One of the most common problems that arise in the first year of a child’s life is regurgitation. For most babies, regurgitation begins while they are still in the maternity hospital. According to statistics, about 70% of parents of children under 3.5-4 months of age face this problem.
Very often, a young mother is scared when she first sees her baby spit up milk. There is no need to worry too much about this: in the vast majority of cases, regurgitation is physiological, and occurs as a result of the structural features of the newborn baby’s body. They are not dangerous to the health and development of the baby. If you take certain measures to prevent the occurrence of such conditions, you can significantly reduce them, or even avoid them altogether.
Regurgitation is the mechanical entry of small volumes of milk from the stomach into the esophagus and oral cavity. As a rule, milk flows in a thin stream when regurgitated; undigested curdled lumps may occur - their appearance means that the milk has had time to curdle. Functional regurgitation is quite natural, and by a certain age it goes away on its own. The mother should not worry if they occur if the child is gaining weight well, and general health the baby is not getting worse.
The causes of physiological (functional) regurgitation may be the structure and maturation of the gastrointestinal tract in newborns, for example:
Such regurgitation completely disappears as they mature digestive system baby. This happens around the age of 4-5 months. Most often, children born are prone to this type of regurgitation. ahead of schedule and those with low birth weight.
In addition to the natural features of the development of the digestive organs, external factors that provoke the pushing of food into the esophagus can also lead to the appearance of regurgitation. These include:
All these reasons are removable and do not pose any danger to the life and development of the baby. However, it also happens that regurgitation that occurs after each feeding can be signs of quite dangerous diseases that require drug treatment. In some cases, surgical intervention may be necessary.
If your baby doesn’t feel well, cries during feeding, or spits up after every meal, you should consult a doctor. Sometimes such manifestations may be the first signs of disease or serious pathologies, which can only be eliminated through drug treatment.
What violations in children's body may cause regular regurgitation in infants:
Parents of first-born children are often frightened when faced with the phenomenon of regurgitation for the first time. Most people think that the baby is vomiting, and begin to call their relatives and friends in a panic, not knowing what to do. similar situation. To protect yourself from unnecessary stress and worry, you need to know how regurgitation differs from vomiting. The table below shows signs of both phenomena, knowing which you can always recognize what exactly bothered your baby.
Sign Regurgitation Vomit
Quantity No more than 2 tablespoons 2 tablespoons or more
Color White Milky, yellow (rarely green, brown)
Consistency Liquid, or with minor inclusions of curdled particles Curdled, thicker (compared to milk)
Frequency of occurrence 1 time after feeding (sometimes every) Unlimited number of times, at any time, regardless of feeding
Manifestation method A thin stream like a leak Fountain (several thrusts at a time)
Advice! To understand how much milk the baby has burped, you need to take a flannel diaper and pour 2 tablespoons of water onto it. Then compare the size of the damp spot on the diaper with the volume of undigested milk - they should be approximately the same.
This condition most often occurs in the first weeks of a newborn's life. Boys are susceptible to it more often than girls. It occurs as a result of the fact that the pylorus, located between the stomach and esophagus, does not block access between them well enough. Vomiting can occur not only immediately after feeding, but even during it. The contents of the stomach are released in small bursts, and its volume can reach the amount of milk eaten by the baby.
Children with this pathology must be registered with a pediatric surgeon and regularly undergo all necessary examinations.
Regurgitation causes a lot discomfort not only for the mother, but also for the child. The baby may get scared, because at such moments the breath is held. In addition, this causes discomfort to the digestive organs, causing additional suffering to the baby. What can be done to alleviate the baby’s condition and prevent the occurrence of such an unpleasant phenomenon:
If the measures taken do not help reduce the number of regurgitations, then the child is prescribed treatment medicines. Riabal can be used to eliminate spasms in the intestines. This is a fairly common drug and is often prescribed to children with similar problems. It is safe enough for use even in infancy.
If a child has problems with intestinal motility, the doctor may recommend Motilium or Coordinax. These are drugs belonging to the group of prokinetics. Their use has a positive effect on intestinal contractions, and in most cases can improve the condition of a small patient.
If the cause of regurgitation is serious enough and cannot be eliminated by using medications, surgery is prescribed.
Important! Never prescribe medications to your child yourself. Only a doctor can assess the baby’s condition and select a medicine that will not harm the child’s body.
Although in most cases the causes of regurgitation in newborns are quite harmless, you should contact your pediatrician if:
In all other cases, it is enough to closely monitor the baby’s well-being and take measures to prevent regurgitation. As a rule, this is enough, and after some time it unpleasant phenomenon goes away on its own.
If, nevertheless, the mother continues to worry and think that something is wrong with her baby, it is worth going to the children's clinic and showing the child to the pediatrician. In matters concerning children's health, it’s better to play it safe than to waste precious time and trigger the course of a serious illness.
The decision to highlight this problem was not accidental, because regurgitation is the most common reason for parents of infants turning to the pediatrician.
About 67% of 4-month-old children do this at least once a day. And in 86% of children in the first half of the year, this syndrome is a universal clinical manifestation of trouble upper sections gastrointestinal tract.
Vomiting is a complex reflex act during which the contents of the stomach are involuntarily expelled through the esophagus, pharynx and mouth. It is usually preceded by nausea, accompanied by paleness, weakness, dizziness, salivation, and sweating.
