medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-17-150-155medsovet-2712Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYФункциональный запор у детей раннего возраста: причины развития, критерии диагностики и тактика веденияFunctional constipation in young children: causes, diagnostic criteria and therapeutic strategiesБогдановаН. М.BogdanovaN. M.

Богданова Наталья Михайловна – кандидат медицинских наук, доцент кафедры пропедевтики детских болезней

Санкт-Петербург

Санкт-Петербургский государственный педиатрический медицинский университет Минздрава РоссииРоссияSt. Petersburg State Paediatric Medical University of the Ministry of Health of RussiaRussian Federation201821102018017150155Copyright © Богданова Н.М., 20182018Богданова Н.М.Bogdanova N.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2712

В статье дано современное определение запора и рабочая классификация, используемая в педиатрии; представлены частота дефекаций и качественная характеристика стула в зависимости от возраста и вида вскармливания. Особое внимание уделено причинам развития функционального запора у детей раннего возраста, критериям диагностики в соответствии с Римским консенсусом IV пересмотра (2016) и тактике ведения малышей, страдающих запором. Часть информации посвящена применению осмотических слабительных средств. Показан основной механизм действия полиэтиленгликоля и его преимущества в купировании запора у младенцев старше 6-месячного возраста.

The article gives a modern definition of constipation and working classification used in Pediatrics; frequency of defecation and qualitative characteristics of stool depending on age and type of feeding are presented. Particular attention is paid to the reasons for the development of functional constipation in young children, diagnostic criteria in accordance with the Rome consensus IV revision (2016) and tactics of management of children with constipation. Part of the information is devoted to the use of osmotic laxatives. The main mechanism of action of polyethylene glycol and its advantages in stopping constipation in infants older than 6 months are shown. age’s.

