The main reasons for the formation of bubbles on a child’s tongue

What is regurgitation?

Regurgitation in infants is considered to be the spontaneous release of a small amount of just eaten food (milk or formula) into the baby’s mouth from the stomach.

Content:

1. Types of regurgitation |
00:56 (in video) 2. Physiological causes of regurgitation | 01:40 (in video) 3. Functional causes of regurgitation | 02:43 (in video) 4. Permissible frequency of regurgitation 05:13 (in video) 5. Until what age can regurgitation continue | 05:47 (in video) 6. Is it necessary to feed the baby after spitting up | 06:23 (in video) 7. Actions when spitting up | 07:11 (in video) 8. Congenital pathologies of the gastrointestinal tract, as a cause of regurgitation 9. Actions to prevent regurgitation Online consultation with a pediatrician (Breastfeeding Specialist)

Online consultation

During the consultation, you will be able to voice your problem, the doctor will clarify the situation, interpret the tests, answer your questions and give the necessary recommendations.

Types of regurgitation in newborns

There are 3 types of regurgitation:

• belching - the release of air captured by the baby when eating, as a rule, a small volume of milk or formula comes out;
• regurgitation - the food received and the air along with it come out very abundantly. In time, this occurs simultaneously with the end of the meal or after a short period of time. Children in the first 5 months of life are more often susceptible to this phenomenon. Does not cause anxiety or crying in the child, appetite does not disappear;
• vomiting is similar to regurgitation, but there are a number of features. The child is capricious, cries, becomes sleepy, lethargic. There is a complete loss of appetite and reluctance to eat.

Another reason for the formation of pimples on a baby’s tongue is dysbacteriosis.

With dysbacteriosis, pimples cover the mucous membrane of the child’s tongue and externally resemble small ulcers. Treatment should be started immediately, since such bubbles cause severe pain.

In cases where pimples turn into ulcers, you should pay attention to the condition of the child’s intestines. After all, it is possible that exactly the same ulcers appear there as on the surface of the tongue. Therefore, if you notice even small pimples on a child’s tongue, you should undergo an examination of the whole body. This will allow us to determine the causes of this phenomenon and begin appropriate treatment.

Physiological causes of regurgitation

• short esophagus or ball-shaped esophagus;
• the esophagus becomes wider in the upper part (has the shape of a funnel);
• the esophagus is narrowed (this process is normal, according to physiology);
• The gastric sphincter is underdeveloped. This is a temporary phenomenon (due to age).

The muscular corset of the stomach is still weak, and the mucous membranes are quite sensitive. That is why, when food enters the stomach, its bottom begins to produce contractile movements. As the pressure level increases, food makes its way back into the oral cavity from the esophagus.

Why is there so much saliva?

Your newborn is growing, becoming large, and reaching two to three months of age. At this stage of development, the salivary glands form and begin to work. Therefore, excessive drooling is normal.

During this same period, the baby becomes more active. The child explores and tastes everything that surrounds him. Therefore, the body produces a protective antibacterial environment - saliva, which washes away dirt that gets into the small mouth.

The newborn has already drooled, but the baby still does not know how to swallow it, so streams flow down his chin. Parents are frightened by such profuse drooling. If the saliva is clear, not foamy, not thick, not stringy, experienced mothers do not worry. Mothers know that this is a normal state for a baby at this age.

Functional causes of regurgitation

Due to the physiological immaturity of the sphincter located between the stomach and esophagus. After food products pass through it, it may not close. Food can easily pass through the esophagus into the oral cavity. In children of the first year of life, this sphincter is poorly developed and may not work well.

• the structure of the gastrointestinal tract (a child’s esophagus differs from the structure of an adult). When the baby lies down, it is easier for food to move back into the esophagus and ultimately into the oral cavity.
• active movements after eating (turns, games).
• overeating (applies to all types of feeding).
• food is not according to the regime. This applies to "artificial babies" who are often fed as if they were breastfed, i.e. on demand. The mixture takes much longer to digest. Eating food not according to a schedule, regime, but at will, on demand, creates excess pressure on the bottom of the stomach, preventing food from being digested normally, so regurgitation may occur.
• the mixture is chosen incorrectly;
• swallowing air during feeding (baby sucks quickly);
• incorrectly attached to the breast, the bottle is positioned incorrectly, read more about breastfeeding positions here;
• with a sudden change of position after eating (swaddling, massage, games).
• due to the resulting pressure on the abdominal cavity - a narrow diaper, a tight diaper, colic, gas, constipation.
• congenital defects of the gastrointestinal tract, diseases associated with neurology, intestinal obstruction.
• poisoning
• diseases and injuries: hyperthermia, head injury, acute respiratory viral infection, pylorospasm, pyloric stenosis
• Pylorospasm and pyloric stenosis.
  What is pylorospasm? The pyloric section of the stomach is the section where the stomach passes into the duodenum. Muscle spasm in this area is called pylorospasm. In such a situation, food does not pass into the stomach or passes through with difficulty, which causes regurgitation.

