The reasons for such violations are diverse. But they are based on the functional immaturity of children's digestive system one . With age, the situation aggravates the development of a psychological response to the child. Many families are the so-called "psychological constipation" or "potted syndrome", which develops in shy children, begin to attend kindergarten, or in cases if the act of defecation is associated with pain.

How do functional intestinal disorders manifest

Disorders of this group are very common. It is known, for example, that abdominal pain in children in 95% of cases is caused by functional disorders 2.

These include:

• functional constipation, meteorism and diarrhea;
• infant colic and jeeping;
• SRK or irritable bowel syndrome;
• cyclic vomiting syndrome and others 1.

For the manifestations of these ailments are characterized by a long time and repeatability. They can all be accompanied by pain in the stomach, and painfulness They are manifested in different ways - from stupid nunts to pariety, sharp 2.

Due to the variety of symptoms, diagnose functional disorders is quite difficult 2.

Treatment of functional disorder of digestion in children

It is known that the basis of the optimal activity of the digestive tract is the power mode. Therefore, the first step in the treatment should be the correction of the nutrition of 1 child. It should be directed at 1:

• food mode - regular food intake ensures the balanced operation of the entire digestive tract;
• the diet is the introduction to the diet of products rich in prebiotics, that is, food fibers, poly- and oligosaccharides that contribute to the normalization of the intestinal protective microflora.

This simple tactic contributes to the restoration of the normal intestine function and maintain its own microflora.

For the normalization of digestion, children's dietary supplements can be used, for example - natural Prebiotic In the form of bears with fruit flavor. Duplempica naturally support a healthy bowel microflora balance, contributing to the growth of their own beneficial bacteria. Thus, Duplemps help the digestion and the proper purpose of the intestine, and also contribute to a regular chair from a child.

1. Dubrovskaya M.I. Modern condition Problems of functional disorders of the digestive tract in children early age // Questions of modern pediatrics 12 (4), 2013. SS. 26-31.
2. Havkin A.I., Zhikhareva N.S. Functional diseases of the intestines in children // RMW. 2002. №2. P. 78.

Because of stresses, many people may have functional disorders associated with the gastrointestinal tract. They are treated quickly and without much difficulty, but their ignoring can lead to serious consequences. Next, let's talk about the symptoms, causes and methods of therapy.

Functions GTC

Before considering the most popular functional disorders of the gastrointestinal tract in children and adults, it is necessary to understand what options this system is performed.

Most often pathology are associated with the problems of digestion. Most of them are not characterized by any organic changes in the type of infections, tumors, and so on. To understand the reasons for disorders, you should know all the assumptions of the gastrointestinal options. Consider them.

• Motor. It allows you to chew, swallow, move food through the body and remove non-digestive residues. This function is carried out by musculature.
• Absorption. It provides consumption of all nutrients into blood and lymph through the special walls of the path.
• Excretory. Thanks to this function, various substances of the exchange products are derived to the gastache cavity. It may be ammonia, salt, and so on. After time, they are completely derived from the body.
• Sector. This feature allows you to produce gastric juice, saliva, bile and so on.

Each of the gastrointestinal departments fulfills its special purpose. When functional early age occurs in adults, all options are knocked down. As a result, the person appears unpleasant symptoms. During the examination, the specialist does not find pathological disorders or changes in the bodies. It is in this case that we are talking about functional problems.

General symptoms

In order for a person to have such problems, he should adhere to all preventive recommendations. Functional disorders of the gastrointestinal tract in children, the clinical manifestations of which will be considered further, and in adults have general indicators. We describe them.

The most common symptoms is the pain in the intestines, the stomach and in some other organs. Often, heartburn may occur. It becomes an indicator of changes in the level of acidity in the stomach.

Another symptom consider pain for the sternum. However, she says not only about problems with the gastrointestinal tract, but also the hearts. Express, bloating, nausea, comes in the throat - common symptoms. But they may also testify about other pathologies, since they are popular manifestations.

Causes of disorders in the gastrointestinal

For various reasons, functional disorders of the gastrointestinal tract can appear. Code on ICD-10: from k00 to k93. These classes combine all the problems associated with the digestive tract.

It should be noted that modern methods The diagnosis was allowed to identify the following fact: the problems with the motor activity of the tract of the tract in no way affect the functions of the system itself. In the 80s of the last century, a theory appeared that a psychogenic factor had an impact on the state of the tract. However, most of the patients who have identified such pathology did not arise any mental problems. That is why, in modern times, one of the main reasons is disturbances of perception of a certain type of impulse sent. A person can realize them as pain. Such a reaction can cause any disease nervous system. Functional disorders of the gastrointestinal tract may occur due to bad habits, stress, medication reception and so on.

The most popular problems

Wested problems is shrinking. If we talk about heavier symptoms, laryngitis, pharyngitis, bronchitis, pneumonia can occur, pneumonia and so on. This problem is manifested by the fact that the contents of the stomach are thrown into the esophagus.

Frequent functional disorder of the gastrointestinal tract (Code of MBC-10: K30) is dyspepsia. It is characterized by pain in the opposite region, as well as other unpleasant sensations. Most often, this disease arises due to problems with the motor function, which appear at the upper parts of the path.

Another popular syndrome - because of it there is a meteorism, a rumbling, diarrhea and constipation. Such symptoms are formed due to problems with the nervous system and hormones.

Reflux disease

This ailment may appear due to hernia, increase pressure, consumption of a large amount of oily food, reducing the tone of the esophagus. The problem is manifested by heartburn, belching, pain. A pressure may also appear, which occurs after meals. That is why it is important not to drink alcoholic, juices and carbonated water.

In case of running cases, dysphagia, breast pressure, vomiting and salivary selection occurs in the patient. Porous sensations can be given in hand, neck, back and so on.

The most popular problem is the manifestation of reflux without the formation of esophagitis. For diagnostics can be used tools such as general analysis urine, test for certain bacteria, abdominal ultrasound and others. To eliminate serious pathologies, you should also visit the cardiologist, pulmonic, Laura and Surgeon.

Treatment of problems is carried out on the basis of symptoms. Nitrates, theophylline, calcium and beta-blockers may be prescribed. If the patient has a power mode, then the diet should be started. It is necessary to consume vegetables, eggs, fruits, especially those that contain vitamin A. Drinks and products that provide an absorbent effect should be excluded. You need to eat six times a day in small portions. After the meal, you should relax, do not exercise and do not tilt the body.

Functional dyspepsia

It should be considered separately to consider such a functional disorder of the gastrointestinal tract as dyspepsia. Opidel possible manifestations illness.

In the presence of a discnetic form, a person has a sense of early saturation, the recession of the gastrointestinal tract, as well as bloody. Sometimes nausea can appear. In the non-specific form of the disease, a wide variety of symptoms (not a consistent offer) are capable of occurring. Most likely, they will all be rather common as manifestations of other pathologies. Treatment depends on complaints of a particular patient.

Diagnosis is carried out special measures that allow you to distinguish functional dyspepsia from biological. Rental for the analysis of the feces, blood, the body is checked for the presence of infections. Also should be sent to the study of the feces to check whether Lymph is available in them.

If there is a need for medication treatment, then the patient is prescribed special therapy, designed for two months. Most often antibiotics adsorbing, antisecretory and prokinetic preparations are prescribed. It should be noted that the total tactics of treatment does not exist. It completely depends on the symptoms that must be stopped, and the reasons.

