Dysbacteriosis in children
The state of the intestinal microflora of an infant depends on the nature of its feeding. When breast feeding in the microflora, there are mainly bifidobacteria of some species( Bifidobacterium: Bifidum, Infantis, Breve), with artificial feeding - another type of bifidobacterium( Bifidobacterium longum), the number of lactobacilli increases, and the number of bacteroids and veinella increases, which increase gas production and may because unstable stools.
Since the age of 3, there have been changes in the microbial composition of the intestine( Bifidobacterium ado-lescentis appears instead of Bifidobacterium infantis).Therefore, in the treatment of dysbiosis, the selection of medicines is carried out taking into account the nature of feeding and the age of the child.
To be more convenient to navigate in a variety of clinical manifestations of dysbiosis, they were combined into 3 groups according to the degrees and corresponding changes in them and in the normal intestinal microflora.
This stage is characterized by a decrease in the number of bifido- or lactobacilli or both at the same time by 1-2 orders of magnitude. The number of intestinal rods also varies - decreases( to 80%) or, conversely, increases with the appearance of their altered forms( Bifidobacterium, Lactobacillus, E. Coli).
Children develop symptoms of bowel dysfunction:
This stage is characterized by the appearance of one type of conditionally pathogenic microorganisms or whole associations of opportunistic bacteria in small concentrations of
. Symptoms of various diseases can manifest in children.
Symptoms of gastritis:
Symptoms of enteritis:
Symptoms of enterocolitis:
Symptoms of colitis:
All forms of dysbacteriosis are characterized by:
Severe disorders of microflora: a high concentration of opportunistic microorganisms of one species and in associations.
During this period, the symptoms of transient bacteremia appear in children:
. Very often parents ask a question: is it necessary to treat a dysbacteriosis if the child does not care? Indeed, if the child has no signs of impaired gastrointestinal function( constipation, diarrhea, non-digestion of food components, pains, regurgitation or vomiting), if he has no allergic manifestations, a good appetite, he is cheerful and cheerful, then, of course, the treatment canand not required. After a violation of the intestinal microflora may be temporary. Teething teeth, the introduction of new products, a single respiratory disease can lead to a short-term decrease in the amount of normal microflora. But quite another thing, if a child is often sick, moody, his appetite is reduced, and muscle tone is weak;In this case( even if it does not have constipation or diarrhea), prevention or correction of dysbacteriosis is necessary. Why? Because if the medical measures do not start on time, in a few years the child may have chronic diseases of the organs of the gastrointestinal tract, immunity will be weakened.
In the past decade, pediatricians have noted an increase in the number of children, especially the first year of life, having dysbiosis. In addition, some children experience a delay in the development of the autonomic nervous system of the intestine, a later onset of enzyme systems and an imperfection of the immune system of the mucous membrane of the gastrointestinal tract. The treatment of such children presents a considerable problem and, naturally, differs from the treatment of adults.
The state of health of the child, especially the baby, depends very much on the state of health of the mother. But, alas, recently, the hormonal disorders in the mother's body that affect the baby's condition, causing the disorders of the gastrointestinal tract, become more common. These disorders are manifested in the form of regurgitation, intestinal colic, constipation or, conversely, diarrhea.
The composition of the intestinal microflora of a child depends on passive immunity - those living leukocytes, immunoglobulins and other substances that are transmitted to the baby from the mother through the blood in the last months of pregnancy, and after birth through the breast milk, which strengthens its immunity. Of great importance is the activity of the nonspecific protective mechanisms of the child, the level of work of which depends on genetic factors. Even more important is the state of the microflora of the mother, because it is with her that a child meets in the first minutes of her life. And if the mother has a dysbacteriosis of the intestine, the child will surely receive it as a legacy.
Therefore, the first thing that parents should do to improve the condition of the child is to take care of the mother's health. To do this, it must fully eat, take vitamins, enough sleep. To improve her emotional state, sedative teas and calm, relaxing music are recommended. In addition, the mother must comply with the diet( of course, if she is breastfeeding): it is necessary to limit the use of cabbage, tomatoes, peas, mushrooms, grapes, any smoked and spicy foods. With a strong concern of the child in the mother's diet, the amount of milk temporarily decreases( note: decreases, but not completely excluded!).If the child has a quick chair, then she should exclude from her diet cucumbers, plums, beetroot, pumpkin. If the baby has constipation, then it is necessary to limit the consumption of rice and bakery products.