Regurgitation is a type of vomiting in children of the first year of life. This occurs due to the passive reflux of gastric contents into the pharynx and oral cavity. The child’s well-being is not affected. Frequency of spitting up and vomiting in children infancy explained by the structural features of their gastrointestinal tract:
Relatively short esophagus.
. The shape of the esophagus resembles a funnel, with its expansion facing upward.
. Mild physiological narrowing of the esophagus.
. Underdevelopment of the muscular sphincter at the entrance to the stomach (“open bottle”).
. Insufficient development of the muscular lining of the stomach, increased sensitivity mucous membrane.
Morphofunctional immaturity in to a greater extent is typical for premature babies, but to varying degrees it can also be present in babies born at term.
There are a huge number of reasons that cause regurgitation and vomiting. This may be a variant of the norm and, unfortunately, indicate a serious pathology.
Let's start with functional reasons, which are a variant of the norm:
Overfeeding or improper and disorderly feeding leads to stretching of the stomach and causes regurgitation in the baby.
. Gastroesophageal reflux is the involuntary reflux of gastric and gastrointestinal contents into the esophagus.
. Aerophagia is the swallowing of air during feeding. When the body is in a vertical position, the air bubble, released from the stomach, is not pushed out a large number of milk, mixture
. Flatulence - increased gas formation, intestinal colic increase blood pressure abdominal cavity, causing regurgitation.
. Inadequate selection of mixture.
. Rapid change in body position, especially after feeding.
. Tight swaddling.
Regarding pathological regurgitation that occurs due to organic reasons, then they can be called:
. Abnormalities of the gastrointestinal tract (pyloric stenosis, diaphragmatic hernia). Pyloric stenosis is a narrowing of the pyloric region of the stomach. This pathology appears 2-3 weeks after birth, more often in boys. The pattern of regurgitation is persistent, prolonged, and the baby quickly loses weight.
. Perinatal damage to the central nervous system ( severe course pregnancy and childbirth, low Apgar scores, increased intracranial pressure). The baby may experience anxiety, tremors of the arms and chin, and others. neurological symptoms.
. Infectious processes(sepsis, meningitis, hepatitis) are accompanied by a change in the general condition of the child - lethargy, change in skin color, monotonous crying.
. Hereditary disorders metabolism (phenylketonuria, galactosemia, adrenogenital syndrome).
. Kidney pathology ( renal failure).
In addition, the cause of vomiting in a baby can be poisoning with various substances.
However, most often the syndrome of regurgitation and vomiting in the first year of life is caused by perinatal encephalopathy (PEP). It occurs as a result of acute or chronic hypoxia(lack of oxygen) to the fetus and injuries during childbirth. This is the so-called vegetative-visceral dysfunction syndrome (VVDS).
Regurgitation and vomiting not only cause great concern for parents, they can also provoke the development of different problems in the baby: child underweight, metabolic disorders, development of inflammation of the esophagus - esophagitis. With persistent vomiting, the baby’s body loses a large amount of water, causing dehydration. The most dangerous complication is aspiration (entry of vomit into the respiratory tract), with possible development neonatal asphyxia and syndrome sudden death or aspiration pneumonia (inflammation of the lungs due to aspiration).
For babies in the first three months of life, the appearance of belching or regurgitation after eating, with feeling good and normal weight gain is a variant of the norm. This is based on the underdevelopment of anatomical structures characteristic of newborns. This picture occurs in 40 - 65% of healthy infants. In this case, as the body matures, regurgitation goes away on its own, only sometimes dietary correction is required to reduce its severity.
If even after this period the regurgitation is persistent, the child should be consulted with a pediatrician.
Modern aspects treatments directly depend on the cause of the syndrome, but there are general measures used for conservative treatment:
The baby should be fed in a semi-upright position, using breaks during which the baby should be held upright.
A good way to prevent regurgitation is to place the baby on his tummy before each meal.
During feeding, make sure that the baby does not rest his nose on your breast, or grab both the nipple and areola with his mouth. When artificial feeding, the nipple must be completely filled with milk.
At the end of feeding, keep the baby in an upright position until the air is released.
Eliminate factors that increase intra-abdominal pressure: tight swaddling, constipation. A nursing mother needs to exclude from her diet foods that increase flatulence (brown bread, legumes, cabbage, apples).
To eliminate regurgitation, therapeutic nutrition is used - “anti-reflux mixtures”. They contain an indigestible additive (thickener) in the form of natural dietary fiber, which is obtained from carob beans (gum). Once in the stomach, these fibers form a soft food clot, which mechanically prevents regurgitation. Further, moving through the intestines, the fibers take on water, increasing the viscosity of the intestinal contents, and peristalsis is stimulated mechanically. For data medicinal mixtures typical reduced content fat After all, it is known that fatty food delays gastric emptying.
The antireflux effect of the mixtures is also determined by the casein dominant. Its protein composition, or more precisely the ratio of whey proteins to casein, is also of great importance. In breast milk it is 60-70/40-30, in cow's milk - 20/80, in most adapted formulas - 60/40. An increase in casein dominance prevents regurgitation, forming a thick mass in the stomach.
The most modern mixtures that meet these requirements include “Nutrilon antireflux”, “Frisov”.
Functional disorders of the gastrointestinal tract may require drug treatment. Most effective medicines, which are used in pediatrics in the treatment of regurgitation and vomiting syndrome, are prokinetics. These include: cerucal, coordinax, motilium, debridate. Their action is to accelerate gastric emptying and enhance antropyloric motility.