General treatments

In order to cure the functional disorders of the gastrointestinal disorders, it is necessary to spend thorough diagnosis and exclude any organic changes. The complexity of therapy is that all such problems may have a large number of causes and various symptoms.

The doctor gives such recommendations: abandon the bad habits, stop accepting medicines that can affect the work of the gastrointestinal tract, start abide by the diet. If the patient has problems with the psychological condition (depression or hypochondria), the specialist has the right to write anxiolytic and other drugs of this group.

Violations of the stomach

The stomach problems are also included in the list of functional disorders of the gastrointestinal tract. (MKB-10: K31). They include a huge number of pathologies that affect features such as motor skills and secretory. In this case, no major changes are fixed. Symptoms of dyspepsia can appear, as well as pain. In order to diagnose, various measures are prescribed, for example, sensing, ultrasound or x-ray. Treatment is only medication. The power mode and rejection of bad habits play a big role.

Treatment of problems with stomach

Therapy is completely dependent on the reason for the appearance of a functional disorder of the gastrointestinal tract and separately stomach itself. Also taken into account I. clinical features. It is necessary to change the power mode. Food should be taken four times a day. One of them should be accompanied by the use of a hot liquid dish. It is necessary to abandon those products that are capable of irritating the mucous membrane. We are talking about pickled, greasy, sharp dishes. Most often, when identifying such problems in a patient, they are quickly solved in whole or in part precisely adjusting the diet and power mode. Often in such situations there are even no need for medication treatment.

If the patient has neurovetative functional disorders of the gastrointestinal tract and stomach, they can be eliminated by taking cholinolithics with a sedative effect. Tranquilizers, phytopreparations help well. In the most difficult cases, antidepressants are prescribed.

If you need to remove the pain effect and restore the motor option, you should drink antispasmodics.

Forecast

If there are functional disorders of the gastrointestinal tract (ICD code is written above in the article), as a rule, the forecast is favorable. The main thing is to diagnose the diagnosis on time and begin treatment. It is important to work on your meal. You should get rid of stress, as well as more rest. If the problem arose in adolescence, then it will most likely take place within two or three years. This is due to the fact that on the basis of hormonal restructuring the neareegetative system begins to work badly.

If it does not start treatment and run the problem in time, then more serious consequences may occur. Provocateurs are violation of the power mode, stress.

RESULTS

As it is clear from the above information, so that such problems do not arise, you should keep a healthy lifestyle, abandon the wrong nutrition and avoid stressful situations. Sometimes functional disorders can appear in adolescents due to the change of hormonal background in the body.

Functional disorders of gastrointestinal intestinal tract (GCC) represent one of the most widespread problems among the children of the first months of life. A distinctive feature of these states is the appearance of clinical symptoms in the absence of any organic changes from the gastrointestinal tract (structural anomalies, inflammatory changes, infections or tumors) and metabolic deviations. With functional disorders, the GTS can change the motor function, digestion and suction of food substances, as well as the composition of intestinal microbiota and activity immune system . The causes of functional disorders often lie outside the affected organ and are due to a violation of the nervous and humoral regulation of the activity of the digestive tract.

In accordance with Roman Criteria III, proposed by the Committee on the Study of Functional Disorders in Children and International working Group According to the development of criteria for functional disorders in 2006, the functional disorders of the gastrointestinal tract among infants and children of the second year of life include:

• G1. Jumping in babies.
• G2. Ruminance syndrome in babies.
• G3. Cyclic vomiting syndrome.
• G4. Colic newborns.
• G5. Functional diarrhea.
• G6. Soreness and difficulties of defecation (Dishesia) in babies.
• G7. Functional constipation.

Children in breast-age, especially the first 6 months of life, most often meet such states as jeeping, intestinal colic and functional constipation. More than half of children, they are observed in various combinations, less often - as one isolated symptom. Since the reasons leading to functional disorders have an impact on various processes in the gastrointestinal tract, the combination of symptoms in one child seems to be quite natural. Thus, after transferred hypoxia, there may be vegetable visual disorders with a change in motility using hyper-or hypotonic type and violation of regulatory peptides, leading simultaneously to jerking (as a result of spasm or sphincter gaping), coliks (dysfunction of the gastrointestinal tract increased gas formation) and constipation (hypotonic or due to spasms of the intestine). The clinical picture exacerbates the symptoms associated with a disruption of digestion of nutrients caused by a decrease in the enzymatic activity of the affected enterocyte, and leading to a change in the intestinal microbiocenosis.

The reasons for the functional disorders of the gastrointestinal tract can be divided into two groups: tied with mother and related child.

The first group of reasons include:

• burdened obstetric history;
• emotional lability of women and stressful furnishings in the family;
• error in nutrition in a nursing mother;
• violation of feeding and cropping equipment with natural and artificial feeding;
• incorrect breeding of dairy mixes;
• woman smoking.

The reasons associated with the child are to:

• anatomical and functional immaturity of the digestive organs (short abdominal diversity of the esophagus, insufficiency of sphincter, reduced enzymatic activity, non-uncomordinated work of the tract of the tract and other);
• violation of the regulation of the work gastrointestinal tract due to the immaturity of the central and peripheral nervous system (intestines);
• features of the formation of intestinal microbiota;
• formation of rhythm sleep / wakefulness.

Frequent and most serious reasons leading to the occurrence of jeeping, colic and violations of the character of the chair are transmitted hypoxia (vegetual manifestations of cerebral ischemia), partial lactase insufficiency and gastrointestinal form of food allergies. Often in one or another severity, they are observed in one child, since the consequences of hypoxia are to reduce the activity of enzymes and an increase in permeability thin gut.

Under jeeping (regurgitation), they understand the spontaneous cast of gastric content in the esophagus and the oral cavity.

The frequency of shinking syndrome in children of the first year of life, according to a number of researchers, ranges from 18% to 50%. Preferably, the tights are noted in the first 4-5 months of life, much less often observed at the age of 6-7 months, after the introduction of more thick foods - food products, practically disappearing by the end of the first year of life, when the child spends a considerable part of the time in a vertical position (sitting or standing).

The degree of severity of the syndrome, according to the recommendations of the ESPGHAN expert group, was proposed to be estimated on a five-point scale reflecting the total characteristic of the frequency and the volume of regurgitation (Table 1).

Infertuous and inhums are not regarded as a disease, since they do not cause changes in the state of children's health. In children with stubborn joins (estimation from 3 to 5 points), complications are often noted, such as esophagitis, lagging in physical development, iron-deficiency anemia, diseases of ENT organs. Clinical manifestations of esophagitis are a decrease in appetite, dysphagia and witnessing voice.

The next, frequently found functional disorder of the gastrointestinal tract in breast-age children is intestinal colic - these are episodes of painful crying and anxiety of a child who take at least 3 hours a day, arise at least 3 times a week. Usually their debut falls for 2-3 weeks of life, they reach the climax on the second month, gradually disappearing after 3-4 months. The most typical time for intestinal colic - evening hours. Crying attacks arise and end suddenly, without any external provoking reasons.

The frequency of intestinal colic, according to different data, is from 20% to 70%. Despite the long period of study, the etiology of intestinal colic remains not quite clear.

For intestinal colic, a sharp painful crying is characterized, accompanied by redness of the face, the child takes a forced position by pressing the legs to the stomach, there are difficulties with the experience of gases and stool. Noticeable relief occurs after defecation.