  What is pyloric stenosis? This is a phenomenon where food does not pass or passes with difficulty from the stomach to the intestinal area. This condition requires surgical treatment.

Hypersalivation

If we consider salivation from a physiological point of view, then in this process the mutual work of receptors in the periphery and the brain is assumed. The idea is that when saliva accumulates in the mouth, a command is transmitted along the motor pathways to the brain to swallow it. If the functioning of the reflex sensorimotor arc is disrupted, as a result of a distortion of sensitivity, or in other words, with hypoesthesia, the flow of information from the oral cavity does not reach the brain. This leads to the fact that the number of involuntary swallows decreases during the day, which means that the amount of saliva increases.

In order to restore reflex swallowing, it is necessary to correct the sensorimotor arc. In order to overcome this problem, you need to try to create conditions under which the brain will begin to receive sufficient information again.

Only a doctor can choose a method of treatment for complicated salivation; the main thing is not to leave everything to chance, the disease will not go away on its own

Cryotherapy is considered the most effective way to combat hypersalivation. The essence comes down to running an ice stick over the baby’s tongue. Naturally, this approach does not provide one hundred percent guarantees, but if drooling does not stop completely, then at least it is significantly reduced. Cryotherapy does not work instantly, but requires endurance and perseverance, but it is less painful than surgery and dental correction.

Acceptable frequency of regurgitation.

As a rule, they indicate a frequency of 6-8 times a day in small portions; you can also find data on regurgitation 2-5 times a day and a volume of ⅔ tablespoons. If the number of regurgitations increases, fever, and vomiting appear, contact your pediatrician. If weakness is added, this is a reason to call an ambulance.

Especially close attention is required when spitting up like a fountain. You need to offer the child water and carry it in a column. If the regurgitation was a one-time occurrence, there is no need to worry.

Do I need to feed my baby after spitting up?

• If the baby has eaten a long time ago, the milk/formula has almost been digested; if the body position changes, the baby may still burp. This is not a reason for additional feeding.
• If regurgitation occurs after feeding, this is a sign of overeating. It’s also not worth feeding.
• If the baby spits up profusely, this is a reason to discuss this issue with the pediatrician. We also don’t supplement feeding.
• If regurgitation is minimal, then you can feed as usual.

Taking into account the physiology of children, it is not possible to find a clear connection between feedings and regurgitation.

Actions to take when spitting up

Sometimes spitting up is easier to prevent than to treat. This does not always apply to cases where regurgitation is not physiological in nature and requires specialist supervision and possible surgical intervention.

So, simple tips to help minimize regurgitation:

• The first time the baby is put to the breast. Try to master this skill while still in the maternity hospital, turning to medical staff for help. You can also seek advice from a breastfeeding specialist. A baby who is properly attached to the breast will swallow less air during feeding, which will reduce the risk of regurgitation and stomach problems in the form of excessive gas formation.
• Get your baby used to lying on his tummy on a hard surface before feeding. This is a kind of massage that also has a beneficial effect on the baby’s stomach, reducing regurgitation and preventing colic and bloating.
• Before feeding, you can do a light massage of the abdomen in a clockwise direction, and light exercises.
• Try not to make your baby scream from hunger, as he will definitely swallow excess air, which will become a likely cause of regurgitation and just a bad mood. If this happens, try to calm the baby down first, and then start feeding.
• If feeding formula from a bottle, make sure it is full. The nipple of the bottle should be filled with milk, not air. Particular attention should be paid to the nipple, namely the hole in the nipple. It must be selected according to the age of the child. The inscription on the box of the bottle will help with this, indicating what age the nipple is designed for. The hole in the nipple regulates the flow of fluid and avoids choking during feeding.
• If during the feeding process the baby stops or begins to arch and cry, you can stop feeding and help the baby burp out excess air. To do this, take him in your arms, position him facing you so that the baby's arms and his head are on your shoulder. The baby will burp and perhaps return to eating again.
• Don't overfeed your baby. It is worth increasing the number of feedings, but reducing the portion. When bottle-feeding, the doctor will calculate the rate of food intake at a time and the total amount per day, based on the age and weight of the baby.