Unfortunately, some defects of the gastrointestinal tract cannot be treated without surgical intervention. It is an unsuccessful treatment for gastroesophageal reflux, an abnormality of the gastrointestinal tract, intestinal obstruction, peritonitis of newborns. Surgical treatment carried out in specialized pediatric surgery centers.
In conclusion, I would like to emphasize once again that treating regurgitation and vomiting syndrome is an extremely difficult task. To solve it, a detailed examination of the child is necessary, identification of the specific cause of the syndrome and careful selection various methods treatment, the basis of which is the use of modern antireflux mixtures.
Department of Pediatrics
Educational and methodological manual
for students of pediatric faculties, interns, residents and pediatricians.
Regurgitation and vomiting syndrome in children
A universal clinical symptom complex of troubles in the upper gastrointestinal tract in newborns and children of the first year of life is the syndrome of vomiting and regurgitation. This syndrome occurs in approximately 86% of children in the first six months of life.
Vomiting is a complex neuro-reflex act, which has both a pathological significance and a protective, compensatory nature and is aimed at maintaining homeostasis and removing harmful substances from the body. Vomiting is usually preceded by nausea - an unpleasant, painless, subjective sensation, accompanied by vegetative-vascular reactions: paleness, weakness, dizziness, sweating, salivation. Vomiting is a complex reflex act, during which the involuntary ejection of stomach contents occurs through the esophagus, pharynx and mouth, while the pylorus contracts and the fundus of the stomach relaxes, the esophagus expands and shortens, a strong contraction of the diaphragm and abdominal muscles occurs, the glottis closes, the soft palate rises . Emptying of the stomach occurs due to repeated jerky contractions of the abdominal muscles, diaphragm, and stomach.
In infants, especially premature ones, vomit is often expelled through the mouth and nose, which is due to imperfect coordination of the components of the vomiting mechanism. This creates real threat aspiration of vomit, the occurrence of aspiration pneumonia, asphyxia.
Regurgitation is a type of vomiting in children of the first year of life, they occur without abdominal tension, are carried out as a result of passive reflux of gastric contents into the pharynx and oral cavity, and the child’s well-being is not disturbed.
The frequency of regurgitation and vomiting in infants is explained by anatomical and physiological characteristics.
It is known that in infants the esophagus is relatively short, its abdominal part is located 2 vertebrae higher than in adults and lies at the level of 8-9 degrees. vertebra. Poor development of the mucous membrane, muscles of the esophagus and the cardiac part of the stomach contributes to the insufficient expression of the angle of His, formed by the abdominal part of the esophagus and the adjacent wall of the fundus of the stomach. There is poor development of circular muscle fibers cardiac part of the stomach. As a result, the Gubarev valve, formed by a fold of the mucous membrane that protrudes into the cavity of the esophagus and prevents the return of food from the stomach, is almost not expressed. The same applies to the loop of Willis - a group of muscle fibers of the internal oblique muscle layer of the stomach, which does not completely cover the cardiac part of the stomach. As a result, the cardiac sphincter of the stomach in children is functionally defective, which can contribute to regurgitation of stomach contents into the esophagus. The lack of tight coverage of the esophagus by the legs of the diaphragm, impaired innervation with increased intragastric pressure, as well as the horizontal position of the stomach, high tone of the pyloric sphincter and physiological insufficiency of the cardia contribute to the ease of regurgitation and vomiting. Regurgitation and vomiting are much more common in children born prematurely.
In creating an antireflux mechanism (ARM), the lower esophageal sphincter (LES) is important (in addition to the diaphragmatic-esophageal ligament, Gubarev's fold, crura of the diaphragm, acute angle of His, and the length of the abdominal part of the esophagus). The LES is a separate morphofunctional formation, which is a muscular thickening formed by the muscles of the esophagus, has a special innervation, blood supply, and specific autonomous motor activity. The LES becomes most pronounced by the age of 1-3 years of life, and before this age all the anatomical structures that cause APM are weakly expressed.
The antireflux mechanism, in addition to anatomical structures, is determined by certain functions. “Esophageal clearance” is the ability for self-cleaning through propulsive contractions due to primary (autonomous) and secondary (during swallowing) peristalsis of the esophagus. Damage to the esophageal mucosa by aggressive reflux contents depends on the clearance time, the alkalizing effect of saliva and the tissue resistance of the esophageal mucosa.
studfiles.net
Both functionally and morphologically, the gastrointestinal tract of a newborn is immature. During sucking, air is often swallowed (aerophagia). In addition, the muscle and elastic fibers in the wall of the esophagus are poorly developed. All this contributes to the occurrence of regurgitation and vomiting.
A significant proportion of gastrointestinal diseases in newborns require surgical treatment. First of all, this concerns malformations of the gastrointestinal tract, which are accompanied by impaired intestinal patency.
This chapter provides information only about those gastrointestinal diseases that most often require drug therapy. These include regurgitation and vomiting syndrome and necrotizing enterocolitis.
Regurgitation and vomiting syndrome is divided into:
■ primary - caused by gastrointestinal diseases;
■ secondary - occurs with impaired brain function, infectious diseases, metabolic disorders.
In addition, there are organic (associated with malformations of the gastrointestinal tract) and functional syndrome of regurgitation and vomiting.
This subchapter discusses the most common variant of the syndrome - functional.
In the absence of diseases that can cause regurgitation and vomiting syndrome, the latter is usually caused by incomplete closure of the opening between the esophagus and stomach. Risk factors for this include flatulence, increased neuro-reflex excitability, etc.