Episodes of intestinal colic cause serious concern for parents, even if the child's appetite is not broken, it has normal indicators The weight curve, grows well and develops.

Intestinal colic is almost the same with the same frequency both on natural and artificial feeding. It is noted that the smaller the body's mass at the birth and gestational age of the child, the higher the risk of developing this state.

In recent years, great attention is paid to the role of intestinal microflora in the occurrence of colic. Thus, in children with these functional disorders, changes in the composition of intestinal microbiotes are identified, characterized by an increase in the number of conditionally pathogenic microorganisms and a decrease in protective flora - bifidobacteria and especially lactobacilli. Increased growth of proteolytic anaerobic microflora is accompanied by gases with potential cytotoxicity. In children with pronounced intestinal colic, the level of inflammatory protein is often rising - calcrottin.

Functional constipation relate to the number of common disorders of the intestinal function and are detected in 20-35% of the first year of life.

Under constipation, the increase in the intervals between the acts of defecation compared with the individual physical and logical norm of more than 36 hours and / or systematically incomplete intestinal emptying.

The frequency of the chair in children is considered normal if between the ages of 0 to 4 months occurs from 7 to 1 act of defecation per day, from 4 months to 2 years from 3 to 1 intestinal emptying. Baby defecation disorders also include dishensias - painful defecation due to the muscle dissigation of the bottom of the small pelvis, and the functional stool delay, for which the increase in the intervals between acts of defecation, combined with the feces of soft consistency, large diameter and volume.

In the mechanism of development of constipation in infants, the role of diskinesia of the colon is great. Most frequent cause The emergence of constipation in children of the first year of life are alimentary violations.

The absence of a clearly defined boundary between functional disorders and pathological conditions, as well as the presence of remote consequences (chronic inflammatory gastroenterological diseases, chronic constipation, allergic diseases, sleep disorders, violations in the psycho-emotional sphere, etc.) dictate the need for attentive approach to the diagnosis and therapy of these states.

Treatment of breast-age children with functional disorders of the GTS is complex and includes a number of consecutive steps that are:

• explanatory work and psychological support of parents;
• diet and therapy;
• drug therapy (pathogenetic and fairrome);
• non-drug treatment: therapeutic massage, water exercises, dry immersion, music therapy, aromatherapy, aeroionotherapy.

The presence of jagging dictates the need to use symptomatic positional (postural) therapy - a change in the position of the child's body aimed at reducing the degree of reflux and facilitating the purification of the esophagus from gastric content, thereby decreases the risk of esophagitis and aspiration pneumonia. It follows to feed the child in the sitting position, when the body is positioned at an angle of 45-60 °. After feeding, it is recommended to hold a child in a vertical position, and sufficiently long, until air removes, not less than 20-30 minutes. Postural treatment must be carried out not only throughout the day, but at night, when the purification of the lower esophageal department is disturbed from aspirate due to the lack of peristaltic waves (caused by the act of swallowing) and the neutralizing effect of saliva.

The leading role in the treatment of functional disorders of the gastrointestinal tract in children belongs to therapeutic nutrition. The appointment of dietotherapy, first of all, depends on the type of breaming of the child.

With natural feeding, first of all, it is necessary to create a quiet environment for a nursing mother, aimed at preserving lactation, to normalize the course of feeding the child, excluding stubble and aerophage. From the power of the mother exclude products that increase gas formation in the intestines (sweets: confectionery, tea with milk, grapes, cottage cheese and cheese, non-alcoholic sweet drinks) and rich extractive substances (meat and fish broths, onions, garlic, canned, marinades, pickles , sausages).

According to a number of authors, the functional disorders of the gastrointestinal tract can occur as a result of food intolerance, most often allergic to proteins of cow's milk. In such cases, a hypoallergenic diet is prescribed, solid cow's milk and products with high allergizing potential are excluded from its diet.

In the process of organizing diet and therapy, it is necessary to exclude the reaches of the child, especially with free feeding.

In the absence of the effect of the above-described activities, "thickeners" use (for example, bio-rice decoction), which are bred and allowed from spoons before breastfeeding.

It must be remembered that even pronounced functional disorders of the GTS are not an indication for transferring a child to mixed or artificial feeding. The preservation of symptoms is an indication for an additional in-depth child survey.

With artificial feeding, it is necessary to pay attention to the feeding mode of the child, on the adequacy of the choice of the dairy mixture corresponding to the functional characteristics of its digestive system, as well as its volume. It is advisable to administer to the diet of adapted dairy products enriched with pre- and probiotics, as well as fermented milk mixtures: Agush Equiphertic 1 and 2, Nan fermencular 1 and 2, non-random milk, non-racc. In the absence of effect, products are used, specially created for children with functional disorders of the gastrointestinal tract: Nan Comfort, Nutrilon Comfort 1 and 2, Friesova 1 and 2, Human AR, etc.

If the violations are due to lactase insufficiency, the child is gradually introduced by lactose mixtures. During food allergies, specialized products based on highly hydrolyzed milk protein can be recommended. Since one of the reasons for joins, colic and violations of the character of the chair is neurological disorders due to perinatal damage to the central nervous system, the dietary correction must be combined with drug treatment, which is appointed by a child neurologist.

Both with artificial, and with natural feeding between feeding, it is advisable to offer child drinking water, especially with a tendency to constipate.

Special attention is paid to children with syndrome of jigging. In the absence of an effect on the use of standard milk mixtures, it is advisable to prescribe antirefluxic products (ar-mixtures), whose viscosity increases by introducing specialized thickeners into their composition. For this purpose, two types of polysaccharides are used:

• undequired (gum, components of the base of gluten bobbow beans (KRD));
• digested (rice or potato starch) (Table 2).

KRD is definitely an interesting component in the composition of baby food products, and on its properties would like to stop more. Basic physiology active component KRD is polysaccharide - Galaktomannan. It refers to a group of dietary fibers and performs two interrelated functions. In the gastric cavity, the KRD provides a more viscous mixture consistency and prevents the occurrence of joins. At the same time, the CRR is referred to unsecured, but fermentable food fibers, which gives this compound classical prebiotic properties.

Under the term "non-represented food fibers" means their resistance to the effects of pancreatic amylase and Disaughter of the small intestine. The concept of "fermentable food fibers" reflects their active fermentation of the useful microflora of the colon, primarily - bifidobacteria. As a result of such fermentation, a number of physiological effects are important for the body, namely:

• increases (ten times) the content of bifidobacteria in the colon cavity;
• in the process of fermentation, metabolites are formed - short-chain fatty acids (acetic, oil, propionic acid), promoting pH shifting into the acidic side and improving the trophic cells of intestinal epithelium;
• due to the growth of bifidobacteria and the change in the pH of the medium in the acidic side, the conditions for suppressing the conditionally pathogenic intestinal microflora are created and the composition of intestinal microbiota is improved.

The positive effect of KRD on the composition of the intestinal microflora in children of the first year of life is described in a number of studies. This is one of the important aspects of the application of modern ar-mixes in pediatric practice.