If the child has flatulence, Espumizan, Sab-simplex or Disflatil may be prescribed to reduce gas production. It is also good to put the baby to yourself: dry heat relaxes the spasms of the intestines, and the baby calms down.
Ideally, if a future mother, before the baby is born, makes every effort to normalize her microflora. During pregnancy, you can take such medications as Normofloriny Lee B, Narine-forte, Bifiform, Santa Rus-B, Hilak-forte, Imbalance, especially if their reception will be combined with the use of soft sorbents - Fervital Extra, Zosterin Ultra 30%.Reception of sorbents is desirable to continue and in the first months after a birth of the child.
Children on artificial feeding are recommended thick mixtures, which prevent vomiting and regurgitation. These include Frisov, Nutrilon-antireflux and Omneo. They can either feed the baby, or add them at the end of each feeding. If the child's propensity for constipation is better suited Omneo, Frisov or Samper bifidus, and with a quick stool - Nutrilon-antireflux or low-lactose mixtures. You can feed your baby and mixtures based on soy protein, but not constantly. Well-proven and mixtures containing live bifido- and lactobacilli, such as Lactofidus and NAN fermented milk.
However, even such mixtures do not abolish the use of live concentrated preparations containing bifido- and lactobacilli. The intake of these drugs is very effective provided they are taken for a long time( at least a month) and alternate with the intake of prebiotics such as Hilak-forte or lactulose preparations( Lactusan syrups or Dufalac syrups).In some cases it is necessary to appoint and enzymes( Creon, Mezim-forte), but their dosage should be selected individually.
Almost every child is useful to take enterosorbents, primarily Zosterin-Ultra 30%, which is suitable even for newborns. In acute conditions Smecta is used. This enterosorbent promotes the improvement of the properties of the mucus of the gastrointestinal tract and protects enterocytes( cells lining the intestinal wall), but it can take no more than 5 days, otherwise, metabolic disorders may occur. Children from 3 years and older are recommended Fervital, which not only cleanses the intestines, but also stimulates the growth of its own microflora.
In some cases, especially with excessive growth of pathogenic staphylococcus, a staphylococcal bacteriophage is used, which is a human-friendly virus that affects only staphylococci. Less frequently( after laboratory tests) other bacteriophages can be prescribed - klebsielezny, koloproteyny, etc.
Children up to 3 months of age are prescribed mainly preparations containing bifido- and lactobacilli. Older children may be prescribed complex drugs, such as Linex, Nutridofilus, Floradofilus( Floradofilus), etc. In the treatment of children older than 1 year, a long-term( up to 3 months) treatment with Santa-Rus-B is effective. At the final stage of recovery of microflora, Laminolact can also be used.
If a child has any pathology from the central nervous system, it is also necessary to have a treatment prescribed by a neurologist, otherwise the useful microflora will constantly "slip off", "leave" from the intestine, the wall of which little "cooperates" with it.
A special problem is the treatment of children with cerebral palsy( cerebral palsy).In this case, in order to achieve a good effect from the treatment of the underlying disease, it is necessary to stop manifestations of dysbiosis for at least 3 months in spring and autumn. Only in this case will the effect of the main therapy.
Children after 1 year are recommended to use products that stimulate the development of normal microflora: dairy, including Aktimel, Imunele, Bifilact;products from corn, buckwheat, uncooked juices, cabbage, carrots, zucchini.
If hemolyzing intestinal bacilli and staphylococci are found in the microflora, the intake of sour-milk products containing bifido- and lactobacilli is useful. If there is a presence of mushrooms of the genus Candida and Protea, then it is necessary to take dairy products that do not contain probiotics, such as kefir, ryazhenka, evita, as they inhibit the growth of this pathogenic flora.