The anatomical sphincter in the area of the transition of the esophagus to the stomach in newborns is not formed. Incomplete closure of the cardiac orifice is facilitated by disruption of the innervation of the lower part of the esophagus, as well as an increase in intra-abdominal and intragastric pressure.
An additional factor The risk is the development of esophagitis due to gastroesophageal reflux.
Regurgitation occurs soon after feeding, it is frequent and light. Possible insufficient weight gain.
Possible complications of regurgitation and vomiting syndrome include:
■ aspiration;
■ postnatal malnutrition.
The diagnosis is made based on clinical manifestations. If it is difficult to make a diagnosis, esophagogastroscopy is indicated.
Differential diagnosis is carried out between diseases that may be accompanied by the occurrence of regurgitation and vomiting syndrome.
Signs indicating possible organic damage, relate:
■ constant heavy regurgitation mixed with bile, accompanied by loss of body weight;
■ heavy general state child. Equivalent to regurgitation in children who are in critical condition and receiving minimal enteral nutrition, serves to increase the residual volume of fluid in the stomach. This circumstance should be taken into account when carrying out differential diagnosis With surgical diseases Gastrointestinal tract in this group of patients.
■ Position in bed with the head end elevated.
In critically ill newborns, proper care profuse regurgitation is usually not observed. Enteral and parenteral nutrition in such children is carried out in doses and individually; with enteral nutrition, bolus administration of mother's milk or an adapted milk formula (for hypogalactia) is preferable. Before each feeding, the presence of residual fluid in the stomach is determined and the dose of administered milk is adjusted in accordance with the results. Antiemetic drugs are prescribed: Domperidone orally 30 minutes before feeding 1 mg/kg/day in 3 divided doses, the duration of therapy is determined individually or Metoclopramide orally 30 minutes before feeding 1 mg/kg/day in 3 divided doses, the duration of therapy is determined individually.
Criteria for the effectiveness of treatment: reduction in the frequency and profuseness of regurgitation or its disappearance, sustainable weight gain.
The use of domperidone may be accompanied by constipation.
Considering that pylorospasm and spasm of the cardiac orifice are not typical for newborns (these conditions cause regurgitation at an older age, starting from the end of the 1st month of life), antispasmodics should not be used, especially in combination with antiemetic drugs.
Depends on the underlying disease.
IN AND. Kulakov, V.N. Serov
medbe.ru
Regurgitation and vomiting in newborns
Normally, a newborn baby burps 5 to 10 milliliters shortly after finishing feeding. The reason for vomiting and regurgitation in newborns is the swallowing of air during fast feeding. However, the baby may not burp for this reason. Also, regurgitation is a sign of overfeeding. In rare cases, a healthy newborn baby may vomit. Signs of a serious disorder are persistent vomiting, which is not combined with delays in the overall physical development of the baby. Causes may include serious infection, gastrointestinal obstruction, gastroesophageal reflux, neurological disorders such as tumors or meningitis, and disorders such as galactosemia or adrenogenital syndrome. Due to duodenal volvulus, intestinal obstruction or pyloric stenosis may develop. In older children, vomiting may be a sign of appendicitis or acute gastroenteritis.
Diagnosis of diseases is based on the volume and frequency of vomiting, diuresis, the presence of abdominal pain, the method of feeding the child, the nature and frequency of stool.
Since vomiting in a newborn baby can occur due to various reasons, then parents should carefully collect all kinds of information about the condition of other organs and systems. For example, the presence of diarrhea and vomiting indicates acute gastroenteritis. Fever may accompany the infection. If vomiting is a fountain, then this is a sign of pyloric stenosis or another obstructive disease. Vomit is greenish or yellow color indicates obstruction below the papilla of Vater. If vomiting is accompanied by strong crying of the child and there is no stool or stool like a currant vein, then this indicates intussusception. Respiratory symptoms, for example, stridor, shortness of breath and agitation can be a manifestation of gastroesophageal reflux. Neurological manifestations, as well as developmental delays, are signs of a central nervous system pathology in a child.
During a general examination of the child Special attention pays attention to signs of dehydration, such as drowsiness, tachycardia, dry mucous membranes, and appearance, general condition, indicators of psychological and physical development. Also general examination focuses on palpation and inspection of the abdomen. If a child is rapidly losing weight or not gaining it, then it is necessary to urgently find out the reason. Pyloric stenosis may be indicated by space-occupying formations that can be palpated in the epigastrium. Also, the presence of space-occupying formations in the abdominal cavity, as well as an enlarged abdomen, are considered a sign of a tumor or obstructive process. If the child is developmentally delayed, there may be a central nervous system disorder. On inflammatory process indicate painful sensations when feeling the abdomen.
If the child is developing well, then carry out additional examination no need. If the results of the examination and medical history indicate that there is a pathology in the child’s body, then the examination should be carried out without fail. Often the procedures include magnetic resonance imaging, computed tomography and radiography. Such an examination is required to detect the causes of gastrointestinal obstruction. The doctor may also prescribe intraesophageal H-metry and radiography of the upper gastrointestinal tract to diagnose reflux. If there is a possibility of disruption of the central nervous system, then they can do an MRI, CT and ultrasound of the brain. To identify an infection, you need to be tested, undergo a bacteriological examination and a special biochemical research blood to detect metabolic disorders.