Many pediatricians, gastroenterologists, and surgeons take into account the recommendations of the working group of the European Society of Gastroenterology and Nutrition:

• position treatment
• use of therapeutic nutrition
• medication use
• surgery

Now more specifically about each:

• Treatment by position. During feeding, it is important to ensure that the baby is in a position in which the head and upper body are raised above the rest of the body. For this purpose, you can use a pillow or diaper. After feeding, hold the baby in a column to allow excess air to escape. Do not swaddle your baby tightly so as not to squeeze the stomach. After feeding, it is recommended to place the baby on his stomach or right side. But WHO recommends putting your baby to sleep only on his back.
• Medical nutrition. This means more frequent feedings with smaller portions. For children who are bottle-fed, the doctor may recommend the use of a therapeutic antirefluxor formula (AR is its designation on the package). These mixtures have an increased proportion of casein relative to whey proteins, so they are thicker, which prevents their release through the esophagus. Also, these types of foods are often enriched with thickeners, for example, starch or gum - a substance that, under the influence of the acid of the stomach contents, becomes thicker. This substance has the peculiarity of not being dissolved by enzymes, which allows it to remain thick in the stomach longer. It also promotes the active movement of food into the intestines from the stomach.
  For more information about artificial feeding, read our article “Artificial feeding: feeding rules and types of formulas.”

  If the child is breastfed, then, on the recommendation of a doctor, the mixture can be added to the diet and enter the child’s body before milk. The duration of use of this mixture is about 3 months.

• Drug treatment. It is prescribed by a doctor, if the previously indicated methods have not brought results, then it is possible to treat with medications that can significantly improve the contraction of the intestinal walls.
• Surgical intervention. This is an extreme measure when the main cause of regurgitation is pathology.

Differential diagnosis of cough in children and its treatment

Cough is a protective mechanism for cleansing the bronchi and trachea. It occurs when exposed to “fast” or irritative receptors of mechanical and chemical stimuli and to “slow” C-receptors - mediators of inflammation. Rare cough shocks are physiological, they remove accumulation of mucus from the larynx; healthy children “clear their throat” 10–15 times a day, more in the morning, which should not alarm parents.

In the differential diagnosis of cough, it is very important to distinguish between its temporary characteristics: acute cough; persistent cough lasting three or more weeks after an acute episode; recurrent, occurring periodically; long persistent cough.

Types of cough

Acute cough . Characteristic of acute viral catarrh of the upper respiratory tract, as well as inflammation in the larynx (laryngitis, croup), trachea (tracheitis), bronchi (bronchitis) and lungs (pneumonia). When the respiratory tube is damaged, the cough is initially dry, unproductive - it does not lead to the discharge of sputum and is subjectively felt as intrusive. With laryngitis and tracheitis, it often acquires a barking character and a metallic overtone. A dry cough accompanies a sore throat with laryngitis. With pneumonia, the cough is usually wet from the first hours of illness and is often described as deep.

A wet cough is characteristic of a full-blown picture of bronchitis; its shocks end with the discharge of sputum (in small children this is perceived aurally), appearing again when it accumulates. The discharge of sputum is subjectively perceived as relief.

In the differential diagnosis of an acute cough, it is important to verify its connection with infection (fever, the presence of catarrhal syndrome). In a child with signs of acute respiratory viral infection (ARVI), hoarseness and difficulty in breathing indicate damage to the larynx with a possible threat of asphyxia (croup). Moist rales in both lungs indicate bronchitis: in older children they are usually large- and medium-bubble, in small children they are often small-bubble, which allows a diagnosis of bronchiolitis.

The key task in the presence of signs of acute respiratory infections is to exclude pneumonia - most often, wheezing is absent in the lungs or is heard over a limited area of ​​the lung, where a shortening of the percussion sound and/or a change in the breathing pattern is also detected. The nature and strength of the cough does not indicate the etiology of pneumonia. An exception is the stokato cough in children with chlamydial pneumonia in the first months of life: “dry”, abrupt, ringing, followed by attacks, but without reprisals, accompanied by tachypnea, but not a febrile reaction.

Spasmodic cough is characteristic of bronchial asthma, and in children of the first years of life - with acute obstructive bronchitis or bronchiolitis. In these forms, wheezing is accompanied by prolongation of exhalation, which indicates the presence of bronchial obstruction. A spasmodic cough is usually unproductive, intrusive, and often has a whistling overtone at the end.

In the event of a sudden onset of cough, including spastic cough, without signs of acute respiratory viral infection, you should think about a foreign body in the respiratory tract, especially in a child who has not previously had a spastic cough. It is characterized by an attack of whooping cough - obsessive, but not accompanied by reprises. This cough may last for a short time; when a foreign body moves into the smaller bronchi, the cough may stop. A foreign body is often accompanied by swelling of one lung, over which weakening of breathing and, often, whistling exhalation are heard; with such symptoms, bronchoscopy is indicated.