The mixtures, including KRD (gum), have a proven clinical effect and functional constipation. Increasing the volume of intestinal content due to the development of the useful intestinal microflora, the change in the pH of the medium into the acidic side and moisturizing the chimus contribute to the increase in intestinal peristaltics. An example of such mixtures are free 1 and frisov 2. The first is intended for children from birth to 6 months, the second - from 6 to 12 months. These mixtures can be recommended both in full and partially, in the amount of 1 / 3-1 / 2 from the required volume in each feeding, in combination with the usual adapted milk mixture, until the resistant therapeutic effect is reached.

Another group of ar-mixes - products that include starch thickener, which are valid only in the upper gastrointestinal departments, and the positive effect occurs when using them in full. These mixtures are shown to children with less pronounced jerking (1-3 points), both with a normal chair and at a tendency to a discharge. Among the products of this group, a mixture of NaN antirefluux is allocated, which has dual protection against shinking: due to the thickener (potato starch), which increases the viscosity of the gastric content and moderately hydrolyzed protein, which increases the rate of gastric emptying and additionally preventive constipation.

Currently, an updated antireflux mixture of Human AR has appeared on the Russian consumer market, which simultaneously introduced the horn tree (0.5 g) and starch (0.3 g), which allows to strengthen the functional effect of the product.

Despite the fact that the AR mixtures are full of full composition and are designed to ensure the physiological needs of the child in food and energy, according to international recommendations, they relate to the Baby food group "for special medical purposes" (Food for Special Medical Purpose). Therefore, the products of this group should be used strictly if clinical Indications, on the recommendation of the doctor and under medical control. The duration of the use of ar-mixes should be determined individually and can be long enough, about 2-3 months. The translation into the adapted milk mixture is carried out after reaching a persistent therapeutic effect.

Literature

1. Belyaeva I. A., Yantyk G. V., Borovik T. E., Skvortsova V. A. Complex approaches to the rehabilitation of children with dysfunctions gastrointestinal tract // Vopr. Sovr. Ped. 2006; 5 (3): 109-113.
2. Frolkis A.V.Functional diseases of the gastrointestinal tract. L.: Medicine, 1991, 224 p.
3. Functional disorders of the gastrointestinal tract in breast-age and their diet organic correction. In the book: National Program for Freeding Children's First Year of Life in the Russian Federation. Union of Pediatricians of Russia, M., 2010, 39-42.
4. Zakharov I. N.Jumping and vomiting in children: what to do? // Consilium Medicum. Pediatrics. 2009, № 3, p. 16-0.
5. Hyman P. E., Milla P. J., Bennig M. A. et al. CHILDHOOD FUNCTIONAL GASTROINTESTINAL DISORDERS: NEONATE / TODDLER // AM.J. Gastroenterol. 2006, V. 130 (5), p. 1519-1526.
6. Havkin A. I. Principles of selection of diet and therapy for children with functional disorders of the digestive system // Children's gastroenterology. 2010, vol. 7, No. 3.
7. Khorosheva E. V., Sorvacheva T. N., Kon I. Ya. Jumping syndrome in breast children // Food Questions. 2001; 5: 32-34.
8. Kon I. Ya., Sorvacheva T. N. Diet and therapy of functional disorders of the gastrointestinal organs in children of the first year of life // The attending physician. 2004, No. 2, p. 55-59.
9. Samsygin G. A. Algorithm for the treatment of children's intestinal colic // Consilium Medicum. Pediatrics. 2009. No. 3. P. 55-67.
10. Kornienko E. A., Vaghemans N. V., Nissebanko O. K. Infant intestinal colic: modern ideas about development mechanisms and new therapy features. St. Petersburg State Ped. honey. Academy, Nestle Institute, 2010, 19 p.
11. Savino F., Cresi F., Pautasso S. et al. Intestinal Microflora in COLICY AND NON COLICKY INFANTS // ACTA PEDIATRICA. 2004, v. 93, p. 825-829.
12. Savino F., Bailo E., Oggero R. et al. Bacterial Counts of Intestinal Lactobacillus Species in Infants with Colic // PediaTr. Allergy Immunol. 2005, V. 16, p. 72-75.
13. Rhoads J. M., Fatheree N. J., Norori J. et al. ALTERED FECAL Microflora and Increased FECAL CALPROTectin in Infant Colic // J. PediaTr. 2009, V. 155 (6), p. 823-828.
14. Sorvacheva T. N., Pashkevich V. V., Kon I. Ya.Diet and therapy of constipation in children of the first year of life. In the book: Guide to child nuts (Ed. V. A. Tutivyan, I. Ya. Konya). M.: Mia, 2009, 519-526.
15. Korovina N. A., Zakharova I. N., Malova N. E. Publishers in young children // Pediatrics. 2003, 9, 1-13.
16. Functional disorders of the gastrointestinal tract in breast-age and their diet organic correction. In the book: Medical nutrition Children of the first year of life (under the general edition of A. A. Baranova and V. A. Tuutyan). Clinical recommendations For pediatricians. M.: Union of Pediatricians of Russia, 2010, p. 51-64.
17. Clinical nutrition of childhood. Ed. T. E. Borovik, K. S. Ladodo. M.: Mia, 2008, 607 p.
18. Belmer S. V., Khavkin A. I., Gasilina T. V.and others. Syndrome in children of the first year. Manual for doctors. M.: RGMU, 2003, 36 p.
19. ANOKHIN V. A., Khasanova E. E., Urmancheva Yu. R. et al. Evaluation of the clinical efficacy of a mixture of frisov in nutrition of children with intestinal dysbacteriosis of varying degrees and minimal digestive dysfunctions // Questions of modern pediatrics. 2005, 3: 75-79.
20. Grybakin S. G.Antireflux mixtures of frisov 1 and freisons 2 with functional disorders of the gastrointestinal tract in children // PRACTICAL PRACTICE. 2006; 10: 26-28.

T. E. Borovik *,
V. A. Skvortsova *, doctor of Medical Sciences
G. V. Yantyk *, doctor of Medical Sciences, Professor
N. G. Callor *, candidate of Medical Sciences
S. G. Gribakin **, doctor of Medical Sciences, Professor

* Ntszz Ramne, ** RMAPO,Moscow

According to modern ideas, functional disorders are a variety of combination of gastrointestinal symptoms without structural or biochemical disorders (D.A. Drossman, 1994). Functional is considered disorders characterized by violation functional state A organ or system that is not accompanied by diagnostically significant morphological changes. The diagnosis of "functional disease" is a diagnosis of exception, which is possible only after a comprehensive examination of the patient.

History of the question

The modern concept about the functional disorders of the gastrointestinal tract has more than 15 years of history. In 1988, the World Congress of Gastroenterologists passed in Rome, during which, on the initiative of his participants, a permanent working committee (Working Team Committee) was created on the functional disorders of the gastrointestinal tract (Chairman - Professor D.A.DROSSMAN, USA). It includes the most authoritative specialists on this issue from different countries. The Committee was created to achieve among scientists a single understanding of the mechanisms for the emergence of functional disorders of the tract and development for practical doctors of different countries of agreed approaches to the diagnosis and treatment of this pathology. Within the framework of the Committee, subcommittees were allocated, including the Stomach and DPK Functional Disorders Subcommittee, which was headed by Professor N.J.Talley from Australia, and the Subcommittee on Intestinal Functional Disorders. Next year, on the initiative of Professor Aldo Torsoli, the Delphi method was introduced for making decisions, in accordance with which the Working Committee should integrate the existing world experience and make a coordinated consistent decision, or formulate a consensus (not necessarily complete) for difficult discussion issues.