Treatment of spitting up and vomiting
Is it necessary to treat vomiting and regurgitation in newborns? This is what we will now try to figure out. As a rule, regurgitation does not need to be treated. If the main reason is incorrect feeding, then doctors recommend using bottles with tight nipples and a smaller hole. After feeding the baby, you need to hold it in an upright position for a little while.
At nonspecific treatment vomiting, hydration should be included. Children who drink well can be served certain time small portions of electrolyte-containing liquids. In rare cases, internal rehydration may be necessary. The youngest children are usually not prescribed antiemetic drugs. More specific treatment vomiting is determined by its cause. If the diagnosis is reflux, then the child should raise the edge of the bed so that the head is always higher than the feet. It is also advisable to feed him thicker food. For this disorder, the doctor may prescribe prokinetics and antacids. Obstructive processes can only be cured operational methods.
Regurgitation in newborns in a video report by Dr. Komorowski
symptomlecheniye.ru
The decision to highlight this problem was not accidental, because regurgitation is the most common reason for parents of infants visiting a pediatrician. About 67% of 4-month-old children do this at least once a day. And in 86% of children in the first half of the year, this syndrome is a universal clinical manifestation of problems in the upper gastrointestinal tract. Vomiting is a complex reflex act during which the contents of the stomach are involuntarily expelled through the esophagus, pharynx and mouth. It is usually preceded by nausea, accompanied by paleness, weakness, dizziness, salivation, and sweating. Regurgitation is a type of vomiting in children of the first year of life. This occurs due to the passive reflux of gastric contents into the pharynx and oral cavity. The child’s well-being is not affected. The frequency of regurgitation and vomiting in infants is explained by the structural features of their gastrointestinal tract: Relatively short esophagus. The shape of the esophagus resembles a funnel, with its expansion facing upward. Mild physiological narrowing of the esophagus. Underdevelopment of the muscular sphincter at the entrance to the stomach (“open bottle”). Insufficient development of the muscular lining of the stomach, increased sensitivity of the mucous membrane. Morphofunctional immaturity is more typical for premature babies, but to varying degrees it can also be present in babies born at term. There are a huge number of reasons that cause regurgitation and vomiting. This may be a variant of the norm and, unfortunately, indicate a serious pathology. Let's start with the functional reasons, which are a variant of the norm: Overfeeding or improper and disorderly feeding leads to stretching of the stomach and causes regurgitation in the baby. Gastroesophageal reflux is the involuntary reflux of gastric and gastrointestinal contents into the esophagus. Aerophagia is the swallowing of air during feeding. When the body is in a vertical position, the air bubble, released from the stomach, pushes out a small amount of milk or mixture. Flatulence - increased gas formation, intestinal colic increases pressure in the abdominal cavity, causing regurgitation. Inadequate selection of mixture. Rapid change in body position, especially after feeding. Tight swaddling. As for pathological regurgitation that occurs for organic reasons, they can be caused by: Anomalies of the gastrointestinal tract (pyloric stenosis, diaphragmatic hernia). Pyloric stenosis is a narrowing of the pyloric region of the stomach. This pathology appears 2-3 weeks after birth, more often in boys. The pattern of regurgitation is persistent, prolonged, and the baby quickly loses weight. Perinatal damage to the central nervous system (severe pregnancy and childbirth, low Apgar scores, increased intracranial pressure). The baby may experience anxiety, tremors of the arms and chin, and other neurological symptoms. Infectious processes (sepsis, meningitis, hepatitis) are accompanied by changes in the general condition of the child - lethargy, changes in skin color, monotonous crying. Hereditary metabolic disorders (phenylketonuria, galactosemia, adrenogenital syndrome). Kidney pathology (renal failure). In addition, the cause of vomiting in a baby can be poisoning with various substances. However, most often the syndrome of regurgitation and vomiting in the first year of life is caused by perinatal encephalopathy (PEP). It occurs as a result of acute or chronic hypoxia (lack of oxygen) of the fetus and injuries during childbirth. This is the so-called vegetative-visceral dysfunction syndrome (VVDS). Regurgitation and vomiting not only cause great concern to parents, they can also provoke the development of various problems in the baby: child weight loss, metabolic disorders, the development of inflammation of the esophagus - esophagitis. With persistent vomiting, the baby’s body loses a large amount of water, causing dehydration. The most serious complication is aspiration (entry of vomit into the respiratory tract), with the possible development of newborn asphyxia and sudden death syndrome or aspiration pneumonia (pneumonia due to aspiration). For babies in the first three months of life, the appearance of belching or regurgitation after eating, with good health and normal weight gain, is a variant of the norm. This is based on the underdevelopment of anatomical structures characteristic of newborns. This picture occurs in 40–65% of healthy infants. In this case, as the body matures, regurgitation goes away on its own, only sometimes dietary correction is required to reduce its severity. If even after this period the regurgitation is persistent, the child should be consulted with a pediatrician. Modern aspects of treatment directly depend on the cause of the syndrome, but there are general measures used in conservative treatment: - Parents are recommended to increase the feeding frequency by 1 - 2 compared to age norm , accordingly reducing the amount of food. - Feed the baby in a semi-upright position, using breaks during which you need to hold the baby upright. - A good prevention of regurgitation is to place the baby on his tummy before each meal. - During feeding, make sure that the baby does not rest his nose on your breast, or grab both the nipple and areola with his mouth. When artificial feeding, the nipple must be completely filled with milk. - At the end of feeding, keep