Prolonged cough (more than 2 weeks). It is observed quite often, usually after acute bronchitis. Most often, it is associated not so much with the inflammatory process as such, but with post-infectious hyperproduction of sputum and, often, with hypersensitivity of cough receptors. When deciphering such a cough, it is important to take into account the child’s age.

In infants after obstructive bronchitis, the persistence of hypersecretion of mucus with an increase in the cough threshold causes a rare wet cough for 4 weeks or more; its distinctive feature is the presence of “hoarseness” - bubbling sounds in the chest, audible at a distance, which disappear after coughing and reappear as sputum accumulates. Sputum from the trachea and larynx in infants is evacuated by more rare cough shocks, when the lumen of the bronchi is almost completely blocked. In such children, coughing with pressure on the trachea (or with a spatula on the root of the tongue) is difficult to induce. The cough associated with hypersecretion gradually subsides, both in frequency and intensity.

However, cough associated with habitual aspiration of food due to dysphagia, the most common cause of prolonged cough in infants, both breastfed and artificially, should be excluded. Establishing the fact of dysphagia usually requires monitoring the feeding process, since not every mother pays attention to the connection between cough and food intake. In addition to “choking” and “coughing” during food, food aspiration is characterized by the appearance of wheezing, which quickly disappears or changes its location and intensity after a cough impulse. Chest radiography in such children usually reveals darkening or intensification of the pulmonary pattern in the upper lobes.

Cough when eating is also observed in the presence of a bronchoesophageal fistula; its distinctive feature is the separation of copious frothy sputum; the presence of this symptom requires a contrast study of the esophagus and esophagoscopy.

Children who, in addition to dysphagia, have gastroesophageal reflux are characterized by coughing attacks during sleep. Finding a wet pillow confirms this diagnosis.

A lingering cough in children of early and preschool age is often caused by the flow of mucus into the larynx from the nasopharynx with long-term nasopharyngitis, adenoiditis, and adenoid hypertrophy; Unlike cough with bronchitis, it is not accompanied by wheezing in the lungs, often has a superficial character and disappears when the process in the nasopharynx is treated. A prolonged episode of bronchitis with cough lasting 2–4 weeks is common in preschoolers with recurrent bronchitis.

A prolonged dry cough in school-age children and adolescents, which can last up to 6 weeks, is not uncommon with tracheitis or tracheobronchitis, which develops with certain respiratory viral infections (RS, rhino-, parainfluenza viruses). It is often painful, paroxysmal, and the attack ends with the discharge of a lump of dense mucus (fibrinous deposits). Special studies, however, have shown that among children of this age who have been coughing for more than 2 weeks, 25% or more experience whooping cough in their characteristic atypical form - without pronounced paroxysms and relapses.

This course of whooping cough is typical for both incompletely vaccinated children and children who received 3 vaccinations and revaccination at 18 months. The fact is that pertussis immunity gradually fades away and after 5–6 years—by school age—most vaccinated people become susceptible to this infection. Its atypical course in them contributes to late diagnosis (if it was carried out at all) and the spread of infection and infection of infants who have not yet received all vaccinations.

A lingering cough in adolescents with whooping cough is characterized by the absence of wheezing in the lungs; it usually does not intensify and does not acquire a specific character, as in those who have not been vaccinated. Sometimes, however, it is possible, by pressing with fingers on the trachea or with a spatula on the root of the tongue, to cause a semblance of a whooping cough shock with protrusion of the tongue, redness of the face, less often with a typical reprise. A bacteriological diagnosis of whooping cough in these children is rarely possible; it is more reliable to determine in the blood of antitoxic antibodies, which in sick people, unlike vaccinated ones, are present in high titers.

Recurrent cough . It is typical, first of all, for patients with bronchial asthma - this is one of the frequent complaints of parents of children whose asthma diagnosis has not yet been established. The cough that accompanies almost every episode of acute respiratory viral infection is also characteristic of recurrent bronchitis - it is usually wet, lingering, its duration exceeds 2 weeks, it is not accompanied by obvious signs of bronchospasm, which, however, is often detected during the study of pulmonary function (PRF) (test with bronchodilators).

