Dysbacteriosis - a disease or a Russian invention? All the latest information about this condition in children is told by a practicing doctor. Dysbacteriosis in infants, symptoms, causes, treatment

Dysbacteriosis (dysbiosis) is a secondary symptom and signal of problems in the body. The main changes in this condition occur at the microflora level. There is an increase in the number of pathogenic and conditionally pathogenic microorganisms against the background of a decrease in the number of beneficial ones. At the same time, the former take the place of the latter and gradually supplant them.

Such an imbalance leads to digestive disorders, deficiency of essential microelements, vitamins and decreased immunity. In some cases, microflora disturbance is a symptom of serious diseases, so parents should know what dysbiosis is in children in order to prevent possible complications in time.

According to statistics, about 95% of infants suffer from disturbances in the composition of microflora. The intestines of newborns are practically sterile, so the correct formation of microflora should begin from the first minutes of life. Breastfeeding plays a significant role in this process.

Adequate treatment is impossible without determining the exact cause of dysbiosis in a child. As a rule, therapy consists not only of prescribing bacterial drugs; the main place in the recovery process is given to diet correction.

CAUSES

In children under one year of age, signs of dysbiosis have slightly different causes than in older children. Most often, deviations in the state of the microflora are associated with the immaturity of the digestive system.

There are several classifications of dysbiosis.

Etiological classification:

• primary;
• age;
• food;
• seasonal;
• professional;
• secondary;
• caused by radiation;
• mixed.

Doctors in their practice actively use clinical classification, which helps to choose the optimal strategy of action to cure dysbiosis in children. This systematization includes identifying the degree of deviation, the main pathogen and clinical forms.

Clinical forms of dysbiosis according to the degree of compensation:

• compensated (latent form) - without any clinical manifestations;
• subcompensated - manifests itself when the diet is violated in the form of local foci of inflammation;
• decompensated - the body cannot cope on its own, treatment of the generalized form is difficult.

Types of dysbacteriosis depending on the pathogen:

• staphylococcal;
• Klebsiella;
• clostridial;
• candidiasis;
• Proteaceae;
• bacteroid;
• associated.

Degrees of microflora composition disturbance:

• I degree - there is a decrease in the number of lactobacilli, E. coli and bifidobacteria by more than 10 times, this phase proceeds secretly.
• II degree - against the background of a normal number of lactobacilli, the number of bifidobacteria is significantly reduced, they are replaced by pathogenic and conditionally pathogenic microbes, and dyspeptic symptoms are present;
• III degree - aerobic microflora shows aggression, its numbers reach high titers. In addition to indigestion, the child is lethargic and moody.
• IV degree - a deep imbalance of microflora and accumulation of toxic breakdown products, functional disorders occur in the digestive system.

SYMPTOMS

In children, symptoms of dysbiosis appear at a time when the compensatory capabilities of their body cannot cope with the disruption of metabolic processes. The initial stages of the disease are asymptomatic, but pronounced microbiological changes are signaled by external clinical manifestations.

Symptoms of dysbiosis:

• Dyspeptic syndrome is manifested by frequent diarrhea, the consequences of which are pain in the anus, itching, burning and cracks. The presence of pathogenic microflora in stool may be indicated by a putrid odor and foamy consistency. Sometimes diarrhea alternates with constipation, or there is a tendency to prolonged constipation. Often, patients with dysbiosis experience bloating and a decreased rate of weight gain.
• Pain syndrome - abdominal pain of various nature, localization, intensity can decrease or disappear after the passage of gas or defecation. As a rule, it is paroxysmal and appears 1.5-2 hours after eating.
• Allergic reactions are detected in more than 95% of children with microflora disorders. They manifest themselves in intolerance to certain foods, the appearance of skin rashes, itching, swelling and bronchospasm.
• Signs of malabsorption appear as a result of impaired absorption processes in the intestine, against the background of which there is a deficiency of necessary substances and fluids. This condition is accompanied by hypovitaminosis, anemia, hypocalcemia, neurotic disorders, dry skin, changes in the nail plates, bleeding gums and pale skin are also possible.
• Intoxication - loss of appetite, sleep disturbance, headaches, low-grade body temperature, malaise, impaired physical development of the child.
• Decreased immunity. In a child, a symptom of dysbiosis may be a tendency to upper respiratory tract infections, the development of viral and fungal infections.

DIAGNOSTICS

Gastroenterologists are specialists who study the symptoms and treatment of dysbiosis in children. It is to doctors of this profile that you should turn to for help with intestinal problems.

Differential diagnosis is carried out to exclude or confirm malabsorption syndrome, nonspecific ulcerative colitis and acute intestinal infection.

TREATMENT

Methods for treating dysbiosis:

• Diet therapy. Experts insist that treatment of dysbiosis in children should begin with diet correction. Diet therapy is individual and depends on the type of feeding of the child. When mixed feeding, it is recommended to diversify the diet with healthy fermented milk products. In the menu for older children, it is advised to limit animal proteins and fast carbohydrates. To normalize digestion, plant fibers and food enriched with biocultures of beneficial microorganisms must be supplied in sufficient quantities.
• Probiotics are preparations containing beneficial bacteria.
• Prebiotics are drugs that promote the growth of normal microflora
• Symbiotics - combined (probiotic + prebiotic).
• Bacteriophages - to suppress pathogenic microflora.
• Enzymes - to regulate digestion.
• Antifungal drugs for diagnosing the active proliferation of fungal microflora characteristic of candidiasis.
• Antibiotics from the group of cephalosporins and macrolides with low activity of antifungal agents.
• Sorbents reduce the severity of intoxication symptoms.