In a year, the second Roman working group proposed the classification of all functional disorders of the gastrointestinal tract, identified the criteria for diagnosis and a fundamental approach to the treatment of each disease.

In 1998, "Standards (Protocols) of the diagnosis and treatment of patients with domesticating diseases", approved by the Order of the Ministry of Health of the Russian Federation dated 17.04.98, were published in the Russian Federation. Since 1999, the ICB-X has been used in our country, in which a number of headings are dedicated to functional disorders.

In 1999, the Committee for the Study of Functional Disorders of the GTS in Children and the International Working Group on the Development of Criteria for Functional Disorders (Roman Group II), in conjunction with the University of Montreal Clinic (Committee on Childhood Functional Gastrointestinal Disorders, Multinational Working Teams to Develop Criteria for Functional Disorders, University of Montreal, Quebec, Canada) was created a classification of functional disorders in children.

In 2006, on the basis of an analysis of 7-year-old world experience at the International Congress of Gastroenterologists in Los Angeles, new diagnostic criteria developed and modified the classification of functional disorders of the tract, including headings for individual periods of children's age.

Epidemiology

Functional disorders of digestive organs belong to the most common human diseases. Total signs of FR GCT are available in almost a quarter of the population of the Earth and are after respiratory infections the second cause of temporary disability. Up to 75% of persons with symptoms of FR GTC for medical help Do not appeal and are treated independently. More often the symptoms of the FR GCC debut in young and childhood And accompany a person all his life.

In recent years, there are increasing disorders of the digestive system in children. Currently, the number of children with various gastroenterological diseases exceeds 12,000 per 100,000 children's population and is, according to 2005, 3,300,834 people. This pathology is most common in early and preschool age (up to 228). Among hospitalized children, 30% are children with functional diseases of the gastrointestinal tract. Functional disorders of the gastrointestinal tract occupy one of the leading places in the structure of the pathology of the digestive organs in children. For example, recurrent abdominal pains are functional in nature in 90-95% of children and only 5-10% are associated with an organic cause. Approximately 20% of cases, chronic diarrhea in children is also due to functional disorders.

Etiology and pathogenesis

The issues of etiology and pathogenesis of functional disorders of the digestive organs are complex and fully studied.

First of all, this refers to the terminological separation of the concepts "organic" and "functional" pathology. In accordance with the common definition of functional disorders by D.DROSSMAN (1994), they are a "diverse combination of gastrointestinal symptoms without structural or biochemical disorders." Traditionally, it is believed that organic pathology is associated with damage to the structure of the body, with the functional pathology of morphological changes, do not detect. However, the vulnerability of such ideas is to depend on the current level of our knowledge and the possibilities of research methods that do not allow you to identify certain structural disorders. From these positions, the definition is more acceptable, according to which, under functional disorders, they understand the "violation of the body functions, the reasons for which lie outside the affected body and are associated with a changed regulation (first of all, the nervous and humoral) impaired function."

The leading role in the etiopathogenesis of FR GST belongs to neuropsychiatric factors. In particular, it is believed that with functional intestinal disorders, there are changes in the BRAIN-GUT-LINK system or "brain intestinal". Clinical analysis shows that patients with FR GST records a high level of anxiety, sleep disorders are observed, in history - frequent stressful situations, such as loss of a loved one, parental divorce, conflict situations in school, unsatisfied ambitions of parents and children. Population studies conducted by D.Drossman in adults with CPCs showed that deviations in the mental sphere were recorded in 54-100% of cases, and non-adaptive answers to conflict stressful situations were observed in 2/3 patients in all spheres of personality functioning: cognitive, behavioral, emotional.

In addition, the role in the development of FR GST is discharged to alimentary factors. In particular, they have values \u200b\u200bsuch negative meals in nutrition, as a refusal of a full breakfast, disruption of the power mode, eating dryness, overeating, low content of ballast substances in the food diet, the abuse of refined carbohydrates, fats, coarse tissue, spices, caffean-containing products.

The role of inflammation and infectious factors in the development of functional disorders of the gastrointestinal tract is widely discussed. Some researchers suggest that inflammation of the intestinal mucosa or nerve plexuses It can contribute to the development of symptoms in functional disorders of the gastrointestinal tract. Peripheral hypersensitivity or hypertwarf may be due to induction of inflammatory cytokines. These assumptions are supported by the fact that about 1/3 of patients with CRK indicate the beginning of symptoms after an acute intestinal infection; In 1/3 of patients with acute intestinal infection, the CRC is subsequently developed; 1/3 of patients with SRCs demonstrate extraordinary manifestations, indicating, as a rule, to involve in the process of nervous formations outside the intestinal wall.

The role of Helicobacter pylori infection in the development of functional dyspepsia is interpreted ambiguously. To prove or refute the relationship between H.Pylori infection and the functional disorder of the stomach, it is necessary, first, to prove the biological credibility of the association, exploring pathophysiological violations in infected individuals. Secondly, check the reality of the association, showing the increased prevalence of the functional disorder of the stomach in the subjects infected with H.pylori, and, thirdly, to prove the reversibility of the association in the event of removal of the cause, that is, after the destruction of the infection.

For each of the above three points, there are very contradictory information in the literature. R. Rintala with co-authors (1994) and P.A. Testoni with co-authors (1993) indicated that the presence in the H.Pylori stomach is associated with more pronounced motor disorders. While, L.E. TronCon et al. (1994) and V. Stanghellini et al. (1996) argued that H.Pylori infection is not related to violation of gastric liberation. A comprehensive assessment of the motor and sensory function of the stomach in H.Pylori positive and negative patients with functional dyspepsia, carried out by M. Thumshirn and colleagues (1999), showed that the gastric accommodation for reception of food was reduced in patients with stomach disorder, regardless of their H. Pylori status.

In a study conducted by N.J. Talley and Hunt R.h. (1997), it was suggested that inflammatory changes in the gastric mucosa associated with H.Pylori infection may disrupt the antral and duodenal motor function, but there were no convincing disruptions to explain the occurrence of the symptoms of dyspepsia.

Based on the hypothesis that H.pylori plays a role in a functional stomach disorder, an infection should more often occur with a given nosological form. Many epidemiological studies have tried to show a higher prevalence of H.Pylori, but the results were ambiguous. However, it is necessary to recall that, despite the greater prevalence of H.pylori in patients with functional dyspepsia in comparison with healthy people, it is still significantly less than with proven HP-associated diseases, such as ulcerative disease. duodenal gutat which the infection of H.Pylori reaches 100%. The prevalence of H.Pylori infection at PD is determined in the range from 35% to 87% (Armstrong D., 1996; Lambert J.R., 1993).

Among provoking factors contributing to the development of functional disorders of the gastrointestinal tract, attention is paid to a sedentary lifestyle, transferred acute gastroenteritis in history, reception of drugs, as well as hereditary factors.

The above provoking factors affect the violation of the gastrointestinal tract functions, primarily motor activity.

1) Violation of the motor function of the tract of the tract of the main types of intestinal cuts: 1. Peristalistics. It includes promotion of intestinal content. The peristaltic wave of reduction in the norm occurs every 3-4 minutes and passes along the entire length of the intestine. Several times a day, a strong wave of peristaltics passes from the middle of the cross-sewing intestine to the sigma. 2. Segmentation. This is an impertuous contraction that performs mixing of intestinal content. In the thick intestine, segmentation reductions reduce the diameter of the lumen and slow down the advancement of feces, thus prevented the premature flow of liquid masses into the rectum. Under normal conditions, the peristalistic and segmentation are coordinated. The predominance of segmentation abbreviations leads to an intestinal content of intestinal content and causes constipation. If, on the contrary, segmentation reductions are becoming more rare and less intense, diarrhea develops.