констипациядефекациямладенецдети раннего возрастаслабительное средствополиэтиленгликольconstipationconstipation. defecationinfantinfantslaxativepolyethylene glycolReferencesКомарова Е.В. Хронический запор у детей (медицинские и социальные аспекты). Автореф. дис. докт. мед. наук. Москва, 2007. 24 с.Komarova EV. Chronic constipation in children (medical and social aspects). Extended abstract of PhD (Med.) Dissertation. Moscow, 2007. 24 p.Van den Berg MM, Benninga MA, Di Lorenzo С. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol, 2006, 101(10): 2401-9.Van den Berg MM, Benninga MA, Di Lorenzo С. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol, 2006, 101(10): 2401-9.Borowitz SM, Cox DJ, Kovatchev B, Ritterband LM, Sheen J, Sutphen J. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics, 2005, 115(4): 873-7.Borowitz SM, Cox DJ, Kovatchev B, Ritterband LM, Sheen J, Sutphen J. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics, 2005, 115(4): 873-7.Сорвачева Т.Н., Конь И.Я. Глава «Основные принципы диетотерапии функциональных нарушений желудочно-кишечного тракта у детей первого года жизни» в кн. Детское питание. Руководство для врачей. Под ред. В.А. Тутельяна, И.Я. Коня. Издание третье, переработанное и дополненное. Медицинское информационное агентство. М., 2013: 423-429.Sorvacheva TN, Kon IYa. Chapter «The basic principles of diet therapy for functional gastrointestinal tract disorders in infants» in the book “Baby food”. A guide for practitioners. Under the editorship of Tutellana VA, Kon IYa. Third edition, revised and enlarged. Medical Information Agency. M., 2013: 423-429.Metaj M, Laroia N, Lawrence RA, Ryan RM. Comparison of breastand formula-fed normal newborns in time to first stool and urine. J Perinatol, 2003, 23: 624–28.Metaj M, Laroia N, Lawrence RA, Ryan RM. Comparison of breastand formula-fed normal newborns in time to first stool and urine. J Perinatol, 2003, 23: 624–28.Madsen JL. Effects of gender, age, and body mass in dexon gastro intestinal transit times. Dig Dis Sci, 1992, 37: 1548–53.Madsen JL. Effects of gender, age, and body mass in dexon gastro intestinal transit times. Dig Dis Sci, 1992, 37: 1548–53.Devanarayana NM, Adhikari C, Pannala W, et al. Prevalence offunctional gastrointestinal diseases in a cohort of Sri Lankanadolescents: comparison between Rome II and Rome III criteria. J Trop Pediatr, 2011, 57: 34.Devanarayana NM, Adhikari C, Pannala W, et al. Prevalence offunctional gastrointestinal diseases in a cohort of Sri Lankanadolescents: comparison between Rome II and Rome III criteria. J Trop Pediatr, 2011, 57: 34.North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr, 2006, 43: 405–407.North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr, 2006, 43: 405–407.Эрдес С.И., Мацукатова Б.О. Распростра ненность и особенности запоров у детей в России: результаты популяционного исследования. Вопросы современной педиатрии, 2010, 9(4): 50-6.Erdes SI, Matsukatova BO. The prevalence and characteristics of constipation in children in Russia: results of population-based study. Voprosy Sovremennoy Pediatrii, 2010, 9 (4): 50-6.Эрдес С.И., Мацукатова Б.О., Ревякина С.А. Запоры у детей (результаты нового российского популяционного исследования). РМЖ. Педиатрия, 2011, 19(3): 159–164.Erdes SI, Matsukatova BO, Revyakina SA. Constipation in children (results of new Russian population-based study). RMJ. Pediatria, 2011, 19 (3): 159–164.Malowitz S, Green M, Karpinski A, Rosenberg A, Hyman PE. Age of Onset of Functional Constipation. J Pediatr Gastroenterol Nutr, 2016 Apr, 62(4): 600-2.Malowitz S, Green M, Karpinski A, Rosenberg A, Hyman PE. Age of Onset of Functional Constipation. J Pediatr Gastroenterol Nutr, 2016 Apr, 62(4): 600-2.Benninga M, Biiller H, Taminiau J. Chronic constipation in children, the effect of biofeedback training with a one year followup. Arch Dis Child, 1993, 68: 126-129.Benninga M, Biiller H, Taminiau J. Chronic constipation in children, the effect of biofeedback training with a one year followup. Arch Dis Child, 1993, 68: 126-129.Mugie SM, Benninga MA, Di LC. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol, 2011, 25(1): 3–18.Mugie SM, Benninga MA, Di LC. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol, 2011, 25(1): 3–18.Chung JM, Lee SD, Kang DI, et al. An epidemiologic study of voiding and bowel habits in Korean children: a nationwide multicenter study. Urology, 76(1): 215–19.Chung JM, Lee SD, Kang DI, et al. An epidemiologic study of voiding and bowel habits in Korean children: a nationwide multicenter study. Urology, 76(1): 215–19.Ludvigsson JF. Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children. Acta Paediatr, 2006, 95: 573–80.Ludvigsson JF. Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children. Acta Paediatr, 2006, 95: 573–80.Lee WT, Ip KS, Chan JS, et al. Increased prevalence of constipation in pre-school children is attributable to under consumption of plant foods: a community-based study. J Paediatr Child Health, 2008, 44: 170–75.Lee WT, Ip KS, Chan JS, et al. Increased prevalence of constipation in pre-school children is attributable to under consumption of plant foods: a community-based study. J Paediatr Child Health, 2008, 44: 170–75.Ip KS, Lee WT, Chan JS, Young BW. A communitybased study of the prevalence of constipation in young children and the role of dietary fibre. Hong Kong Med J, 2005, 11: 431–36.Ip KS, Lee WT, Chan JS, Young BW. A communitybased study of the prevalence of constipation in young children and the role of dietary fibre. Hong Kong Med J, 2005, 11: 431–36.Inan M, Aydiner CY, Tokuc B, et al. Factors associated with childhood constipation. J Paediatr Child Health, 2007, 43: 700–6.Inan M, Aydiner CY, Tokuc B, et al. Factors associated with childhood constipation. J Paediatr Child Health, 2007, 43: 700–6.Cheng C, Chan A O, Hui W M, et al. Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population-based study. Aliment Pharmacol Ther, 2003, 18: 319–26.Cheng C, Chan A O, Hui W M, et al. Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population-based study. Aliment Pharmacol Ther, 2003, 18: 319–26.Хавкин А.И., Файзуллина Р.А., Бельмер С.В. и др. Диагностика и тактика ведения детей с функциональными запорами. Рекомендации общества детских гастроэнтерологов. Вопросы практической педиатрии, 2014, 9(5): 62-76.Khavkin AI, Fayzullina RA, Belmer SV, et al. Diagnosis and approaches to the management of children with functional constipation. Recommendations of the Society for Paediatric Gastroenterology. Voprosy Prakticheskoy Pediatrii, 2014, 9 (5): 62-76.Leung A, Chan P, Cho H. Constipation in children. Am Fam Phys, 1996, 54: 611-618.Leung A, Chan P, Cho H. Constipation in children. Am Fam Phys, 1996, 54: 611-618.Хавкин А.И., Бельмер С.В., Горелов А.В., Звягин А.А., Корниенко Е.А., Нижевич А.А., и др. Диагностика и лечение функционального запора у детей (Проект Консенсуса Общества детских гастроэнтерологов). Вопросы детской диетологии, 2013, 11(6): 51-8.Khavkin AI, Belmer SV, Gorelov AV, Zvyagin AA, Kornienko EA, Nizhevich AA, et al. Diagnosis and treatment of functional constipation in children (Draft Consensus of the Society for Paediatric Gastroenterology). Voprosy Detskoi Dietologii, 2013, 11 (6): 51-8.Урсова Н.И. Актуальные и нерешенные проблемы функциональных запоров у детей раннего возраста. Вопросы современной педиатрии, 2010, 9(3): 63–69.Урсова Н.И. Актуальные и нерешенные проблемы функциональных запоров у детей раннего возраста. Вопросы современной педиатрии, 2010, 9(3): 63–69. /Ursova NI. Actual and unsolved problems of functional constipation in young children. Voprosy Sovremennoi Pediatrii, 2010, 9 (3): 63–69.Национальная программа оптимизации вскармливания детей первого года жизни в Российской Федерации. Союз педиатров России. М., 2010: 39-42.Национальная программа оптимизации вскармливания детей первого года жизни в Российской Федерации. Союз педиатров России. М., 2010: 39-42. /National programme for optimization of nutrition for children under one year in the Russian Federation. Union of Pediatricians of Russia. M., 2010: 39-42.Yousef NN, Di Lorenzo C. Childhood constipation: evaluation and treatment. J Clin Gastroenterol, 2001, 33: 199–205.Yousef NN, Di Lorenzo C. Childhood constipation: evaluation and treatment. J Clin Gastroenterol, 2001, 33: 199–205.Hyman PE, Milla PJ, Bennig MA et al. Childhood functional gastrointestinal disorders: neonate/toddler. Am J Gastroenterol, 2006, 130(5): 1519-1526.Hyman PE, Milla PJ, Bennig MA et al. Childhood functional gastrointestinal disorders: neonate/toddler. Am J Gastroenterol, 2006, 130(5): 1519-1526.Benninga S, Nurko MA, Faure C, Hyman PE, James Roberts ISt, Schechter NL. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology, 2016, 150(6): 1443–1455.Benninga S, Nurko MA, Faure C, Hyman PE, James Roberts ISt, Schechter NL. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology, 2016, 150(6): 1443–1455.Xinias I, Mavroudi A. Constipation in Childhood. An update on evaluation and management. Hippokratia, 2015 Jan-Mar, 19(1): 11–19.Xinias I, Mavroudi A. Constipation in Childhood. An update on evaluation and management. Hippokratia, 2015 Jan-Mar, 19(1): 11–19.Riad Rahhal, Aliye Uc. Functional constipation. Walker W, Durie P, Hamilton J, Walker-smith J, Watkins J (eds). Pediatric gastrointestinal disease: pathphysiology, diagnosis and management. 5th edition, Decker, Hamilton-Ontario. 2008: 675–682.Riad Rahhal, Aliye Uc. Functional constipation. Walker W, Durie P, Hamilton J, Walker-smith J, Watkins J (eds). Pediatric gastrointestinal disease: pathphysiology, diagnosis and management. 5th edition, Decker, Hamilton-Ontario. 2008: 675–682.Vandenplas Y, Gutierrez-Castrellon P, VelascoBenitez C, Palacios J, Jaen D, Ribeiro H, et al. Practical algorithms for managing common gastrointestinal symptoms in infants. Nutrition, 2013, 29(1): 184-94.Vandenplas Y, Gutierrez-Castrellon P, VelascoBenitez C, Palacios J, Jaen D, Ribeiro H, et al. Practical algorithms for managing common gastrointestinal symptoms in infants. Nutrition, 2013, 29(1): 184-94.Clifford C, Gorodzinsky F. Canadian Paediatric Society, Community Paediatrics Committee. Toilet learning: Anticipatory guidance with a child-oriented approach. Paediatr Child Health, 2000, 5(6): 333-5.Clifford C, Gorodzinsky F. Canadian Paediatric Society, Community Paediatrics Committee. Toilet learning: Anticipatory guidance with a child-oriented approach. Paediatr Child Health, 2000, 5(6): 333-5.Vandenplas Y, Alarcon P, Alliet P, et al. Algo rithms for managing infant constipation, colic, regurgitation and cow’s milk allergy in formula-fed infants. Acta Paediatr, 2015, 104(5): 449–57.Vandenplas Y, Alarcon P, Alliet P, et al. Algo rithms for managing infant constipation, colic, regurgitation and cow’s milk allergy in formula-fed infants. Acta Paediatr, 2015, 104(5): 449–57.Salvatore S, Barberi S, Borrelli O, Castellazzi A, Di Mauro D, Di Mauro G, et al Pharmacological interventions on early functional gastrointestinal disorders. Ital J Pediatr, 2016 Jul 16, 42(1): 68.Salvatore S, Barberi S, Borrelli O, Castellazzi A, Di Mauro D, Di Mauro G, et al Pharmacological interventions on early functional gastrointestinal disorders. Ital J Pediatr, 2016 Jul 16, 42(1): 68.Petuely F. Bifidusflora bei Flaschenkindern durch bifidogene Substanzen (Bifidusfactor). Z Kinderheilkd, 1957, 79: 174-177.Petuely F. Bifidusflora bei Flaschenkindern durch bifidogene Substanzen (Bifidusfactor). Z Kinderheilkd, 1957, 79: 174-177.Tabbers MM, Di Lorenzo C, Berger MY, et al. Evaluation and Treatment of Functional Constipation in Infants and Children: EvidenceBased Recommendations From ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr, 2014, 58(2): 258–274.Tabbers MM, Di Lorenzo C, Berger MY, et al. Evaluation and Treatment of Functional Constipation in Infants and Children: EvidenceBased Recommendations From ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr, 2014, 58(2): 258–274.Candy DC, Edwards D, Geraint M. Treatment of faecal impaction with polyethelene glycol plus electrolytes (PGE + E) followed by a doubleblind comparison of PEG + E versus lactulose as maintenance therapy. J Pediatr Gastroenterol Nutr, 2006, 43: 65–70.Candy DC, Edwards D, Geraint M. Treatment of faecal impaction with polyethelene glycol plus electrolytes (PGE + E) followed by a doubleblind comparison of PEG + E versus lactulose as maintenance therapy. J Pediatr Gastroenterol Nutr, 2006, 43: 65–70.Schiller LR, Emmett M, Santa Ana CA, Fordtran JS. Osmotic effects of polyethylene glycol. Gastroenterology, 1988, 94: 933–41.Schiller LR, Emmett M, Santa Ana CA, Fordtran JS. Osmotic effects of polyethylene glycol. Gastroenterology, 1988, 94: 933–41.Бабаян М.Л. Коррекция функциональных запоров у детей. Детская гастроэнтерология, 2011, 4(8).Babayan ML. Correction of functional constipation in children. Detskaya Gastroenterologiya, 2011, 4 (8).Шемеровский К.А. Проблема запора: хронофизиологический подход. Врач, 2011, 10.Shemerovsky KA. The problem of constipation: chronophysiological approach. Vrach, 2011, 10.Еремеева А.В. Опыт применения осмотического слабительного (полиэтиленгликоля 4000) в лечении хронического запора у детей. Вопросы современной педиатрии: научно-практический журнал Союза педиатров России, 2013, 12(4): 172-175.Eremeeva AV. Experience in using osmotic laxative (polyethylene glycol 4000) in the treatment of chronic constipation in children. Voprosy Sovremennoy Pediatrii: Nauchno-Prakticheskiy Zhurnal Soyuza Pediatrov Rossii, 2013, 12 (4): 172-175

The authors declare that there are no conflicts of interest present.