With recurrent obstructive bronchitis (ROB) in children under 3–4 years of age, a cough—wet or “spastic”—occurs against the background of ARVI, usually in the presence of fever and catarrhal syndrome. Unlike cough in bronchial asthma, it does not have the character of an attack. However, by the type of cough, these two forms can hardly be distinguished, since cough and obstruction due to ARVI are the most common type of exacerbation of bronchial asthma, especially in young children. For many of them, the diagnosis of ROB eventually “flows” into the diagnosis of asthma, if such episodes are repeated more than 3-4 times or if periods of coughing are associated not with ARVI, but with an allergen, physical activity, cold air, or if they occur for no apparent reason at all - as a consequence of increased inflammatory changes in the bronchial mucosa.

Long, persistent cough . It is observed in chronic diseases of the respiratory system, which immediately distinguishes it from the types of cough described above. Of course, it can intensify or weaken at certain periods of time, but it is fundamentally important that the child coughs almost constantly.

A wet, persistent cough is observed in most suppurative lung diseases, accompanied by accumulation of sputum. The cough is often especially severe in the morning, and becomes less frequent after sputum has been removed. A cough that is “deeper” to the ear is typical of bronchiectasis; with defects of the bronchial cartilage (Williams–Campbell syndrome), it may have spastic overtones.

In cystic fibrosis, the cough is often intrusive and painful due to the viscosity of the sputum, often accompanied by signs of obstruction. The diagnosis is not difficult in the presence of other manifestations of cystic fibrosis - weight loss, polyfecal matter, tympanic fingers, etc., however, there are milder forms of this disease, so a study of sweat electrolytes is indicated in all children with a persistent cough.

A persistent dry cough with a change in voice may indicate laryngeal papillomatosis. A dry cough accompanied by shortness of breath, chest deformation, signs of cor pulmonale, and tympanic fingers is characteristic of fibrosing alveolitis.

Psychogenic cough deserves special attention , for which a persistent cough is also typical. This is usually a dry cough with a metallic tint, which is observed only in the daytime and disappears during sleep; its distinctive feature is regularity and high frequency (up to 4-8 times per minute), stopping during eating and talking. A psychogenic cough usually occurs as a reaction to stressful situations in the family and school, then becomes habitual; it often begins during an acute respiratory infection, quite quickly acquiring the character described above. In some children, this cough has the character of a tic or a manifestation of obsessive-compulsive disorder (Gilles de la Tourette syndrome).

Young children often cough when stressed, usually to achieve their goals; The cough intensifies before and during the doctor’s examination, stopping at the end of it (relieving “anticipation stress”). A new coughing attack can be provoked by touching on a topic that is unpleasant for the child (whims, keeping a daily routine) or even by simply starting an abstract conversation, without paying attention to the child. The reason for the strengthening of the cough reflex in a child may be increased anxiety of parents and concentration of their attention on respiratory symptoms. Such children require an in-depth examination to exclude organic pathology, sometimes trial treatment with antispasmodics and steroid aerosols.

Some types of cough differ in nature.

Bitonal cough (low, then high tones). Occurs with tuberculous granulations from a lymphobronchial fistula, sometimes with foreign bodies in large bronchi. Is an indication for bronchoscopy.

Cough when taking a deep breath . Accompanied by pain, indicates pleural irritation; it goes away after pain relief (codeine, Promedol). The same cough during restrictive processes is associated with increased lung rigidity (allergic alveolitis). Taking a deep breath also causes a cough in children with asthma - it occurs as a result of bronchial hyperreactivity; shallow breathing is an integral part of a number of physical therapy (physical therapy) systems used to treat asthma.

Night cough . Characteristic of bronchial asthma, it usually occurs closer to the morning due to increased bronchospasm; It often indicates an allergy to the feathers in the pillow. In some children, nocturnal cough is the equivalent of asthma, so these children should be assessed accordingly. Night cough is also observed with gastroesophageal reflux, while older children complain of heartburn. Quite often, night cough occurs in children with sinusitis or adenoiditis due to mucus entering the larynx and drying of the mucous membrane when breathing through the mouth.

Cough during exercise is a sign of bronchial hyperreactivity and is observed in a significant proportion of patients with bronchial asthma.

Cough with syncope - short-term loss of consciousness - occurs due to a decrease in venous inflow with an increase in intrathoracic pressure and, as a result, a decrease in cardiac output; The condition is benign and does not require treatment other than antitussives.

Cough treatment

The fight against cough has been fought by humanity since time immemorial - even now, when we know so much about cough, both parents and many pediatricians consider cough as an undesirable symptom and strive to stop it. Complaints about cough and persistent requests from parents to treat the cough are apparently connected not only with the fact that cough is a clear sign of a child’s ill health. Subjectively, the cough of a person nearby or in a close environment is perceived as an irritating, unnerving phenomenon. Hence the desire to stop coughing at all costs.