Children from 1 year and older can be offered finished sour-milk products: Bifidok, Bifilife and others, containing, as a rule, acidophilus bacillus and bifidobacteria. But they do not have a lot of bifidobacteria, therefore they can not replace Bifidumbacterin and Lactobacterin preparations, but they always successfully supplement them. A large amount of useful microflora is found in sour-milk Bifilact.
If the state of the child's gastrointestinal tract causes anxiety in the treating physician, he can prescribe Bactisubtil, which consists of a spore of bacteria uncharacteristic of the human intestine, but helps digest food and displace the microflora that is not associated with the intestinal mucosa. But in this case, a constant observation of a specialist is necessary, since with a long uncontrolled intake of this drug, bacterial spores can spread beyond the intestine, which is fraught with serious complications.
Of all the variety of probiotics, it is worthwhile to highlight the liquid biocomplexes of Normo fllorins L, B and D. They contain bifido- and lactobacilli in the biologically active state, and, not least, the products of their vital activity: vitamins, trace elements, amino acids, natural antibiotic complexes, enzymes and peptides that improve the formation of local immunity. Normoflorins contain the prebiotic lactitol, which stimulates the growth and multiplication of useful microflora in the intestine.
Normo fllorins fully meet all safety requirements because they do not contain the protein of the cow's mole and lactose, which allows them to be prescribed to children with allergies and with lactase deficiency since birth.
Normoflorins are represented in three types: L-based on lactobacilli, B-bifidobacteria and D-combination of lacto- + bifidoflora( but their strains are different, this is not a direct replacement for L + B, but another drug).Assign them as a combination( morning and dinner - L evening - B or D), and separately( with constipation first 2 weeks - A then 2 weeks - B or D).In addition, Normoflorin Lmozhno use in the form of skin applications, to rinse your throat, instillation into the nose, and B - in the form of microclysters, which is especially important for young patients.
In addition to the above means for the normalization of microflora, vitamins, trace elements and adaptogens are used.
Among the vitamin preparations I can recommend Biovital, Multitabs, Sana-salt, and also children's Vitrum, Centrum, Jungle, Pikovit and others. Very effective, but, unfortunately, due to high prices, complex multivitamin preparations of "New Age", Sunrider, Vision, Inrich, Artlife. They contain, as a rule, chelate complexes, that is, vitamins associated with proteins and therefore easily penetrate directly into the cells.
In order to strengthen immunity and create favorable conditions for the "healing" of useful microflora, we use such widely known adaptogens as ginseng, Chinese magnolia vine, aralia, rhodiola rosea, and extracts from them, for example, Neovitin. In the case of metabolic disorders and a decrease in appetite, preparations containing trace elements, such as Beresh Plus drops, can be prescribed.
At the end of the section I want to tell the readers about the prospects, in principle, very narrow-minded.
The methods of introducing donor( mother) bifido- and lactobacilli to the child have been developed 2 hours after birth( to prevent colonization of the pathogenic microflora in its intestine).Very promising in the quality of prevention and treatment is the so-called functional nutrition, when the finished food products are supplemented with biopreparations created on the basis of the human's own microflora, including the child.
Once again I want to recall that since dysbacteriosis has many causes of occurrence, the selection of means for its correction is strictly individual, taking into account many factors. So, there will be no effect from treatment based only on the results of the analysis of feces for dysbiosis. It is necessary to take into account the causes that led to the disruption of microflora, clinical manifestations, the duration of the process, the presence of other diseases. But nevertheless I can give some general recommendations.
First, it is necessary to take enterosorbents, which not only remove toxins and allergens, but also enhance the protective properties of the intestinal mucosa( especially the Zosterin-Ultra 30%).
Secondly, it is necessary to eliminate the causes that led to dysbiosis.
Thirdly, any treatment should be conducted for a long time, with repeated support courses. Otherwise, the state of the intestines will deteriorate again.
Fourthly, do not forget to tell the doctor about your( !) Problems with the gastrointestinal tract( many diseases are inherited).
Fifthly, probiotics should be selected individually and periodically( every 2-4 weeks) to replace them with others.
