![REFLUKS U NIEMOWLAKA](https://zdrowieodpoczatku.pl/wp-content/uploads/2022/09/MALINOWE-ZDROWIE-YouTube-Thumbnail-1140-×-641px-1140-×-641px-1140-×-641px.jpg)
Refluks i ulewanie u niemowląt
Dziś o refluksie, ulewaniu u niemowląt. Myślę, że jest to dość częsty problem, który generuje dużo stresu i u dziecka i u rodziców.
Co to jest refluks?
Choroba refluksowa przełyku (GER) jest definiowana jako mimowolny powrót treści żołądkowej do przełyku i zdarza się to u około 25% dzieci, co jest drugim największym problemem dotyczącym najczęściej występujących dolegliwości przewodu pokarmowego.
Wyróżnia się dwie postaci refluksu:
- patologiczny, powodowany najczęściej wadliwą pracą dolnego zwieracza przełyku,
- fizjologiczny związany z niedojrzałością czynnościową układu trawiennego oraz jego budową w tym wieku.
Refluks u większości niemowląt jest fizjologiczny i może występować nawet do roku czasu. Później można mówić o chorobie refluksowej, która ma szerszy charakter.
Najczęstsze objawy sugerujące problemy z jedzeniem to:
- trudności w ssaniu i połykaniu,
- bezdech,
- powtarzający się kaszel i/lub krztuszenie się,
- nadmierna drażliwość,
- zmiany zachowania podczas karmienia,
- czas żywienia dłuższy niż 30 do 40 minut,
- odmowa jedzenia
- i deficyt wzrostu.
Czemu dziecko jest takie niespokojne?
A dlatego, że wymiotuje, krztusi się, brakuje mu powietrza, bywa, ze towarzyszy temu zapalenie przełyku. Dziecko kojarzy jedzenie z dyskomfortem, bólem i nieprzyjemnością.
Z drugiej strony GER zagraża integralności motoryki jamy ustnej dziecka, powodując nadwrażliwość w jamie ustnej, przewidywanie odruchów wymiotnych i niechęć do stymulacji dotykowej, uzasadniając odmowę niektórych pokarmów i tekstur.
Ciekawe jak to jest potem, czy dzieci z neofobią żywieniową borykały się wcześniej z refluksem. Hmm 🙂
Patologiczny refluks niemowlaka, tudzież choroba refluksowa objawiają się poprzez takie symptomy, jak:
- uporczywy, utrzymujący się kaszel,
- niepokój, rozdrażnienie, nadpobudliwość,
- zapalenie przełyku,
- krwiste wymioty,
- niedokrwistość,
- występujące bezdechy,
- nawracające zapalenia płuc,
- spowolniony przyrost masy ciała.
Co może pomóc przy refluksie u niemowlaka?
Mówi się o tym, że w przypadku refluksu rodzaj pokarmu nie ma znaczenia, więc nie byłoby to zasadne przechodzenie z karmienia piersią na mleko modyfikowane. Jednak jeśli związane jest to z nietolerancją na rożne pokarmy mama karmiąca może przeprowadzić próbę eliminacji różnych pokarmów ze swojej diety (zwykle jest problem z nabiałem, glutenem i innych, szczególnie tych, które mama spożywała w dużych ilościach).
Warto również przyjrzeć się technice karmienia, można udać się do doradcy laktacyjnego, który tu może bardzo pomóc. Zwykle problem jest w tym, że dziecko zasysa zbyt dużo powietrza podczas jedzenia. Można karmić krócej i w mniejszych ilościach (za to częściej), zwracając uwagę na dokładne przyleganie ust malucha do sutków.
Leczenie refluksu u niemowlaka w dużej mierze zależy od charakteru i nasilenia objawów. W przypadku niegroźnego refluksu fizjologicznego, wystarczy dać zadziałać siłom natury i prawom fizyki, a więc po prostu pozwolić na swobodne ulanie się pokarmu. Najlepiej w tym celu jest wziąć dziecko na ręce, w pozycji pionowej, z główką wspartą na ramieniu, rączki przełożone przez nasze ramię, podłóż pieluszkę;)
Leczenie farmakologiczne stosowane jest wyjątkowo rzadko u maluchów. Leki, które działają objawowo i zaburzają prawidłową pracę układu pokarmowego. W bardzo sporadycznych przypadkach refluks żołądka oraz refluks przełyku leczy się operacyjnie.
U dzieci karmionych mlekiem modyfikowanym, u których z nieznanych przyczyn występują wymioty i częsty płacz w nocy, zaleca się stosowanie hydrolizatu białka przez 2-4 tygodni. Takie postępowanie może przynieść poprawę u maluchów z alergią na białko mleka krowiego.