What new does the modern understanding of the nature of cough give us? Firstly, that there are several causes of cough and that it only makes sense to suppress coughs caused by “dry” inflammation of the mucous membrane of the respiratory tract - for example, with laryngitis, as well as coughs associated with irritation of the pleura. In those cases when the cough leads to the removal of sputum, suppressing it is impractical and even dangerous. It is important to explain to parents that coughing is a protective reaction aimed at clearing the airways in conditions of hypersecretion of mucus and reduced efficiency of mucociliary clearance. In practice, treatment of cough as such is required only in rare cases when it significantly disrupts the patient’s life.

Antibiotics . First of all, it is important to understand that the presence of a cough in itself is not a reason for antibiotic therapy. It is carried out only in cases of proven bacterial infection of the upper respiratory tract (otitis media, sinusitis, streptococcal tonsillitis) and lung damage (pneumonia, including chronic pneumonia, cystic fibrosis, lung malformations). With regard to acute bronchitis, it has been proven that antibacterial therapy is justified only for mycoplasma and chlamydial etiology (10–15% of the total number of bronchitis, more often at school age), while the majority of bronchitis, including obstructive ones, are viral diseases.

Antibacterial treatment of whooping cough, including those that occur in the form of a prolonged cough with an early onset (in the first 7–10 days), can interrupt clinical manifestations. At a later date, it is difficult to expect a great effect from antibiotics, but such treatment stops the release of bacilli within 2-3 days, so it is completely justified from an epidemiological point of view. Erythromycin (50 mg/kg/day) and clarithromycin (15 mg/kg/day) for 10–14 days or azithromycin (10 mg/kg/day) for 5 days have proven effectiveness.

Data on the use of the local antibiotic fusafungin (Bioparox) after tonsillectomy and adenotomy operations, as well as for adenoiditis and ARVI, have been published in the literature, primarily by otolaryngologists. The drug also has a local anti-inflammatory effect. Taking into account the fact that during ARVI, pneumococci and Haemophilus influenzae multiply, its use may be justified in children at risk. However, for proven bacterial infections (streptococcal tonsillitis, otitis media, etc.), Bioparox does not replace systemic antibiotics.

Treatment of laryngitis . When a barking cough accompanies laryngitis, it is customary to inhale hot steam - for example, in a bathroom with an open hot water tap. However, this type of treatment has been proven to be ineffective for both croup and bronchitis. A meta-analysis of numerous studies on the treatment of croup has shown that intramuscular dexamethasone (0.6 mg/kg) or, in milder cases, inhaled budesonide (Pulmicort) is most effective in preventing the development (or progression) of laryngeal stenosis. These remedies also help to quickly stop coughing.

Antitussives and expectorants . A dry cough is theoretically an indication for the prescription of antitussive drugs, but in most cases of ARVI, after a few hours it gives way to a wet cough, in which these drugs are contraindicated. As antitussives in children, mainly non-narcotic drugs are used - butamirate, dextromethorphan, glaucine, oxeladine, pentoxyverine (

). A recent study showed, however, that a spoonful of buckwheat honey at night calmed nocturnal coughs in children 2–18 years old with acute respiratory viral infections at least as well as a dose of dextromethorphan. And milk with alkali, tea with jam, etc. “homemade” remedies soothe a barking cough with pharyngitis (sore throat) no worse than “antiseptic” lozenges or sprays. This gave WHO grounds to recommend only home remedies for coughs.

In cases where it is necessary to prescribe medications for pharyngitis, taking into account the fact that most drugs contain antiseptics that disrupt the biocenosis of the oral cavity, it is preferable to use inhalations of Bioparox, a bacteriostatic agent that also has anti-inflammatory effects.

With a wet cough, cough suppression is unacceptable, so intervention is justified only if there is difficulty in sputum evacuation. The effectiveness of expectorants (mainly of herbal origin) is highly questioned; in addition, their use in young children may be accompanied by an allergic reaction and vomiting. However, these remedies (preparations of mint, marshmallow, licorice, oregano, coltsfoot, anise, wild rosemary, thyme, etc.) are widely used, which can be justified by their cheapness and safety (Table 2). But the use of expensive forms of such products, even if they contain extracts of exotic plants (Greenland herbs, quebracho, ivy leaves), cannot be justified. Rubbing the chest with preparations containing essential oils (eucalyptus, pine needles, etc.) and balms that are absorbed by the skin are no more effective than expectorants.

There are combination products on sale that contain both expectorants and antitussives (Bronholitin, Tussin, etc.) (). The idea of ​​their creation is to make coughing less frequent, but more productive, which should reassure parents. These combinations also do not have proven effectiveness in children, but their testing in adult patients showed that such combinations do not improve sputum discharge, but significantly reduce respiratory function. It is unlikely that after this we can seriously recommend these remedies for practice.