Classification of motor disorders of the gastrointestinal tract:

· Change of permitting activity:

o Reduced

o Raising

· Changing sphincter tone

o Reduced

o Raising

· Appearance of retrograde motility

· Appearance of pressure gradient in adjacent gastrointestinal departments

When it comes to functional disorders as a nosological unit, the impaired motor function is usually understood, but it is quite legitimate to talk about other functional disorders. The main physiological processes (functions) arising from the gastrointestinal tract are: secretion, digestion, absorption, motility, microflora activity and activity of the immune system. Accordingly, violations of these functions are: secretion violations, digestion (maldigesty), suction (malabsorption), motility (dyskinesia), microflora states (dysbiosis, dysbacteriosis), activity of the immune system. All listed dysfunctions are interconnected through a change in the composition of the inner medium and if there may be a violation of only one function at the beginning of the disease, then the rest are disturbed as progressing. Thus, in the patient, as a rule, all functions of the gastrointestinal tract are disturbed, although the degree of these violations is different (Fig. 1).

Fig.1 of the consequences of the violation of motility (according to S.V. Belmer, T.V.Gasilina, A.I.Havina, A.S. Eeberman, 2006).

2) visceral hypersensitivity

Until the 1980s All functional disorders of the gastrointestinal tract were explained by violations of its motor activity. With the development of modern methods for studying the motor activity of the gastrointestinal tract, it became obvious that the pathological, or increased, the reduction of the intestine was not always caused by patients or other symptoms. Conversely, when any deviations of the motor activity of the gastrointestinal tract were recorded, patients often did not make any complaints. The correlation between different clinical symptoms and violations of the motor activity of the gastrointestinal tract is sufficiently low.

After it was found that the main role in the occurrence of functional disorders of the gastrointestinal tract is not at all violations of motor activity in the 80s. The theory of psychogenic effect on the functional activity of the gastrointestinal tract was proposed. However, most people with symptoms of irritable sin syndrome, who have not appealed for medical care, were mentally quite healthy, no difference in these indicators from the control group of healthy people. It became clear that alone only the theory of psychogenic influence on the functional activity of the gastrointestinal tract cannot be explained the occurrence of these functional disorders.

In the last decade, according to the main theory, explaining the appearance of clinical symptoms in patients with functional disorders of the gastrointestinal tract, in such patients there is a disturbed perception of nicoiceceptive pulses, which are interpreted by patients as pain or other symptoms. Cultural, social, psychological and interpersonal factors can affect the perception of pain. This theory does not contradict the biopsychosocial model of the disease, in contrast to the traditional biomedical model.

The most detailed mechanism of visceral hypersensitivity is studied with irritable intestinal syndrome. WhiteHead With the help of a balloon test, a decrease in the rectal pain sensitivity threshold with a quick mechanical stretching of the rectal wall in patients with SRK (Fig.2)

Fig.2. Visceral hypersensitivity at CPC.

In this case, 2 types of visceral hyperalgesia were observed: 1. Reducing the threshold of perception of pain; 2. A more intense feeling of pain in the normal threshold of its perception. Visceral hypersensitivity in patients with SRC was characterized by selectivity for mechanical stimuli: electric, thermal and chemical influences Differences of perception did not reveal on the wall of the intestine compared to healthy persons. At the same time, the level of tactile somatic afferent sensitivity, resistance to electric and thermal skin stimuli in patients did not change. In the SRC, there was a diffuse nature of violation of pain perception throughout the intestine. The severity of the visceral hyperalgesia syndrome has correlated well with the symptoms of the SRK, and the balloon-dialing test turned out to be easily reproducible and highly specialized for SRC. In this regard, visceral hyperalgesia is considered to be a biological marker of the CRC, and a balloon-dialing test of a specific (95%) and sensitive (70%) method of diagnosing the disease and evaluation of drugs during their tests in patients. The condition for the formation of visceral hypersensitivity is the interaction, so-called sensitizing factors, among which are considered such as intestinal infection, in particular, dysentery, psychosocial stress, physical injury, one way or another associated with abdominal pain. W. healthy man The enteral nervous system is mainly independently, with minimal participation of sympathetic and parasympathetic nerve systems, regulates the basic intestinal functions - not only motor activity, but also the processes of absorption and secretion. In this case, an afferent stimulation of a small number of neurons spinal cord And the reflector regulating response is perceived without pain. During the validity of the sensitizing factor, any deviations of the intestine function cause activation of a large number of spinal neurons, causing a spinal hyperbulment syndrome associated with the activation of a large number of nitric oxide molecules, and the corrective reflex response is perceived as painful. Some faces have a peculiar long-term trace memory of pain, which depends on the neuroplasticity of the central departments of the nervous system and the presence of trace tonic cortical pulses. In this case, the usual, not excessive deviations, for example, the expansion of the intestine wall with a small amount of gas, causes an aggreed painful response, the same as when exposed to the stressing sensitizing factor. The syndrome of visceral hypersensitivity is formed. Thus, the sensitizing factor serves as a mechanism configuring the process of perception of pain in patients with CPCs on a super-sensitive way. The path of neuronal transmission of visceral pain in patients with SRC is not damaged. The process of perception of visceral pain is under the influence of the regulatory activity of the central brain departments. Differences in regional activation of the cerebral cortex in patients with CPCs compared to healthy persons were studied using positron emission tomography, which showed that after rectal expansion, healthy subjects have noted an activation of the front of the rim of the cortex of the cortex. This zone of the limbic system is associated with active opiate compounds, which may normally contribute to a decrease in the perception of incoming visceral afferentation. In patients with CRC, in response to the holding of a balloon testing test, the prefrontal zone of the cerebral cortex is activated, which is not associated with opiate compounds. It is assumed that under the CRC, the process of downward suppression of pain perception is disturbed, i.e. There is central antinocyptive dysfunction. Clinical manifestations of visceral hypersensitivity are symptoms of hyperalgesia and allodynia. Hyperalgesia can manifest itself in the form of increased sensitivity to pain incentives and a feeling of pain caused by non-basal incentives. Allodine is called the disorder of the function caused by pain. Such symptoms of CPCs, like meteorism, violation of motility, transit and defecation act are regarded as secondary caused by pain syndrome.

3) Violation of a secretory function.

The violation of secretion in the functional diseases of the gastrointestinal tract in children is associated with the anatomy-physiological characteristics, in particular, the significant variability of the activity of the gastric, pancreatic and intestinal lipase, low activity of pepsin, the immaturity of disaccharidases, in particular lactases, which contribute to the development of shinking syndromes, intestinal colic, meteorism, Dyspepsia.

To date, the literature discusses the role of hypersecretion in the development of functional dyspepsia. Studies have shown that there are no significant differences in the level of secretion of hydrochloric acid in patients with functional dyspepsia and healthy. However, the effectiveness of antisecretory drugs (proton pump inhibitors and histamine receptors H -2) was noted. It can be assumed that a pathogenetic role in these cases plays not hypersecretion of hydrochloric acid, but an increase in the contact time of acidic content with the mucous membrane of the stomach and duodenum, as well as the hypersensitivity of its chemoreceptors with the formation of an inadequate response.