And, finally, the last. It is impossible to make a mistake in interpreting the changes taking place in the state of the child. If the baby is better, and then again there are symptoms that indicate a poor gastrointestinal tract, you should consider whether we are taking dysbacteriosis, for example, acute infectious enterocolitis. Treatment in this case is different.
There is a good way to monitor the effectiveness of treatment of dysbacteriosis disorders in the intestines of a small child. This is not only sowing feces for dysbiosis( alas, this is a very long process), but also the dynamics of weight gain in a child, as well as his psychomotor development. If a child develops according to age, is active and cheerful, then you are on the right track!
As we have already said, dysbiosis can cause a variety of reasons - from malnutrition to the anomaly of child development. Therefore, the treatment of this disease should be individual and complex.
It is complex! Many years of practice shows that it is impossible to cure dysbacteriosis( regardless of the cause of its occurrence) by one, even the most modern and high-quality drug. Yes, applying one drug for a long period, you can see an improvement in the child's health. Moreover, this improvement will be confirmed by analyzes. But practice shows that after a few months the child starts to get sick again, becomes sluggish, does not eat well, he has a disorder of stool. That is, everything returns to normal. ..
Treatment of dysbacteriosis in children is a complex of measures: taking medications, proper nutrition, observing the regime of the day and eating, preventing dysbacteriosis in others( parents, nannies).In addition, treatment should be phased. I distinguish two stages of proper treatment and the third - final, which fixes the effect obtained after the first two.
The first stage is to suppress pathogenic microbes and normalize microflora. Let's say a child has signs of dyspepsia: diarrhea, vomiting, dehydration, complaints of pain in the intestine. What should I do first? Remove all these manifestations. Hence, the first step at this stage is to stop vomiting and normalize the stool.
In this case, the infant receives only the main food: breast milk or a mixture. Older children must follow a diet( up to 3 years, even a healthy child's diet should be dietary).But at any age, consumption of vegetables and fruits is sharply limited. Fruit juices are completely excluded. If the child does not eat well, then the lack of products is compensated by water, sweet tea or special solutions, which the doctor will recommend. It can be glucose-salt solutions - Regidron, Citroglycosolan. In addition, in small doses( from 1 teaspoon to 2 tablespoons depending on the situation), give broths of herbs with antiseptic effect 5-6 times a day, chamomile, St. John's wort, sage, or plants that help to strengthen the stool: it canbe a decoction of the root of the cotton spoon or berries of dried blueberries.
If all these measures have brought the desired result, the diet can be made more free. Babies are introduced lures in the form of puree from vegetables, fruits, cereals. But in any case in the diet must be present sour-milk mixtures, as well as foods enriched with bifidobacteria and lysozyme. The choice of sour-milk mixes is now quite large, and parents together with the pediatrician can pick up the sick child most suitable for him.
In severe cases, when with the help of these measures, digestive disorders can not be removed( the stool does not return to normal, continues to be troubled by belching, bloating, nausea, etc.), the child needs a strict diet. In addition, in the diet of the child, it is necessary to include therapeutic products containing prebiotics and insoluble dietary fiber. They will work to restore intestinal motility and promote the normalization of microflora. The most effective are the following.
In addition, such well-established products as Bifilin, Biopact adapted with lysozyme, Bifidumbacterin fermented milk, Narine-forte, and also the well-known food additive FERVITAL, also proved to be very good.
The next step is suppression of inflammatory dyspeptic disorders in the gastrointestinal tract, oppression of pathogenic microflora. For this purpose, bacteriophages are used. They actively fight harmful( pathogenic) microbes and at the same time do no harm useful. They are not toxic, do not cause adverse reactions and complications. Staphylococcus bacteriophage( as it follows from its name) has the ability to suppress strains of staphylococcus, klebsielle - klebsiella, bacteriophage pseudomonasum is used to treat dysbacteriosis caused by Pseudomonas aeruginosa, coliprotein is active against enteropathogenic E. coli and protea, pyobacteriophage can be used in the fight against staphylococci, escherichia, Pseudomonas aeruginosa.