Mucolytics . The use of mucolytics is more justified, especially in chronic diseases accompanied by an abundance of viscous sputum (cystic fibrosis, chronic pneumonia, bronchial malformations). The most pronounced mucolytic effect is that of N-acetylcysteine, which in pediatric practice is used mainly for cystic fibrosis and chronic pulmonary suppuration. However, it is difficult to classify it as an essential drug: for example, in the USA, acetylcysteine ​​is used relatively rarely in patients with cystic fibrosis, with preference given to vibration massage. In the presence of purulent sputum in patients with cystic fibrosis, Pulmozyme (dornase-alpha) is indicated, which breaks down the DNA that accumulates in the sputum during the breakdown of cellular elements (

). The use of these agents is permissible only in conditions where postural drainage can be carried out after their administration.

Acetylcysteine ​​should not be used in acute diseases, including bronchitis, since viscous sputum is rare in them, and there are no possibilities for postural drainage in case of “swamping” of the lung with liquid sputum, and this drug is approved from 12 years of age.

In acute and recurrent bronchitis, improvement of mucociliary transport is better achieved with the help of carbocysteine ​​and ambroxol, the latter can be used both orally and as an aerosol in children receiving inhaled sympathomimetic for obstructive bronchitis.

Suppressing the cough that accompanies obstructive syndrome is also not an end in itself - the use of sympathomimetics, eliminating bronchospasm, also contributes to the cessation of cough (

). In case of status asthmaticus, accompanied by the formation of bronchial casts, attempts to use N-acetylcysteine ​​can lead to increased bronchospasm.

Anti-inflammatory drugs . The use of locally acting inhaled corticosteroids (ICS) forms the basis of the treatment of moderate and severe bronchial asthma. Both metered dose inhalers (beclomethasone, budesonide, fluticasone) and nebulizer solutions with budesonide (Pulmicort) are used, especially in children under 3–5 years of age (Table 5). By suppressing inflammation in the bronchial mucosa, ICS help stop the cough it causes.

ICS can also be used for more severe respiratory infections, in which cough is associated primarily with an inflammatory process in the bronchial mucosa. In particular, the use of these drugs during the convulsive period of whooping cough reduces the frequency of coughing attacks and its intensity. ICS (together with sympathomimetics) can be used in the treatment of obstructive bronchitis (especially relapse of bronchitis) in young children. And although ICS does not shorten the duration of the disease, they have a positive effect on the severity of the acute period; There is also evidence of a reduction in the frequency of relapses of obstruction with continued treatment with ICS for 2–4 weeks after the end of the acute period. With prolonged cough due to tracheitis, ICS also often bring lasting relief.

The use of ICS, for obvious reasons, cannot be a “cough control” for most respiratory infections. An alternative to them is the non-steroidal anti-inflammatory drug fenspiride (Erespal - syrup 2 mg/ml), which, as a rule, does not have serious side effects. This drug improves mucociliary clearance, has activity as an antispasmodic and a blocker of H1-histamine receptors. In many patients, especially with recurrent bronchitis, including obstructive, chronic pathology, Erespal (at a dose of 4 mg/kg/day, in children over 1 year - 2-4 tablespoons per day) brings clear relief of cough and condition generally.

Treatment of psychogenic cough . Children with psychogenic cough are usually not helped by antitussives, expectorants, muco- and antispasmodics. Their treatment (after excluding a possible organic cause of cough) usually requires the prescription of antipsychotics, hypnotherapy and is carried out in conjunction with neuropsychiatrists. In the presence of compulsive-obsessive type disorders, there is experience in using slowly increasing doses of Clonidine. Treatment usually requires considerable time (many months), although in some cases the cough may suddenly disappear and begin again (in some cases in the form of obsessive sneezing).

V. K. Tatochenko , Doctor of Medical Sciences, Professor of the Scientific Center for Children's Medicine of the Russian Academy of Medical Sciences , Moscow

Congenital pathologies of the gastrointestinal tract as a cause of regurgitation

• Hiatal hernia. This is a congenital defect expressed in the underdevelopment of the structures of the diaphragm. Regurgitation begins within a couple of weeks after birth, lasts a long time, occurs immediately after feeding, the baby stops gaining weight or even loses weight. To identify this diagnosis, an x-ray examination is performed.
• Relaxation of the cardia (or chalasia of the sphincter that separates the esophagus and stomach). If it is not completely closed, then milk is released unchanged from the stomach into the esophagus. This type of regurgitation appears in the first days after birth and can be severe, especially if the baby has not burped up air. The child is lethargic, sucks poorly, sleep is disturbed, and there is no weight gain. X-ray examination can confirm the diagnosis.
• short esophagus (congenital anomaly) - the stomach is located above the diaphragm due to the fact that the esophagus does not correspond to the size of the chest.

