People think that constipation is a simple problem, not a disease, but a symptom, which will not affect anything. It stays on a very superficial, traditional, and empirical non-scientific understanding. For constipation, ten doctors will have ten answers: drink more water; exercise more; eat more vegetables; bananas are good; sesame oil is effective; mommy loves it; honey is good; Let's change the milk powder; or stop the milk powder; use Kaiserol; use soap bars; rub your belly; it doesn't work! Then take a film and make a colonoscopy! Enema! Take laxatives! However, many children have tried all the traditional methods to drink more water, exercise more, eat more vegetables, eat more whole grains, bananas, sesame oil, honey, mommy love, intestinal tract, change milk powder, stop milk powder, clear fire, cultivate regular defecation Habits, cultivating the toilet habit, Kaiseli, soap bars, rubbing belly, etc., especially drinking water, eating vegetables, eating whole grains have been very much, but still not alleviated, some of the constipation is getting worse, and the baby has severe stool pain Has refused to take the initiative to defecate, refuse to do it. For constipation, you need to recognize the following facts:
2. Some children have transient constipation, which will get better after a period of time.
3. However, functional constipation in children is intractable and treatment is very difficult. Parents must have a correct understanding and strive for early treatment.
4. Intractable constipation through dietary conditioning, increasing drinking water, stopping or reducing milk powder feeding, changing milk powder, behavior intervention (encouragement, training bowel habits, eliminating fear, etc.), increasing dietary fiber and other measures have no obvious effect.
5. About 50% of children get better within 1 year, 25% get better within 2 years, and 25% get better for many years. During this period, parents need to understand correctly, not to be impatient, not to be anxious for success, not to sit idly by, let alone scold or blame the child. To give children psychological comfort, behavior and diet adjustments, the most important thing is to rely on safe, mild, non-absorbable laxatives for long-term maintenance treatment, wait for the children's gastrointestinal function to gradually improve, and then slowly stop the medication . Many parents stop the drug repeatedly and the constipation recurs repeatedly, which is not conducive to the continuity and effectiveness of the constipation treatment.
6. Children often have a fear of defecation because of the severe pain of constipation. Therefore, they will deliberately suppress defecation and delay defecation as much as possible, so the constipation gradually worsens, leading to a vicious circle. Therefore, early treatment is required.
7. Long-term constipation leads to a variety of adverse consequences: affect the physical and mental development of children, and daily fear and psychological stimulation cause immeasurable mental and psychological pressure, which in turn affects autonomic nerve function and further harms the normal physiology of the gastrointestinal tract Function; mental stress can also affect mental development; the rectal and anal mucosa is scratched and lacerated by dry stool, causing local chronic inflammation, which further affects its function; long-term constipation will cause rectal tension to become less and less sensitive As the rectum becomes worse and worse, the volume of the rectum becomes larger and larger, which will cause the stool to accumulate more and more, thicker and harder to excrete; constipation will affect the excretion of toxins, so toxins in the body will increase, especially heavy metals; Constipation can cause intestinal metabolism disorders; but effective treatment can prevent or greatly reduce such adverse consequences, especially to prevent physical and mental harm to children.
8. There are many drugs and methods for adult constipation, but the research on pediatric constipation has been relatively lagging, especially drug treatment. There are many reasons. One is that most parents do not want to use their children as experimental products; the other is that children cannot actively respond to problems and it is not easy to cooperate with the research; and the third is that drug developers are unwilling to make great efforts to make small money.
9. However, in the past ten years, the United States and other developed countries have done a large number of clinical trials on constipation in children, so that people have a more scientific understanding of the problem of constipation in children, and a more scientific standard in treatment has been overturned. Sexual methods and traditional understanding.
