Журнал «Здоровье ребенка» 3 (54) 2014

The present situation shows that the intestinal colics in infantsare an actual problem of the practical pediatrics and often become the reason for the parents to consult the pediatrician. The occurence of the intestinal colics in babies varies from 3 to 40 %.

Nowadays according to the Roman criterias III the functional disorders of the digestive system, the diagnosis of the intestinal colicshave been conducted. The motor anxietyattacks occur or the babies shout within the four first months of their life. which begin and stop without any evident reason, occur three and more times a day, last for three and more days a week. The symptoms of the hypothrophy, the organic and contagious diseases are absent, the psychomotor evolution of a baby is normal.

The common attack of colics and shouting begins in the same time, often in the afternoon or in the night. The shouting period lasts long, intensively and does not stop while feeding. More often the symptoms emerge in the first six weeks of life and become maximally intensive at the age of eight.

The reason for the excessive shouting in babies can be the natural reasons, e.g. the injury of the central nervous system, the alimentary canal, traumas, infections.

When the natural diseases occur the colics tend to intensify and an additional pathological symptoms occur.

Materials and methods. The modern views on etyology, pathogenesis, diagnosis and treatment of colics in babies are regarded, as well as the nutrition correction directions.

The results and its discussion.

Now there still remains the question why the intestinal colics in chidren emerge. Often the reason for their emergency becomes functional immaturity of the digestive and neurous system in babies, the disrupted balance between nutrition and the digestive system.

The intestinal colics are regarded as a transitory lactative insufficiency. In the same time certain researches consider that the manifestations of the intestinal colics can be the typical clinical evidence of an IgE-independent food allegry. This has shown that for children with the intestinal colics clinically effectively was the prescription of probiotics Lactobacillusreuteri DSM 17 938 in contrast to simethicone in case of the intestinal colics in children. Many authors consider that there exist a complex of the correlations of the intestinal immune system in babies and symbiotic flora. Recently it was proved that the endogenous intestinal flora can initiate the key processes of the immune memory and adaptive answers of the master. The important reason for the intestinal colitis can be the exceeded aerogenesis as well as the peculiarities of the qualitative composition of the intestinal gas which is defined by the composition of the intestinal microflora. 

To the pointof view of the Korniyenko H.A. (2006) the general pathogenesis of the intestinal colitis can be presented as a “bewitched circle”, the trigger factor is intestinal microfloral balance disruption. It is the source of the pathological metabolics accumulation and aeration stimulating the sensitive receptors of the intestine. This becomes the reason for the adaptation зрив and the inflammation in the intestinal mucous membrane directly and via the mediators of inflammation, influences the intestinal sensory neurons. This effects the motility disorder. In the process of inflammation the permeability of mucous coat reinforces. Thus the sensibilisation improves and the inflammation effects the functional opportunities of the intestinal epithelium, constipates the digestion disruption, which reinforces the symptoms. The dominant locus of inflammation, which results in pain syndrome.

To provide the diagnosis and treatment of the colics the algorithm is used which enables to define the main reasons for colics and formulate the principles of the food correction.

In case of the symptoms of colics the existence of the diahorrhea and vomiting should be distinguished. If they are absent the significant medical and infectious problem is unlikely. It is recommended to talk to parents in a calm way, to explain them the main functional reasons of the probable babies impatient/shouting, to discuss the technique of the feeding and falling into sleep, to support the parents psychologically and calm them down, to make an arrangement about the monitoring. In case of vomiting it is recommended to distinguish the extra symptoms of an allergy to the cows milk protein (CMP): the skin, respiratory and gastrointestinal. If there is a suspition or confirmation of CMP. If the mother breastfeeds she should be prescribed the elimination diet with the CMP products excluded. If the baby is bottle feeded the child should be feeded with the hydrolyzed protein formulas. The other reason for the vomiting can be the hastroesofagal reflux. In this case the special formulas usage is recommended containing the thickener, the so-called AR-formulas.

If the vomiting is absent but there is a diarrhoea and/or insufficient weight growth it can point to the possibility of the food allergy (it is often the mixtures of blood and mucus presented in the negative bacterial crops). In this case the approach to the food corrections are described above. The other reason for the diarrhoea, bloating can be the lactase insufficiency to be proved laboratory. In case of lactase insufficiency the emptying become more acid, the percentage of the regenerative substances in the foecals becomes more than 25%. In case of lactase failure the baby breastfeeded each time should gain the required doze of the enzyme (lactase). If the baby is bottle feed the non-lactase milk formulas are used and the formulas with the reduced content of lactose.

At first the baby is unclosed or should wear comfortable clothes. The warm diaper, heating pad should be put on the abdomen, a gentle massage is made. It is recommended  holding on the hands, swinging, non-nutritive sucking, the vertical position of a child, monotonous rhythmical singing of its mother, going in the car.

The peculiar attention is payed to the pshycosocial problems of a baby, the relations in the family. The doctor should  regularly communicate with the parents, discuss the difficulties in the treatment of a baby with the colics, help to optimize the way of life of a family, to provide the planned course of a common events in the life of a child with the certain `minutes` of sleep.

The lactating mother should not take the products which promote the aerogenesis (coffe, chocolate, milk, honey, broccoli, beans, salad, etc.) or are highly allergic (cow’s milk, eggs, fish). If the child is artificially feeded it is recommended to prescribe the formula containing partially hydrolyzed protein, reduced lactozecontentand prebiotic oligosaccharide. It is recommended to avoid weaning, formulas substitution without the medical indications.

The last systemic review edited in 2012 denoted that the intestinal colics in the babies are common diseases. The effectiveness of the treatment of simethicon, dicyclomine hydrochloride and cimetropium bromide, lactase from the point of view of the evidence-based medicine. The better effect had adequate correction of the nutrition, hydrolyzed milk formula usage and the mother hypoallergic diet while breastfeeding.

Conclusions. The babiescolics are the common disease for the young children, the diagnosis and treatment of it requires certain diagnostic and therapeutic algorithm. The most effective method of treatment are the food correction of the babies diet and the lactating mother, the usage of the probiotic medication.