If a mother is alarmed by the baby’s regurgitation and at least one of these signs is present, this is a reason to consult a doctor immediately.

• the child spits up often and a lot;
• bile and blood are present;
• regurgitation began after six months or did not go away by this time;
• poor weight gain, lethargy, rare urination.
• restless behavior
• increase in body temperature,
• skin rashes.

The formation of a mechanism that prevents regurgitation begins in the last 3 months of the mother’s pregnancy and continues after the birth of the baby.

Reflux is a mechanism of regurgitation, antireflux is the opposite phenomenon.

The antireflux mechanism is a complex system that can be damaged by various factors. Often this damage is observed in premature babies or children with developmental delays, as well as during difficult pregnancy, cesarean section, difficult childbirth, hypoxia and increased intracranial pressure.

If these factors are present, in addition to regurgitation, the baby will have signs of a nervous system disorder: mild excitability or vice versa, the child will be very lethargic, sleep will be disturbed, there will be tremor of the arms and legs, the presence of hypertonicity and hypotonicity.

As a rule, to determine the cause of regurgitation and prescribe appropriate treatment, ultrasound, x-rays, and computed tomography of the abdominal cavity are used.

Preserving the health of the child is the main task of parents. If your baby’s behavior, sleep, or health have worsened and you are concerned, consult a doctor. Consulting a specialist will never be superfluous. There are a lot of reasons for regurgitation, as a rule, they are all due to physiology, but only mom and dad are able to notice in time that something is going wrong and correct the situation in time without harm to the health of the little person.

Neurological disorders

In rare cases, excessive salivation indicates neurological disorders (cerebral palsy, various abnormalities in the functioning of the central nervous system). In this case, the following are observed:

Such conditions are diagnosed by specialists in the first months of a baby’s life and require serious and long-term therapy. Excessive drooling is a secondary symptom.

Parents should regularly wipe their baby's chin, neck and chest to avoid skin irritation. If your child constantly sucks his fist or keeps his fingers in his mouth, you need to keep his hands clean. If possible, you should disinfect all objects that he may lick. The lack of necessary hygiene measures leads to the entry of pathogenic microorganisms into the body, weakened by the underlying disease. The development of an infectious process can significantly worsen the baby’s condition.

Actions to prevent regurgitation

• hold in a column after feeding until burping;
• do not place on the stomach after eating;
• if the child is bottle-fed, then after consulting a doctor, you can choose an antirefluxor formula. It will prevent regurgitation due to its thickness;
• We do not play active games after feeding, we do not swaddle. Due to the physiological immaturity of the sphincter located between the stomach and esophagus. After food products pass through it, it may not close. Food can easily pass through the esophagus into the oral cavity. In children of the first year of life, this sphincter is poorly developed and may not work well.

Saliva and its functions

Saliva is necessary for the body at any age. In the oral cavity, under the tongue, on the inside of the cheeks, behind the lower teeth, there are salivary glands. They work constantly, producing up to two liters of fluid per day for an adult.

Saliva takes care of maintaining pH in the desired state, preventing the formation of tartar and caries. Saliva destroys harmful microorganisms, thereby preventing unpleasant odor in the mouth.

Saliva is involved in processing and digesting food. Salivary enzymes help break down and digest substances and produce glucose from starch.

This liquid softens and liquefies food for better digestion. Without saliva, taste buds do not work.

In newborn babies, saliva performs many tasks related to digestion and protection. Protective functions of saliva in a baby’s life:

• Protection of the oral cavity from the colonization and proliferation of pathogenic microbes and bacteria.
• Protection and lubrication of mucous membranes from irritation and damage.
• Protecting mucous membranes from dehydration and drying out during swallowing, chewing, and talking.
• Cleaning the oral cavity from foreign bacteria and food debris.

In addition to protective functions, saliva performs a number of other tasks. It plays a great role in matters of nutrition and the functioning of the gastrointestinal tract. The enzymes it contains are responsible for the initial processing of starch. And tongue lipase helps infants digest milk. It is saliva that forms the sense of taste by helping taste buds dissolve solids in food.

In the future, the gums will swell, become inflamed, the teeth will feel, saliva will soften the pain and protect the wounds from infection. And when the teeth erupt, saliva will maintain the integrity of the tooth enamel by treating it with calcium, phosphate, and fluoride dissolved in it.