the baby in an upright position until the air leaves. - Eliminate factors that increase intra-abdominal pressure: tight swaddling, constipation. A nursing mother needs to exclude from her diet foods that increase flatulence (brown bread, legumes, cabbage, apples). - To eliminate regurgitation, therapeutic nutrition is used - “anti-reflux mixtures”. They contain an indigestible additive (thickener) in the form of natural dietary fiber, which is obtained from carob beans (gum). Once in the stomach, these fibers form a soft food clot, which mechanically prevents regurgitation. Further, moving through the intestines, the fibers take on water, increasing the viscosity of the intestinal contents, and peristalsis is stimulated mechanically. These medicinal mixtures are characterized by a low fat content. After all, it is known that fatty foods delay gastric emptying. The antireflux effect of the mixtures is also determined by the casein dominant. Its protein composition, or more precisely the ratio of whey proteins to casein, is also of great importance. In breast milk it is 60-70/40-30, in cow's milk - 20/80, in most adapted formulas - 60/40. An increase in casein dominance prevents regurgitation, forming a thick mass in the stomach. The most modern mixtures that meet these requirements include “Nutrilon antireflux”, “Frisov”. Functional disorders of the gastrointestinal tract may require drug treatment. The most effective drugs used in pediatrics for the treatment of regurgitation and vomiting syndrome are prokinetics. These include: cerucal, coordinax, motilium, debridate. Their action is to accelerate gastric emptying and enhance antropyloric motility. Unfortunately, some defects of the gastrointestinal tract cannot be treated without surgical intervention. This is an unsuccessful treatment for gastroesophageal reflux, gastrointestinal tract abnormalities, intestinal obstruction, and neonatal peritonitis. Surgical treatment is carried out in specialized pediatric surgery centers.
In conclusion, I would like to emphasize once again that treating regurgitation and vomiting syndrome is an extremely difficult task. To solve it, a detailed examination of the child is necessary, identification of the specific cause of the syndrome and careful selection of various treatment methods, the basis of which is the use of modern antireflux mixtures.
Correct and balanced diet A child's first year of life largely determines his future health. This is especially true for children with any illnesses. A fairly common problem in children in the first year of life is functional disorders of the gastrointestinal tract. They are associated with changes motor function and somatic sensitivity, with deviations in the secretory and absorption functions of the digestive system. Regurgitation syndrome occupies a significant place among these disorders.
Regurgitation syndrome refers to the reflux of stomach contents into the oral cavity. In this case, unlike vomiting, regurgitation of gastric contents occurs passively, without tension of the abdominal press and diaphragm, and is not accompanied by autonomic reactions (hypersalivation, pale face, tachycardia, cold extremities).
Regurgitation, which in some cases is observed in healthy newborns, is not in itself a sign of any disease. Persistent regurgitation in children in the first year of life may be associated with weakness of the lower esophageal sphincter and abnormal motility of the esophagus, which lead to spontaneous reflux of gastric contents into the esophagus.
Regurgitation in children of the first year of life and newborns can occur without organic changes in the gastrointestinal tract, as well as against their background.
Organic changes - the reasons leading to the occurrence of regurgitation are:
- pyloric stenosis;
- malformations of the gastrointestinal tract.
Regurgitation without organic changes in the gastrointestinal tract:
- rapid sucking, aerophagia, overfeeding, violation of feeding schedule, inadequate selection of formulas, etc.;
- perinatal damage to the central nervous system (CNS);
- early transition to thick foods;
- pylorospasm.
According to modern concepts, the intensity of regurgitation is assessed by five-point scale , reflecting the frequency and volume of regurgitation:
Persistent regurgitation can cause both pathological gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD).
If physiological regurgitation is usually observed during wakefulness, then pathological regurgitation most often occurs when the child is in a horizontal position.
Besides clinical picture, for the diagnosis of regurgitation are of great importance laboratory and instrumental examination methods. In some cases, only with their help can you install correct diagnosis and determine further treatment tactics.
24-hour intraesophageal pH-metry. It is the most informative method for this disease. This method allows you to identify the total number of reflux episodes, their duration, and the level of acidity in the esophagus. According to pH-metry, with functional regurgitation (regurgitation), the pH in the distal esophagus can be below 4, but not more than 1 hour daily (less than 4% of the total monitoring time); with GER, the pH in the distal esophagus reaches 4, exceeding 4 .2% of the total monitoring time, and in case of pathological reflux its duration exceeds 5 minutes.
Treatment of regurgitation in infants should be consistent and include a set of measures:
- conducting postural therapy;
- diet therapy, use of thickeners;
- use of drug therapy:
- prokinetics,
- H2-histamine receptor blockers,
- proton pump inhibitors;
- surgical methods treatment.
At the same time, psychological support and explanatory work carried out by the doctor with parents are of no small importance. This primarily helps to assess the effectiveness of the prescribed treatment, since an adequate assessment of the frequency and volume of regurgitation largely depends on correct understanding parents of the situation and the degree of their emotional comfort.
Postural therapy(changing the position of the child’s body) is aimed at reducing the reflux of gastric contents into the esophagus and should be carried out during the day, as well as at night. Feeding the child should occur in a sitting position, at an angle of 45-60 C. Holding the child after feeding should be at least 20-30 minutes.
A significant place in the treatment of regurgitation belongs to the highly effective method - diet therapy. The choice of diet therapy depends on the type of feeding the child is on.