1) Stimulant laxatives are generally used less or not, such as senna, magnesium sulfate, phenolphthalein tablets, fruit guide tablets, rhubarb tablets, etc.;
2) Anal plug preparations such as Kaisailu and enema can only be used temporarily, and should not be used as a routine or long-term continuous use, because long-term use will cause dependence;
3) Behavior interventions (such as encouragement, training to go to the toilet, diet conditioning, increased exercise, etc.) are only effective for a small number of children, but for most children, they can only help and cannot be treated. Drug therapy cooperation;
4) Basic drug treatment. At present, there are two drugs that are considered safer by the current study, polyethylene glycol 4000 (Note: There is Shutaiqing in China, which is divided into packages A and B. Children can only take package A; imports seem to have " Fusong”) and lactulose (Note: Du Mik is imported), both of which are osmotic laxatives, that is, through the water absorption properties of the medicine itself, it increases the water content of the intestinal contents and keeps the stool moist.The characteristics of these two drugs are that they are non-toxic, and they are basically not absorbed by the body and cannot be decomposed. They are directly eliminated from the body through the intestinal tract after oral administration (lactulose can be catabolized by intestinal probiotics in the intestine), and has an impact on the intestinal There is no irritation, so it can be taken safely for a long time. Through a large number of clinical trials and follow-up studies, these two drugs have not found any adverse effects on growth and development, nutrient absorption, toxicity tests, blood index analysis, etc. However, polyethylene glycol 4000 has not been written into the instructions for children with constipation, but it has been used in children in foreign clinics. Dumic has written instructions for children with constipation, and pregnant women can also use it, so it should be safer.
5) Drug treatment should be maintained for a certain period of time until the child has established normal bowel function. The time may be 3 months, 6 months, 1 year or several years. After a certain period of time, you can try to reduce the amount and observe whether you can defecate normally. If you are still constipated, you need to continue medication.
6) The dosage of the medication: everyone is not necessarily the same, because these two medications have no "ceiling effect", that is, no dosage limit, so the dosage of the medication can be safely increased, and the medication can be adjusted according to personal circumstances. The standard is "keep the stool moist." , Unobstructed, stool is effortless, painless, and not too loose." It can be administered once a day or divided into two doses a day.
7) Medication can effectively prevent psychological problems and physical damage caused by long-term constipation, and prevent a series of complications such as hemorrhoids, anal fissures, anal fistulas, perianal abscesses, enteritis, autonomic disorders, metabolic disorders, and toxin excretion disorders. After the constipation is effectively relieved, stool becomes a normal physiological need, even a joyful enjoyment, rather than a mental and physical burden. Only in this case can the child be better and faster Jiezhong establishes a normal physiological defecation mechanism.
For our country, I read some documents, combined with my own experience and knowledge, and summarized as follows:
1. Our country is relatively backward in the research and understanding of constipation, especially constipation in children.
2. People do not fully understand the adverse consequences caused by constipation.
3. The causes and mechanisms of constipation are complex, and no one can explain it clearly.
5. Nowadays medicine is evidence-based medicine, that is, any treatment methods and methods must have scientific clinical verification and scientific and strict statistical data. Rather than relying on personal experience, individual case inference, and subjective assumptions. So now the medical profession is no longer the so-called old experts, but young and middle-aged scholars, who can read foreign literature without barriers and keep track of the latest international research results and the latest diagnosis and treatment standards.
Supplement personal experience:
For some stubborn children with constipation, especially those with constipation whose defecation interval is more than 3 days, if Doumi overcomes the effect of using a certain dose, the effect of using polyethylene glycol 4000 may be better.
The reason is: Dumic can be catabolized and metabolized by bacteria in the intestine. Although the stool is moisturized after oral administration of Dumic, if the child does not excrete the stool within 2 days, the Dumic may have been basically metabolized by bacteria. After that, the feces become dry and clumpy again in the intestine. Even if I eat every day, Dumic who goes in the back may not be able to reach the front of the fecal mass. After all, this medicine is a relatively mild medicine, and children often use a small dose.
There are two solutions, one is to further increase the dose of Dumic (it feels that a single use per day is better than two use at the same dose); the other is to change to polyethylene glycol 4000, because the drug Unlike Dumic, it cannot be metabolized by bacteria and remains in the stool for a continuous function of softening the stool.
But one thing to note: Although foreign clinicians often use polyethylene glycol 4000 for children, and several clinical trials for children with constipation in the past few years have shown that the drug has a better laxative effect than Dumic and is equally safe, but Based on the consideration that the samples from several clinical trials are still insufficient, the FDA has not approved polyethylene glycol 4000 for children with constipation. Therefore, there are only instructions for adults in the manual. Although the domestic "Shutaiqing" does not include children's use in its package insert, the drug instructions on its website indicate the use of infants and children. (If parents use domestic Shutaiqing, they must know that there are package A and package B in the package, package A is polyethylene glycol 4000, package B is electrolyte powder, please do not give package B to children). For the imported Fukusong, I haven't tried it. It seems to be a single polyethylene glycol 4000 without electrolyte.