Warto zwrócić uwagę na pozycję dziecka przy karmieniu. Silne odgięciowe ułożenie główki znacznie utrudnia przełykanie, zwiększając ryzyko zachłyśnięcia. Jest wysoce prawdopodobne, że u dziecka karmionego stale w ten sposób rozwinie się choroba refluksowa. Odsyłam do moich filmików dotyczących prawidłowej pielęgnacji dziecka na youtube.
Najkorzystniejszą pozycją w łagodzeniu refluksu jest pozycja na lewym boku i pozycja na brzuchu. Na brzuszku kładziemy dziecko tylko pod kontrolą. Nie ma badań na to, że pozycja wyższa pomaga. Choć zdarzało się, że niektórzy rodzice szukając pozycji znaleźli inne niż zalecane.
Refluks może generować napięcia w układzie nerwowo-mięśniowym, a w efekcie zaburzać wzorce ruchowe i rozwój motoryczny. Zdarzało się, że dzieci przychodziły do mnie z diagnozą w zmożonego napięcia mięśniowego a okazywało się, że to objaw refluksu. Dziecko się wtedy napina się i pręży co uniemożliwia mu zdobywanie nowych zdolności motorycznych w prawidłowych wzorcach. Dziecko, które nie otrzymuje odpowiedniej ilości kalorii też być apatyczne i po prostu nie mieć siły, by się ruszać.
Kiedy dziecko częściej płacze sytuacja w domu jest również bardziej napięta. Rodzice, szczególnie matki bardziej są wtedy narażone na wystąpienie depresji. Dziecko nie ma odpowiedniej podaży kalorii, jest w stresie, dużo płacze, mało śpi. To powoduje, ze jego motywacja do nabywania nowych umiejętności ruchowych maleje. A z tym również rozwój poznawczy, bo zamiast się bawić, obserwować, doświadczać tego co jest dookoła to jest bardzo często w dyskomforcie.
Warto aby zapewnić maluchowi mimo wszystko dużo spokoju, powolne zabiegi pielęgnacyjne, zrównoważone środowisko, nie bałagan sensoryczny. I tu również odsyłam do moich filmów na youtube gdzie pokazuję jak prawidłowo nosić niemowlę. Unikanie trzymania dziecka z odgiętą głową będzie dla niego w ty momencie sprzyjające, zresztą w każdym momencie;) Tak nie nosimy dziecka.
W skrajnych przypadkach stosuje się leczenie operacyjne.
Kto jest w grupie ryzyka refluksu?
Do choroby refluksowej predysponują:
– otyłość,
– wrodzone choroby przełyku,
– zaburzenia neurologiczne,
– niektóre zespoły genetyczne,
– rodzinne tendencje do refluksu.
– przeszczep płuc,
– mukowiscydoza,
Diagnostyka refluksu żołądkowo-przełykowego
U niemowląt objawy choroby refluksowej przełyku mogą występować także przy fizjologicznym refluksie, kolce niemowlęcej czy alergiach pokarmowych, dlatego z samego wywiadu nie można postawić diagnozy. Ale jest on ważną częścią procesu diagnostycznego i powinien uwzględniać informacje dotyczące diety i karmienia, szczegółów dolegliwości dziecka, innych problemów zdrowotnych, stosowanych leków, historii medycznej rodziny, sytuacji psychospołecznej w otoczeniu dziecka (możliwy stres), ogólnego rozwoju.
Badania stosowane w diagnostyce choroby refluksowej to:
– godzinna pH-metria przełyku,
– kojarzenie pH-metrii i pomiaru impedancji wewnątrzprzełykowej,
– manometria przełyku (badanie motoryki przełyku,
– badanie endoskopowe i biopsja błony śluzowej przełyku,
– badanie kontrastowe górnego odcinka przewodu pokarmowego z papką barytową,
– scyntygrafia,
– USG przełyku i żołądka,
– badanie popłuczyn oskrzelikowo-pęcherzykowych i aspiratu z ucha środkowego.
Obserwujcie maluszki i działajcie:)
Zdrówka
- https://link.springer.com/article/10.1007/s00431-020-03855-6
- https://www.scielo.br/j/rcefac/a/TWqrTjyqcsLyV9rxGkL6JSp/?lang=en&format=htmlhttps://pediatrics.aappublications.org/content/142/1/e20181061
- https://www.mp.pl/pediatria/artykuly-wytyczne/wytyczne/50181,postepowanie-wrefluksie-zoladkowo-przelykowym-udzieci-cz-i
- https://www.mp.pl/pediatria/artykuly-wytyczne/wytyczne/52038,postepowanie-w-refluksie-zoladkowo-przelykowym-udzieci-cz-ii
- https://gastrologia.mp.pl/diagnostyka/86073,leczenie-operacyjne-choroby-refluksowej-i-przepukliny-rozworu-przelykowego-fundoplikacja-sposobem-nissena
- https://www.medme.pl/artykuly/refluks-u-niemowlat-jak-rozpoznac-objawy-leczenie,72021.html
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