Thus, non-psychic, alimentary and infectious and inflammatory factors, which cause a change in the motor, secretory functions of the tract, and the violation of the visceral hypersensitivity are playing a leading role.

Classification

The classification of the functional disorders of the gastrointestinal tract was developed in 1989, then was repeatedly modified, the last changes were made in 2006. The classification is based on the topographic principle, in accordance with which 6 columns are distinguished. various areas GTC, where arise clinical symptoms: esophagus (category A), gastroduodenal zone (category B), gut (Categories C, D), gall-bubble (Category E), and anorectal area (category F).

Citation:Keschishyan E.S., Berdnikova E.K. Functional disorders of the gastrointestinal tract in young children // RMG. 2006. №19. P. 1397.

Considering the anatomy-physiological features of the child, it is safe to argue that the intestinal dysfunctions are in virtually all children in one degree or another, and are functional, to some extent conditionally, the physiological state of the period of adaptation and ripening of the gastrointestinal tract baby.

However, in consideration of the frequency of complaints and appeals from parents and various severity clinical manifestations In a child, this problem is still of interest not only in pediatricians and neonatologists, but also in gastroenterologists and neuropathologists.
The functional includes the states of the gastrointestinal tract, consisting in the imperfection of the motor function (physiological gastro-ensophahal reflux, violation of the accommodation of the stomach and antfillic motility, dyskinesia of fine and colon) and secretion (significant variability of the activity of gastric, pancreatic and intestinal lipase, low activity of pepsin , immaturity of disaccharidases, in particular, lactases) underlying syndromes of jigging, intestinal colic, meteorism, dyspepsia, not related to organic reasons and not affecting the health of the child.
Dysfunctions of the gastrointestinal tract in young children are most often clinically manifested by the following syndromes: shinking syndrome; intestinal colic syndrome (flatulence in combination with gravity pains in stomach and cry); An irregular chair syndrome with a tendency to constipate and periodic periodic periods.
A characteristic feature of jeling is that they appear suddenly, without any precursors and occur without noticeable participation of abdominal muscles and diaphragms. Jumping are not accompanied by vegetative symptoms, do not reflect on well-being, behavior, child's appetite and weight gain. The latter is the most important for differential diagnosis With surgical pathology (pylorostenosis), requiring urgent intervention. Jumping is rarely a manifestation of neurological pathology, although, unfortunately, many pediatricians mistakenly believe that the jurisdiction is characteristic of intracranial hypertension. but intracranial hypertension Provokes typical vomiting with a vegetual visceral component, the state of the production, the abandonment of feeding, the lack of weight gain, is accompanied by a long cry. All this is significantly different from clinical picture Functional joins.
Functional jeanings do not violate the state of the child, to a greater degree of excitement of parents. Therefore, for the correction of functional joins, it is necessary to correctly advise parents correctly, explain the mechanism of joins, remove the psychological alarm in the family. It is also important to evaluate feeding, the correctness of applying to the chest. With breastfeeding, it is not necessary to immediately change the position of the child and "put it with a column" to remove air. With proper applied to the chest, Aerophagia should not be, and the change in the child's position can be a crossing provocation. When using a bottle, on the contrary, it is necessary that the child jumped the air, and it does not matter that it may be accompanied by a small disorder of milk.
In addition, jeeping can be one of the components of intestinal colic and the reaction to the intestinal spasm.
Colic - comes from the Greek "colikos", which means "pain in the colon". Under this understand the bogs in the stomach, causing discomfort feeling of cutting or squeezing in the abdominal cavity. Clinically intestinal colic in infants proceeds the same way as in adults - abdominal pain, wearing spastic character, but the child has a fortune with a long crying, anxiety, the "sustavation" of the legs. Intestinal colic are determined by a set of reasons: morphofunctional immaturity of intestinal peripheral innervation, dysfunction of central regulation, late start of the enzymatic system, disorders of the formation of the intestinal microbiocenosis. The pain syndrome during colic is associated with increased intestinal gas filler against the background of feeding or in the process of digesting food, accompanied by spasm of intestinal sections, which is caused by the immaturity of the regulation of cuts of various sections. There is no consensus about the pathogenesis of this state. Most authors believe that the functional intestinal colic is due to the immaturity of the nervous regulation of the intestinal activity. Various dietary versions are also considered: the intolerance of proteins of cow's milk in children on artificial feeding, enzymesopathy, including lactase insufficiency, which, in our opinion, is quite controversial, since in this situation the intestinal colic is only a symptom.
The clinical picture is characteristic. The attack, as a rule, begins suddenly, the child screams loudly and shrirly. So-called paroxysms can continue long, the face redness or the pallor of the nasolabial triangle can be marked. The belly will start and tense, legs are tightened to the stomach and can instantly straighten up, the feet are often cold on the touch, the hands are pressed against the body. In severe cases, the attack sometimes ends only after the child is completely extended. Often noticeable relief occurs immediately after defecation. Attacks arise during or shortly after feeding. Despite the fact that the seizures of intestinal colic repeat often and represent a very depressing picture for parents, we can assume that it is real general state The child is not broken - during the period between the attacks, he is calm, normally adds in weight, has a good appetite.
The main question that needs to be solved for himself to every doctor who is engaged in leading children of early age: if the attacks of colic are characteristic of almost all children, is it possible to call it pathology? We answer "no" and therefore we offer not the treatment of the baby, but the symptomatic correction of this state, giving the main role of the physiology of development and maturation.
Thus, we consider it expedient to change the principle of approach to conducting children with intestinal colic, making the focus on the fact that this is functional state.
Currently, many doctors without analyzing the features of the condition of the child and the situation in the family associated with unrest on pain in the child, they offer immediately 2 surveys - the analysis of the feces on dysbacteriosis and research of the level of carbohydrate feces. And that, and another analysis almost always in children of the first months of life has deviations from the conditional norm, which makes it possible to diagnose dysbacteriosis and lactase insufficiency to some extent to be diagnosed and actively introduced medications - from pre-or probiotics to phages, antibiotics and enzymes, as well as changes in nutrition until the child is removed from breastfeeding. In our opinion, both is inappropriate, which is proved by the absolute lack of effect from such therapy during the comparison of groups of children who were on this therapy without it. The formation of microbiocenosis in all children is gradually coming, and if the child did not have a previous one antibacterial treatment or the serious disease of the gastrointestinal tract (which is extremely rare in the first months of life), it is unlikely to have dysbacteriosis, and the formation of microbiocenosis at this age is more due to proper nutrition, in particular, breast milk, which is saturated with substances with prebiotic properties. In this regard, to start the correction of intestinal colic from examination on dysbacteriosis is hardly advisable. In addition, the obtained analyzes with having deviations from the conventional norm will make even greater alarm in the family.
Primary lactase insufficiency is quite rare pathology and is characterized by a sharp bloating, liquid frequent and abundant chair, jerking, vomiting and lack of weight gain.