At natural feeding You should continue breastfeeding. It should be remembered that even persistent regurgitation is not an indication for transferring a child to mixed or artificial feeding. To successfully treat regurgitation, it is necessary to create a calm environment for the mother and normalize the child’s feeding regimen, excluding overfeeding or aerophagia.
Regurgitation and GER may be manifestations food intolerance. In this case, the mother should be prescribed a hypoallergenic diet.
In case of persistent regurgitation or lack of effect from the therapy, it is permissible to use thickeners breast milk(for example, "BIO-Rice water".
For children older than 1-2 months. it is permissible to use denser foods - dairy-free rice porridge, added in the amount of 1 teaspoon. The presence of a thickener provides greater viscosity of the mixture, as a result of which it stays in the stomach longer. This leads to swelling of the stomach contents and increased pressure from the food gruel on the muscular sphincter at the outlet of the stomach, which promotes its opening. The effect of gravity on food bolus prevents it from being thrown back from the stomach into the esophagus, and all this together leads to the normal progressive movement of food through the digestive tube and the cessation of regurgitation.
IN in this case It is also necessary to evaluate the child’s diet: the volume and quality of the artificial formula used. The child should receive an adapted milk formula in a volume appropriate for his age.
If there is no effect from the main measures (postural therapy, establishing a feeding regimen), it is necessary to decide on the appointment of a specialized anti-reflux mixture. A special feature of this group of mixtures is the presence of a thickener in their composition, which increases their viscosity.
Depending on the type of thickener, anti-reflux mixtures are divided into two groups:
It also has a certain significance ratio of whey protein to casein in the mixture. It is known that casein in the stomach forms a denser clot and enhances the effect of the thickener (locust bean gum or starch). Similar casein-predominant mixtures are “Nutrilon antireflux” and “Enfamil AR”.
When choosing an antireflux mixture, you should use differentiated approach. Most pronounced clinical effect observed when using mixtures containing gum. They can be recommended either in full or partially, as a replacement for part of the feeding. In this case, the amount of mixture needed by the child is determined by the onset of the therapeutic effect. The duration of use of these mixtures is on average 3-4 weeks.
Artificial mixtures containing as a thickener starch, act “softer”. They are indicated for children with mild forms of regurgitation (1-3 points) both with normal stool and with a tendency to unstable stool. They are recommended to be prescribed to completely replace the previously obtained mixture. The duration of their use is somewhat longer than when using gum-containing artificial mixtures.
Drug treatment. If diet therapy is ineffective, it is prescribed drug therapy, combined with the continued use of a therapeutic antireflux mixture.
The prescribed groups of medications include the following:
1. Antacids(Phosphalugel, Maalox). These drugs are prescribed in a dose of 1/4 sachet or 1 teaspoon after each feeding - for children under 6 months; 1/2 sachet or 2 teaspoons after each feeding - for children 6-12 months. The course of treatment is 10-21 days.
2. Prokinetics:
- metoclopramide (Cerucal, Reglan);
- cisapride (Prepulsid, Coordinax);
- domperidone (Motilium).
The course of treatment with prokinetics is 10-14 days. They are prescribed at a dose of 0.25 mg/kg 3-4 times a day 30-60 minutes before meals. However, you should remember side effects of this group of drugs, limiting their use in pediatric practice.
Metoclopramide drugs have a pronounced central effect (pseudobulbar disorders have been described) and are not recommended for use in infants with regurgitation syndrome.
When using cisapride drugs, prolongation of the QT interval on the electrocardiogram (ECG) in children has been described, which serves as a limitation on the use of such drugs.
In practice, the best result and small by-effect gives the drug "Motilium" (domperidone), produced in a convenient form for giving to children early age- in syrup. The drug affects intestinal motility and, thus, accelerates the passage of both gastric and intestinal contents, which leads to faster gastric emptying and, accordingly, to the absence of regurgitation.
3. H2 receptor blockers. They are the drugs of choice in the presence of pathological GER, manifested by regurgitation. Recommended doses: Ranitidine 5-10 mg/kg per day, Famotidine 1 mg/kg per day. Duration of treatment is up to 3 months with gradual withdrawal of drugs.
Thus, regurgitation syndrome in children of the first year of life is a common problem. Diet therapy plays a significant role in the treatment of these conditions. Adequate and timely recommendations for feeding a child with regurgitation syndrome avoid possible complications and ensure normal growth and development of the child.
E.A. Gordeeva, candidate medical sciences
T.N. Sorvacheva, Doctor of Medical Sciences RMAPO, Moscow
Professor G.N. Chumakova, Associate Professor T.L. Shiryaeva, Associate Professor A.A. Usynina
Department of Neonatology and Perinatology, Northern State Medical University
Vomiting is a powerful, (produced with effort) act of expelling gastric contents through the mouth. Vomiting is a highly coordinated act in which the pyloric region of the stomach and epiglottis closes, the stomach, esophagogastric junction and esophagus relax, and the muscles of the diaphragm and anterior abdominal wall. The medullary vomiting center coordinates this complex process. Afferent stimuli to this center that can cause vomiting come from various parts of the body, including pelvic organs and abdominal organs and peritoneum, genitourinary system, larynx, heart. The medullary zone at the base of the 4th ventricle may be irritated as a result of metabolic disorders, ingestion various medications, sending afferent impulses to the center of vomiting.
It is necessary to distinguish from vomiting regurgitation, which is understood as reflux (reflux) of the contents of the esophagus or stomach into the oral cavity, occurring without effort.
