vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v14i3.1374vsp-702Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCEЗапоры у детей: в помощь педиатруConstipation in Children: Assisting PaediatriciansЗахароваИ. Н.ZakharovaI. N.

доктор медицинских наук, профессор, заведующая кафедрой педиатрии РМАПО, главный педиатр Центрального федерального округа России, заслуженный врач Российской Федерации

zakharova-rmapo@yandex.ruСугянН. Г.SugyanN. GМайковаИ. Д.MaykovaI. D.БережнаяИ. В.BerezhnayaI. V.КолобашкинаИ. М.KolobashkinaI. М.Российская медицинская академия последипломного образования, Москва, Российская ФедерацияРоссияRussian Academy of Post-Graduate Education, Moscow, Russian FederationRussian FederationРоссийская медицинская академия последипломного образования, Москва, Российская Федерация Амбулаторно-поликлинический центр No 133 г. Москвы, Российская ФедерацияРоссияRussian Academy of Post-Graduate Education, Moscow, Russian Federation Outpatient Centre No. 133 of Moscow City, Russian FederationRussian FederationДетская городская клиническая больница им. З.А. Башляевой, Москва, Российская ФедерацияРоссияZ.A. Bashlyaeva Children City Clinical Hospital, Moscow, Russian FederationRussian FederationРоссийская медицинская академия последипломного образования, Москва, Российская ФедерацияRussian Federation201525082015143Вопросы современной педиатрии380386Copyright © Захарова И.Н., Сугян Н.Г., Майкова И.Д., Бережная И.В., Колобашкина И.М., 20152015Захарова И.Н., Сугян Н.Г., Майкова И.Д., Бережная И.В., Колобашкина И.М.Zakharova I.N., Sugyan N.G., Maykova I.D., Berezhnaya I.V., Kolobashkina I.М.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/702

В статье обсуждается понятие функционального запора в соответствии с Римскими критериями III, Парижским консенсусом и предложениями Североамериканского общества детских гастроэнтерологов, нутрициологов и гепатологов (NASPGHAN). Представлены данные о распространенности функциональных запоров у детей, которые существенно различаются у отдельных авторов (от 0,7 до 29,6% при среднем показателе 8,9%). Функциональный запор регистрируют у детей всех возрастных групп — от новорожденных до подростков. Тяжесть его может варьировать от легких до тяжелых форм. Только в 1,6% случаев причиной запора оказывается органическая патология, в остальных случаях нарушения дефекации носят функциональный характер. В статье обсуждаются факторы риска развития запоров у детей, описан алгоритм дифференциальной диагностики хронического запора и болезни Гиршпрунга. Основная цель лечения запоров у детей — восстановление консистенции кишечного содержимого и скорости транзита его по толстой кишке. Алгоритм ведения ребенка раннего возраста с функциональными запорами предусматривает, в первую очередь, коррекцию питания ребенка и проведение режимных мероприятий, включающих выработку рефлекса на дефекацию. Медикаментозная терапия подразумевает назначение пероральных слабительных, применение средств, стимулирующих моторику желудочно-кишечного тракта. В педиатрии предпочтение отдают пероральным слабительным препаратам с осмотическим механизмом действия, в частности полиэтиленгликолю — высокомолекулярному полимеру, который увеличивает объем, размягчает кишечное содержимое за счет образования дополнительных водородных связей с молекулами воды и опосредованно оказывает стимулирующее действие на перистальтику кишечника. 

The article focuses on the definition of functional constipation in accordance with the Rome III diagnostic criteria, the Prague consensus and suggestions offered by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). It presents data on functional constipation occurrence in children, which differ greatly between some authors (ranging from 0.7 to 29.6%, average occurrence being 8.9%). Functional constipation is detected in children of all age groups — from infants through teenagers. Severity varies from light to nasty. Only 1.6% of all cases occur due to organic disorders, while the rest are purely functional. The article describes risk factors for juvenile constipation and an algorithm for differential diagnosis of chronic constipation and Hirschprung’s disease. The main goal of treatment is to re-establish the normal density of the content of the intestines and speed up colonic transit. The algorithm of recording infants suffering functional constipation requires, first and foremost, correct nutrition and regular activities aimed at stimulating the exoneration reflex. Drug therapy includes administering peroral laxatives and other medicines to stimulate bowel movement. Pediatrics inclines toward using osmotic peroral drugs, particularly polyetilenglicol — a high-molecular polymer, which increases the volume of and softens the content of the bowels through building extra hydrogen bonds with the molecules of water and indirectly stimulates bowel movement. 

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