Transient lactase deficiency is quite frequent. However, in breast milk there is always lactose and lactase, which allows you to use breast milk well during the ripening of the enzyme system in the child. It is known that the reduction in the level of lactase is characteristic of many people who poorly tolerate milk, experiencing discomfort and bloating after consumption of animal milk. There are whole cohorts of people who normally have lactase deficiency, for example, people of yellow races, northern peoples who do not tolerate cow's milk and never use it in food. However, their children are perfectly fell into breast milk. Thus, even if insufficient digestion of carbohydrates is noted on breast milk, which is determined by its elevated level in feces. This does not mean that it is advisable to translate the child to a specialized low or a lactose mixture, limiting breast milk. On the contrary, it is only necessary to limit the mother in the consumption of cow's milk, but keep breastfeeding in full.
Thus, the significance and role of generally accepted diagnoses in young children - dysbacteriosis and lactase deficiency - are extremely exaggerated, and their treatment can even cause harm to the child.
We have developed a certain stratitude of actions when the intestinal colic is chosen, tested by more than 1000 children. Events are highlighted for removing the acute pain attack of intestinal colic and background correction.
The first stage and, in our opinion, it is very important (which is not always likely to attach great importance) is to conduct a conversation with confused and frightened parents, explaining them the reasons for colic, the fact that this is not a disease, the explanation, how they proceed and when these flour. Removing psychological stress, creating a residence aura also helps reduce the pain in the child and correctly fulfill all the pediatricians. In addition, many works have recently appeared, proving that the functional disorders of the GCT are much more likely found among the firstborn, long-awaited children, children of older parents and in families with high levels Life, i.e. Where there is a high threshold of anxiety about the state of the child's health. To a large extent, this is due to the fact that frightened parents begin to "take action", as a result of which these disorders are fixed and strengthened. Therefore, in all cases of functional disorders of the activities of the GTS, treatment should be started with common events that are aimed at creating a calm psychological climate surrounded by a child, normalizing the lifestyle of the family and the child.
It is necessary to find out how the mother eats, and while maintaining the diversity and the usefulness of nutrition, to propose a limitation of fatty products and those that cause meteorism (cucumbers, mayonnaise, grapes, beans, corn) and extractive substances (broths, seasonings). If my mother does not like milk and rarely drank him before pregnancy or after him, flatulence intensified, it is better not to drink milk, but to replace it with fermented with fermented milk products.
If mom is enough breast milk, It is unlikely that the doctor has moral right to limit natural feeding and suggest the mother mixture, even therapeutic. However, it is necessary to make sure that breastfeeding comes correctly - the child is properly applied to the chest, feeds at will and mother holds him enough for his chest, so that the baby sucks not only the front, but also the rear milk, which is especially enriched with lactase. There are no rigorous restrictions in the duration of applying to the chest - some kids suck quickly and actively, others slowly, with breaks. In all cases, the duration should be determined by a child when he himself stops sucking and then calmly maintains a break between feeding for more than two hours. In some cases, only these measures may be enough to significantly reduce the frequency, duration and force of intestinal colic.
If a child is on mixed and artificial feeding, then you can estimate the type of mixture and change the nutrition, for example, to eliminate the presence of animal fats, the milk component in it, taking into account the very individual reaction of the child into ferocular bacteria or partially hydrolyzed protein to facilitate digestion.
The second stage is the physical methods: traditionally it is customary to hold the child in a vertical position or lying on the stomach, it is desirable with legs bent in the knee joints, on a warm heating or diaper, a massage of the abdomen is useful.
It is necessary to distinguish between the correction of the acute attack of intestinal colic, including such events as warm on the belly, massage in the abdomen, the purpose of the preparations of Simeticon, and the background correction, which contributes to a decrease in the frequency and severity of intestinal colic.
The background correction includes the proper feeding of the child and holding background therapy. Background preparations include vegetable facilities of wind turntable and soft antispasmodic action. The best results gives the use of such dosage formlike phyto Tea Planttes. Fruits of Fennel I. essential oilIncluded in PLATEX, stimulate digestion, increasing the secretion of gastric juice and intestinal peristalsis, so food is faster and absorbed. The active substances of the drug prevent the accumulation of gases and contribute to their disbelief, soften the intestinal spasms. PLATEX can be given from 1 to 2 bags per day in the form of a drink substitute, especially with artificial feeding. Plain Plantx Child can not only feed or after feeding, but also use it as a replacement of all fluids after monthly age.
For the correction of acute attack of intestinal colic, it is possible to use Simeticon preparations. These drugs have a windwise effect, education makes it difficult and contributes to the destruction of gas bubbles in the nutrient suspension and mucus of the gastrointestinal tract. Released gases can be absorbed by the intestinal walls or is derived from the body due to the peristaltic. Based on the mechanism of action, these drugs are unlikely to serve as a means of collecting colic. It must be borne in mind that if a meteorism plays a preferential role in the genesis, the effect will be wonderful. If in Genesis, the violation of the peristaltics is predominantly played by the intestinal innervation immaturity, the effect will be the smallest. The simethicon preparations are better to use not in the preventive mode (adding to the power, as indicated in the instructions), and at the moment of colic, when the pain occurs, if there is a meteorism, the effect will occur in a few minutes. In prophylactic mode, it is better to use background therapy preparations.
The next stage is the passage of gases and feces with a gas-conductive tube or enema, it is possible to introduce a candle with glycerin. Unfortunately, children who have immaturity or pathology by nervous regulation will be forced to resort more often to this method of killing colic.
In the absence of a positive effect, prokinetics and antispasmodic preparations are prescribed.
It was noted that the effectiveness of the etching therapy of intestinal colic is the same in all children and can be used both in the docking and premature.
Currently, the effectiveness of wider use of physiotherapy, in particular magnetic therapy in children with the immaturity of the regulation of intestinal peristals, in the absence of effect from the above steps of phased therapy
We analyzed the effectiveness of the proposed scheme of correctional measures: Using only 1 stage gives - 15% of efficiency, 1 and 2 stages - 62% of efficiency, and only 13% of children demanded the use of the entire complex of measures to relieve pain syndrome. Our study has not established a reduction in the frequency of colic and pain of pain syndrome when inclusive in the proposed scheme of enzymes and biological products.
Thus, the proposed scheme allows the smallest drug load and economic costs to adjust the state at the overwhelming number of children and only in the absence of effectiveness to prescribe an expensive examination and treatment.

Literature
1. Havkin A.I. "Functional disorders of the gastrointestinal tract in young children" allowance for doctors, Moscow, 2001. p.16-17.
2. Leung AK, Lemau JF. Infantile Colik: A Review J R Soc Health. 2004 jul; 124 (4): 162.
3. ITTMANN P.I., Amarnath R., Berseth C.L., Maturation of Antroduodenalmotor Activiti in Preterm and Term Infants. Digestive DIS SCI 1992; 37 (1): 14-19.
4. Korovina N.A., Zakharova I.N., Malova N.E. "Lactomatic deficiency in children." Questions of modern pediatrics 2002; 1 (4): 57-61.
5. Sokolov A.L., Copanev Yu.A. "Lactomatic insufficiency: a new look at the problem" Questions of children's dietology, №3 2004, p.77.
6. Mukhina Yu.G., Chubarova A.I., Geraskin V.P. "Modern aspects of the problem of lactase deficiency in young children" issues of child nutrition, №1 2003. pp .50.
7. Berdnikova E.K. Havkin A.I. Kechishyan E.S. The influence of the psycho-emotional state of parents on the severity of the "Restless Child" syndrome. Tez. Docked 2 Congress "Modern Technologies in Pediatrics and Children's Surgery" page 234.