the treatment of colic in infants, however, has recently been called into question, because many studies show that the composition of breast milk is less dependent on the mother’s diet than was commonly believed. If there is increased gas formation, the use of a gas outlet tube can also help, but many doctors recommend using it only as a last resort.

In this case, pediatricians recommend trying to recreate conditions for the child that are close to the conditions of the mother’s womb. To do this, it is necessary to provide the child with maximum tactile contact (carry him in your arms, in a sling, practice co-sleeping, place the baby with his bare stomach on the parent’s stomach (“kangaroo pose”)); rock him in your arms, in a vibrating cradle, in a stroller. “White noise” helps many babies “- a special type of sounds, characterized by uniformity and monotony (the sound of pouring water, a babbling stream, a waterfall, some operating electrical appliances). During attacks of colic, the baby can play an audio recording with such sounds or, if possible, keep the child close to their immediate source.

If colic is caused by eating

During feeding, the mother must ensure that the baby latches onto the breast correctly and does not swallow excess air. If colic is provoked by a strong stream of milk or “greedy” sucking, during colic attacks you can feed the baby expressed milk from a spoon or, in extreme cases, from a bottle.

If a possible cause of colic is stress in a nursing mother

In this case, the mother needs to take measures to stabilize her state of mind; if necessary, it makes sense to consult a psychotherapist or join a support group.

If you suspect a serious illness

If all the measures listed above do not alleviate the baby’s condition in any way, it makes sense to seek advice from a specialist and undergo the necessary tests.

Infantile colic (R10.4) is a paroxysmal acute pain in the abdominal cavity of a functional nature in children of the first year of life. In the event of functional abdominal pain in children of the first year of life, a diagnosis of infant colic is made. The incidence of this disease is about 45% of all visits to the pediatrician for abdominal pain.

The development of infant colic seems to be a consequence of poor nutrition of a nursing mother and a practically healthy child. This is the mother's consumption of hot and spicy foods while breastfeeding, or foods that increase gas formation, including whole cow's milk. With artificial feeding, this is the use of poorly prepared, unadapted or age-inappropriate milk formulas. The occurrence of colic is promoted by an unbalanced diet, early introduction of juices, fruit purees, vegetable dishes, cow's milk and other types of complementary foods.

The causes of intestinal colic include impaired feeding technique, rapid sucking or swallowing air during sucking, emotional discomfort of the child, anxious state of the mother, asocial living conditions and deprivation.

The formation of infant colic occurs during pathological childbirth, injuries to the cervical spine, intestinal dysbiosis, changes in the hormonal status of a nursing mother, in particular, a lack of production or metabolism of progesterone.

The action of causative factors is realized against the background of morphofunctional, primarily enzymatic, immaturity of the gastrointestinal tract and imperfection of the nervous regulation of the intestine. This causes disruption of the digestion and absorption of milk components and other foods, which leads to increased gas formation, stretching or spasm of certain parts of the intestine and thereby provoking visceral abdominal pain of a spastic nature.

Symptoms of infant colic

The following is considered characteristic of an attack:

• onset at 1–4 months of age, usually in the evening;
• restlessness of the child, prolonged crying;
• facial skin hyperemia, cramped legs;
• bloating and rumbling in the stomach;
• reduction or disappearance of symptoms following the passage of gases and feces;
• recurrent nature of symptoms;
• the duration of symptoms is more than 10% of the time of day.

Initially, attacks of acute abdominal pain occur 1-2 times a week and last about 20 minutes. Subsequently, the frequency and duration of attacks increases, intestinal colic worries daily, and continues with short breaks for up to 5 hours a day. It should be emphasized that intestinal colic is not characterized by any changes in stool, as well as in the behavior and appetite of the child in the non-attack period.

Diagnosis of infant colic

First of all, an anamnesis is studied to clarify the nature of the nutrition of the mother and child. A coprological study is carried out, including detection of carbohydrates in feces, bacterial culture for the intestinal and typhoid paratyphoid group of pathogens of intestinal infections, tests for helminthic-protozoal infestation. According to indications, a surgeon is consulted, stress tests with lactose and D-xylose are performed, and the level of total and specific Ig E in the child’s blood serum is determined.

Treatment of infant colic

First, a set of predominantly non-drug treatment and preventive measures should be carried out aimed at relieving spasms and increased gas formation in the intestines, normalizing the child’s nutrition and feeding techniques, and creating a favorable moral and psychological climate in the family.

When breastfeeding, it is necessary to limit or completely eliminate whole cow's milk and gas-forming products in the mother's diet. At the same time, fermented milk products must be included in the diet of a nursing mother.

When artificial feeding, you need to follow the correct technology for preparing formulas and not use formulas enriched with iron in the diet. In between feedings, as well as during an attack, you need to place the baby on your stomach; tactile contact between the skin of the baby’s abdomen and the skin of the mother’s abdomen is necessary.

If there is no effect from non-drug corrective measures, medications are used to reduce increased gas formation, which have an antispasmodic and carminative effect.

The ineffectiveness of therapy over the course of a week indicates the possible organic nature of pain in the abdominal cavity, which requires additional diagnostic measures.

Essential drugs

There are contraindications. Specialist consultation is required.

1. Simethicone () is a drug that reduces flatulence. Dosage regimen: infants and young children are prescribed 1 measuring spoon 3-5 times a day. The drug is taken orally during meals or after meals, and if necessary, also before bedtime. For infants and young children, the drug is given with baby food from a bottle or with liquid after meals. The bottle of emulsion must be shaken before use.
2. (a drug that reduces flatulence). Dosage regimen: the drug is prescribed orally, after meals. Before use, the bottle should be shaken until a homogeneous emulsion is obtained. For precise dosage of the drug, the bottle should be held vertically during instillation. With increased gas formation and accumulation of gases in the gastrointestinal tract, children from the 28th day of life to 2 years are prescribed 8 drops (20 mg of simethicone) 4 times a day; children from 2 to 6 years old - 14 drops (35 mg of simethicone) 4 times a day; children over 6 years of age and adults - 16 drops (40 mg of simethicone) 4 times a day. For more convenient administration of the drug, in particular to young children, it can be pre-mixed with a small amount of cold boiled water, baby food or non-carbonated liquid. After the symptoms disappear, the drug should be discontinued.
3. (prevents the accumulation of gases in the intestines and promotes their discharge). Dosage regimen: newborns and children under 1 year: 1-2 sachets (5-10 g) per day in 2-3 doses; children after 2-3 months - up to 2 sachets per day. To prepare the solution, pour the contents of the sachet into a bottle or cup, add 100 ml of warm boiled water and stir until the granules are completely dissolved. Plantex is recommended for use as a means of background correction in children with infantile intestinal colic. The drug can be given to the child in several doses, both between meals and after meals.