It is very important to choose from all available drugs exactly the one that is needed, which will suppress the specific pathogenic flora that caused the disease. Bacteriophages are used in combination with other forms of drug treatment. In each case - their own. For example, staphylococcal( isolated) dysbacteriosis can be treated by prescribing a staphylococcal bacteriophage in combination( or in sequential order) with 1% alcohol solution of Chlorophyllipt.
In the development of dysbacteriosis in infants fed by breast milk, along with the treatment of the baby, it is necessary to prescribe the reception of immunopreparations for the nursing mother. The child should be temporarily( for 5-7 days) transferred to feeding sterilized breast milk. Throughout this period, the forced treatment of dysbiosis is carried out both in the child and in the mother.
To maintain and "feed" the not very healthy healthy bacteria, you need to give your child vitamins C, B1, B2, B6, as well as juice and cranberry juice, apple juice, dry apple compote, decoction of wild hips.
In the second stage, it is necessary to restore useful microflora, its quantity and functions, and also to eliminate the consequences of dysbacteriosis, for example, allergy, anemia, hypovitaminosis. In addition, it is necessary to strengthen the vitality of the child's body, as the child at that time loses a lot of energy, "takes" a variety of diseases against the background of dysbiosis, becomes sluggish and unable to resist.
The first thing with which to begin the second stage is the introduction of beneficial bacteria, especially bifidobacteria into the body. Why? Because they are the most important representatives of the intestinal flora. They are both advocates, and breadwinners, and immunostimulants. In addition, other very important microorganisms, lactobacilli, can not function properly without them. There are several preparations containing bifidobacteria: Bifidumbacterin in dry and liquid form, Beefilong, etc. It is important that the doctor selects a drug suitable for a particular child and his disease.
Following the bifidobacteria are introduced lactobacilli: Lactobacterin, Nutrolin "B", Linex, Floradofilus( Floradofilus), Santa Rus-B( prescribed for children over 1 year), etc. A good effect is achieved with the intake of Normoflorin L, it can be given to the child from the firstmonths of life. Then, if necessary, drugs are prescribed containing a full-bodied E. coli( Bifikol, Colibacterin).As a rule, they are taken orally in 2 doses 30 minutes before meals. In some cases, they are recommended to be administered rectally - by microclysters.
To improve the vital activity of a useful microflora, Hilak-forte is prescribed, 1 milliliter of which contains metabolic products of 100 billion microorganisms, including lactic acid, fatty acids, lactose and amino acids. Reception Hilak-forte improves peristalsis of the intestine, with its help the cells of its epithelium and their functional activity are restored.
To improve the functional properties of microflora, concomitantly with probiotics, the intake of vitamins C, B1, B2, calcium pantothenate, a complex of fat-soluble vitamins A and E in the age curative dose, vitamin P in a preventive dose is prescribed. Children from 3 years old - a combination of vitamins C and Group B with trace elements, in particular with selenium, especially beneficial for the microbiocenosis of the intestine. The course of treatment is 3-4 weeks.
In addition, it is necessary to improve the immunity of the child. In some cases, it is necessary to take pharmaceuticals( interferon preparations and, first of all, Kipferon), but only according to the doctor's prescription! The fact is that the children of the first year of life in the immune system is dominated by inhibitory factors. If we begin to "stimulate" the immunity of a small child, then these inhibitory factors will primarily react, and instead of increasing the immunity we will get a real reduction. The doctor can appoint and Kipferon, and Derinat, and Polyoxidonium, but it's the doctor, you can not do this yourself. Independently you can correct with milder forms of treatment, for example, taking food supplements containing trace elements, in particular zinc, and foods rich in vitamins, especially group B.
The third stage cures the underlying disease against which dysbacteriosis has developed and is fixedthe effect obtained during the entire previous treatment.
As for the underlying disease, then, of course, the methods of treatment depend on what the child is sick with. If a child has a disability in the work of the gastrointestinal tract, then special therapy is performed in conjunction with a gastroenterologist;if the main reason is immune protection factors, then it is necessary to connect the immunologist and strictly follow all his recommendations.
