Constipation in babies and children; Although it is known as not pooping, it does not only mean prolonging the defecation interval. Every baby and child has a defecation pattern that they are accustomed to. Disruption of this order, which varies depending on eating habits and age, and the sum of the subsequent findings are defined as constipation. In short, late (infrequent) defecation, difficult defecation and hard defecation for more than two months are called chronic constipation. Problems in the intestinal structure, congenital anatomical problems, familial intestinal slowness and wrong food selection, exaggerating milk consumption, constantly feeding solid food, not going to the toilet when necessary, children's fear of pain are the main causes of constipation in children.
Babies fed with breast milk. In the first days after birth, they can poop 7-10 times a day, and then 5-7 times. The number of defecations may be less or more. During this period, poop is watery and soft. However, it should be known that it is natural for babies, especially those who are breastfed, not to poop for periods of up to a week. In babies, as long as there is no excessive or bilious vomiting, significant abdominal distension, and a pause or regression in development, this situation should be considered normal and no treatment or intervention should be applied.
After the transition to feeding with solid foods, the stool becomes darker and begins to solidify. At the same time, the number of defecations also decreases. The number of defecations per day in a school-age child is 1-3, reaching the frequency seen in adults during adolescence.
Constipation; It may cause hard and painful defecation, tear/crack in the anus (anal fissure), blood in the stool, hiding and postponing defecation when there is a need to defecate, abdominal pain especially after meals, irregular nutrition and deterioration of toilet habits. . In fact, although these problems are the result of constipation, they can also be the reason for the onset of constipation in a child. For example, a tear in the anus for any reason may cause pain during defecation, which may cause the child to hold in his/her stool and cause constipation after a while. Long-term and applied treatments However, in case of recurrent constipation, some behavioral disorders may occur in the child. As a result, the most appropriate definition for constipation is the change in defecation habits and, accordingly, the emergence of the above-mentioned findings.
Problems caused by constipation in children:
1. Long defecation interval: It is the change in the normal defecation frequency. For example, the frequency of defecation of a child who poops once a day increases to 3-4 days. 2. Change in the quality of defecation: The stool loses its normal consistency and becomes harder. This situation usually changes depending on the change in the eating pattern.
3. Difficult and painful defecation: It is when the child strains himself, cries or feels pain during defecation. These children usually also have an anal fissure (tear).
4. Abdominal pain: Shortly after meals (about 10 minutes), the gastrocolic reflex begins and the intestines begin to move. This leads to the need to defecate. In cases of ongoing constipation, these bowel movements manifest themselves as cramp-like abdominal pain.
5. Blood in the stool: This is a condition that occurs due to hardened stool causing a tear in the anus. It is seen as fresh blood smeared in the stool.
6. Storing stool: It can be both the cause and the result of constipation. The most important reason is the fear that pain may occur during defecation. It may become a habit after a while. It is one of the most difficult problems to solve in treatment. The stagnant stool remains hardened in the last part of the intestine, and as it remains, more water is absorbed and becomes harder. The child then begins to leak poop little by little, and this condition is called "fecal incontinence". It is a sign of advanced constipation.
7. Constipation does not cause similar symptoms in every child. The severity and effects of complaints vary from child to child. It may not be easy to communicate with these children. Therefore, it is of no use to directly apply general rules in the treatment of constipation in children. Treatment methods that include "multiple approaches" for each child, based on the findings specific to that child should be implemented. This is the point where modern treatment has come today: Instead of applying the known standard treatment to each patient, applying specific treatment methods for each patient!
8. However, the treatment of constipation in children is a long-term and patient process that requires both physicians and parents. and should be kept in mind by adults. Discontinuing the treatment because there is no response or because the symptoms are gone may cause the symptoms to appear more intense than the first. A diet containing more fiber-containing foods and regular toilet habits are essential in the treatment of constipation. • 50% of cases under the age of five recover within one year, and 60-75% within two years. It is known that it persists until adolescence in one-third of school-age child cases.
Is it necessary to investigate patients with chronic constipation?
• 95% of the cases have functional (idiopathic) causes (cases in which organic causes need to be investigated, approximately one in 20 cases). ). There are no structural, endocrine or metabolic problems in these. • 5% of the cases have an organic cause. These are:
o If there is a history of constipation that started in newborn and early infancy
o Delayed passage of meconium
o Thin stools, blood in the stool, tight anal sphincter, empty rectum when touched
o If there is growth and development retardation
o Abdominal distension, ileus, bilious vomiting
o Decrease in lower extremity reflexes and tone, weakness of anal reflex, pilonidal dimple, absence of cremaster reflex
o Anteriorly located anus
Treatment:
The aim is to remove accumulated lumps and prevent re-accumulation. Treatment of functional constipation is long and relapses are common. Doctors should cooperate closely with the family when treating a constipated child.
How should babies and children be treated for constipation?
1. Being informed about nutrition is important. As a general rule, it is necessary to consume plenty of pulpy vegetables and fruits, and limit the consumption of bagged foods bought from grocery stores and markets.
2. Toilet training. Having the child sit on the toilet at appropriate times of the day so that the intestines can catch up with their cyclical rhythm. Providing the child with the opportunity to go to the toilet by sitting rather than squatting (toilet and age-appropriate toilet facilities). use of spelling). Using an adapter for the toilet and using steps to keep your feet on the ground. Also, in terms of the habit of spending time in the toilet, do not keep objects that may attract your attention, such as TV, toys, etc.
3. Treating anal fissure, if any, and taking precautions.
4. Emptying the accumulated poop with the help of ready-made enemas
5. Necessary and sufficient poop softening drug supplement to prevent the hardening of the stool in the intestine. The main point of the treatment is to continue the necessary treatment adequately. While medications are being used, it does not mean that the child's or baby's constipation is gone. Families should continue this long treatment with patience. The timing of medication reductions or discontinuation must be determined by the doctor.
As a result:
• Most of the applications due to chronic constipation are functional (idiopathic) constipation.
• Diagnostic examinations and treatment are required for organic constipation.
• Evidence of the effectiveness of constipation treatments is weak, treatment is largely based on clinical experience
• Childhood constipation is a long-term problem requiring treatment over months to years
• Half of the cases of chronic constipation, usually in children under 5 years of age, are diagnosed with one per year, three quarters recover within two years
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