Regurgitation and vomiting most often occur during the first two weeks of life.
Causes:
A. Variant of the norm
B. Gastroesophageal reflux
B. Stenosis, esophageal atresia
G. Achalasia
D. Congenital intestinal obstruction
1. stenosis, intestinal atresia
2. incomplete intestinal rotation
3. meconium ileus
4. meconium impaction
5. Hirschsprung's disease
6. anal atresia
7. Duplication of intestines
E. Other gastrointestinal pathology
1. necrotizing enterocolitis
2. allergy to cow's milk
3. lactobezoar
4. intestinal perforation with secondary peritonitis
G. Neurological pathology
1. subdural hematoma
2. hydrocephalus
3. cerebral edema
4. kernicterus
Z. Renal pathology
1. obstructive uropathy
2. kidney failure
I. Infections
1. meningitis
2. sepsis
K. Metabolic disorders
1. phenylketonuria, galactosemia
2. congenital adrenal hyperplasia
Gastroesophageal REFLUX
1. Diagnostics: frequent vomiting from the first days of life at the time of feeding or shortly after it + curdled or unchanged milk in the vomit, sometimes an admixture of blood + malnutrition + hypochromic anemia + often bronchitis and pneumonia + throwing contrast agent into the esophagus with a contrast X-ray examination in the Trendelenburg position + signs of peptic esophagitis are possible during esophagoscopy.
2. Tactics
establishing a diagnosis. Constantly elevated position of the child. Fractional feeding with thick mixtures. Sedative, antacid drugs. If treatment is unsuccessful and esophagitis is present, transfer to surgery department.
ESOPHAGAL ATRESIA
1. Diagnosis: often pregnancy with polyhydramnios, foamy discharge from the mouth and nose + a feeling of obstruction or the appearance of a catheter in the oral cavity when probing the esophagus to a depth of 24 cm from the gum line + breathing problems and cyanosis when trying to feed + moist rales of different sizes + “blind” the upper segment of the esophagus on a radiograph with a contrast agent or a radiopaque catheter + the presence (absence) of gas in gastrointestinal tract.
2. Tactics:
To exclude esophageal atresia, probing of the esophagus of a newborn child is performed in the maternity hospital. Stop feeding. Suction the contents of the oropharynx after 5-15 minutes. Transportation to a specialized pediatric surgery center accompanied by a doctor.
HIGH CONGENITAL INTESTINAL OBSTRUCTION
1. Diagnostics: vomiting from the first day of life (with an obstruction below the papilla of Vater, vomit is colored with bile) + repeated vomiting, the volume exceeds the number adopted by the child milk + scanty meconium stool + lethargy + progressive loss of body weight + dehydration + sunken abdomen with swelling in the epigastrium (disappears after vomiting) + two gas bubbles from the horizon. fluid levels on plain radiographs + aspiration. pneumonia + hypochloremia, hyponatremia, hypokalemia, increased hematocrit.
2. Tactics
clinical and x-ray examination in the maternity hospital. Nasogastric tube. Transfer of a child to a specialized children's center
surgery.
LOW CONGENITAL INTESTINAL OBSTRUCTION
1. Diagnostic key: absence of meconium + vomiting for 2-3 days, vomit is colored with bile, colibacillary odor + motor restlessness + increasing adynamia + gray-sallow skin color + progressive bloating + visible peristalsis of distended intestinal loops + pain on palpation of the abdomen. Complications - perforated fecal peritonitis. Distended bowel loops with multiple uneven horizontal levels on radiographs.
2. Tactics
upon diagnosis, transfer to a specialized pediatric surgery center.
ACUTE FORM OF HIRSPRUNG'S DISEASE
1.Diagnostics: delay or absence of stool from the first days of life + progressive bloating + visible intestinal peristalsis + profuse vomiting + low effectiveness of enemas + on radiographs, expansion of the lumen of the colon with the presence of a narrowed zone of aganglionosis.
2. Tactics:
in the maternity hospital clinical examination and plain radiograph. An attempt to resolve the obstruction with enemas with a 1% solution table salt. Transfer to a specialized children's department (DCU).
PERITONITIS OF NEWBORNS
1. Diagnostics: sharp deterioration general condition + adynamia + grayish-pale skin + severe bloating + vomiting + pain on palpation + absence of perilstatics + swelling and hyperemia of the anterior abdominal wall + pronounced venous network on the abdomen + swelling of the genital organs. With perforation of a hollow organ - disappearance of hepatic dullness, free gas under the diaphragm on a survey radiograph taken in a vertical position.
2. Tactics:
if there is a threat of peritonitis, intensive infusion therapy and antibiotic therapy are indicated. Nasogastric tube. Transfer to DRL.
NEUROLOGICAL PATHOLOGY (SUBDURAL HEMATOMA, HYDROCEPHALUS, CEREBRAL EDEMA)
Diagnosis: medical history, severe general condition + lethargy or agitation + bulging large fontanel + eye symptoms+ vomiting + changes in muscle tone + impaired consciousness + rapid increase in head circumference. During NSG examination, changes characteristic of each pathological condition are detected; with lumbar puncture, increased intracranial pressure is detected. Diagnosis can be made using computed tomography and nuclear magnetic resonance.
Tactics:
Prescribing diuretics for dehydration. Puncture of the hematoma for the purpose of aspiration of blood. Lumbar puncture and bypass surgery.
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