And yet, do not forget that the third stage is the period when a sick child should become healthy! Therefore, the main attention should be given to the correct regime of the day. The child needs to walk a lot, sleep a lot, eat well. Parents should create a favorable psychological atmosphere in the house: it is necessary to protect the baby from any conflicts and stresses.
It is very important at this stage to monitor compliance with diet and diet. Of course, the diet should always be agreed with the attending physician, but nevertheless it is necessary to diversify it as much as possible. In the diet of the child should be enough foods containing vitamins and trace elements. Fruits, vegetables, berries, juices should always be on the table.
If possible, at least for the period of treatment, buy environmentally friendly products. The same goes for water. I want to remind readers, especially residents of industrial cities, that tap water can not be drunk, especially not to give it to a sick child! Water should either be bought or filtered. Of all the variety of modern filters on the market for water purification, it is advised to choose the products of the Japanese company "Nikken".In addition to the standard cleaning that all manufacturers of modern filters offer, with the help of Nikken filters, water, firstly, is mineralized( ie, enriched with the necessary mineral substances), and secondly, magnetized and structured, acquiring the properties originallylaid down by nature. This water is called "alive".
And the last. Even if the child looks absolutely healthy, it is necessary to watch the condition of its microflora for a long time: it is necessary to periodically show the child to the doctor, to take tests. Do not forget about the prevention: use supplements, such as Fervital, infusions of medicinal herbs. In the chapter devoted to the treatment of dysbiosis in adults, the necessary phytopreparations are indicated, many of them are suitable for children. But still I advise you to familiarize yourself with Appendix 4, which lists the medicinal herbs used in the treatment and prevention of dysbiosis in children.
Dysbacteriosis, as already mentioned, occurs with many diseases, which, it would seem, do not have a direct relationship to the intestines. Atopic dermatitis, bronchial asthma, urticaria, other allergic diseases - among them. Why is this happening?
The fact is that the natural healthy intestinal microflora inhibits the processes, as a result of which histidine is synthesized from food histidine, which actually causes allergic reactions. Thus, the allergic potential of the eaten food is reduced and, naturally, allergy manifestations decrease. With pronounced dysbacteriosis, on the contrary, the penetration of allergens into the blood is accelerated, which causes an increase in allergic reactions. In addition, in healthy children, microflora produces liposaccharides responsible for the formation of food tolerance. In children with allergies, the production of these liposaccharides is in most cases severely impaired. Therefore, treatment and prevention of intestinal dysbiosis in children with all forms of allergic processes helps minimize allergy manifestations. For example, according to Finnish scientists, the intake of probiotics by a woman during pregnancy and breastfeeding helps reduce the risk of atopic( allergic) dermatitis in a child during the first 2 years of life.
Treatment of microflora disorders in allergies has its own specifics primarily because over the past few years, a large number of young children have intolerance to cow's milk proteins. But most probiotics contain these proteins. Therefore, for the treatment of dysbacteriosis in children with allergies, Normoflorins L, B and D are used, which are prepared on the basis of hydrolyzate of skim milk and do not contain them( in Finland, the same dumbbell Lactofilus is used).Admission Normoflorinov can alternate with other drugs, such as Bifiform( preferably in capsules, because Bifiform "baby" in powders and tablets contains vitamins and therefore in most cases causes allergic reactions), Floraldofilus( Flora-dophilus), Waitodophylus( Sunrider").
The reception of probiotics( that is, preparations containing live microflora) is desirable to alternate with the intake of prebiotics( drugs that stimulate the development of normal microflora).As a prebiotic, Hilak-forte is most often used.
Almost always assigned enterosorbents, especially Zosterin-Ultra 30%( in some cases, when necessary immunostimulating effect - Zosterin-Ultra 60%), Enteros-gel, Lactofiltrum, Fervital or Fervital-Extra.
It is necessary to completely eliminate the use of products that cause allergic reactions, and with the increase of allergic manifestations, take antihistamines: it can be Tavegil, Fenistil, Zirtek, Claritin, Erius, etc. In the presence of cutaneous manifestations of allergy, Lacquer cream, Bepanten, Advantanum, Elidel.