Many children in the first year of life have symptoms of microflora disorders. For most of them, the problem disappears on its own or after correcting the diet. Unfortunately, cases of treatment of dysbiosis in a child over 3 years old with such symptoms are not uncommon. Parental attention and proper complex therapy play a huge role in this process.

COMPLICATIONS

Intestinal dysbiosis in children can lead to the development of serious pathologies.

Possible complications:

• decreased immunity;
• retardation in physical development;
• dermatitis;
• neurodermatitis;
• Iron-deficiency anemia;
• bronchial asthma;
• rickets;
• proctosigmoiditis;
• disruption of hematopoietic processes;
• urinary tract infection;
• dyskinesia of the intestines and biliary tract.

PREVENTION

Prevention measures:

• pregnancy planning;
• balanced nutrition for the expectant mother;
• treatment of genital tract infections before birth;
• avoidance of stress and compliance with the regime;
• early attachment of the baby to the breast;
• prolonged breastfeeding;
• gradual introduction of complementary foods at the recommended time;
• timely treatment of diseases of the digestive system;
• prevention of intestinal infections.

PROGNOSIS FOR RECOVERY

Children's dysbiosis is treated comprehensively. The result of therapy depends on the timeliness and correctness of the chosen treatment tactics and the severity of the pathological process. In most cases, the prognosis is favorable, but long-term maintenance treatment and constant monitoring of the child’s nutrition are required.

Found a mistake? Select it and press Ctrl + Enter

In the fetus in the womb, the gastrointestinal tract is absolutely sterile and there are no microorganisms in it. After birth, the baby’s gastrointestinal tract begins to be actively populated by various bacteria that enter his body during the passage of the birth canal. This is the process of creating a normal and healthy intestine. After the baby is born, its gastrointestinal tract continues to be actively populated by microflora that are found in the environment.

Breast milk contains bifidus factor. This substance promotes the production of bifidobacteria, which constitute up to 99% of the baby’s intestinal flora. They normalize the functioning of the immune system, promote digestion and prevent pathogenic bacteria from growing.

What is dysbiosis and its causes?

Dysbacteriosis in a one-month-old baby is a disruption of the natural balance of microflora in the intestines. Microorganisms that are not characteristic of normal flora may appear in the body. In most cases, dysbiosis is caused by intestinal infections or taking antibiotics.

Its diagnosis is carried out by severe symptoms or stool analysis. Specific symptoms are difficult to identify. According to the International Statistical Classification of Diseases, this condition is not classified as a disease.

If your child’s loose stools do not go away within two to three days, then it is necessary to do an analysis for dysbacteriosis. Also, indications for diagnostics are greenish stools, foamy stools, the presence of mucus or particles of undigested food. The child experiences bloating in the tummy, which is accompanied by painful sensations.

Is dysbiosis dangerous?

First of all, it causes a disruption in the normal functioning of the digestive process. This leads to the fact that the baby receives insufficient quantities of nutrients that are so necessary for its normal development.

Treatment of dysbiosis in infants.

Only a pediatrician can prescribe medications.
One of the best means of combating dysbiosis is breastfeeding. With mother's milk, all necessary substances enter the baby's body. This helps restore intestinal microflora.

If a woman cannot breastfeed her baby, then he needs to choose a mixture with prebiotics. This component stimulates the growth of beneficial bacteria.

The pediatrician may also prescribe various medications that contain live bacteria. This therapy will improve the baby’s condition and normalize digestion.

In what cases should you consult a doctor?

If your child exhibits the following signs, you should consult a doctor.

• severe diarrhea (more than 12 bowel movements per day);
• elevated temperature;
• vomit;
• weight loss or low weight gain.

Severe diarrhea can lead to dehydration. This condition threatens the child's life.

Dysbacteriosis in infants differs in the nature of its course. A 2-month-old child cannot complain and explain the location of the pain, so sometimes it comes to emergency conditions, when the symptoms of dysbiosis in infants become truly frightening. The task of treatment immediately arises. A mother is the first medicine of a sick child. Mother's milk forms the necessary prebiotics and probiotics. Pathogenic flora is extinguished by antibiotics or bacteriophages.

The main populations of normal microflora in the large intestine are formed in children and adults by anaerobic bacteria of the genera and species Bifidobacterium, Lactobacillus, Bacteroides, Peptococcaceae. The total weight of organisms reaches 99%. Other aerobic organisms (Escherichia coli, saprophytic and epidermal staphylococci, enterococci, yeast) make up the remainder. Some researchers argue that dysbiosis manifests itself as a secondary pathology, being caused by diseases of the digestive system. The information does not correspond to the fact that the phenomenon has been detected in 90% of the population.

The diagnosis is made based on the results of bacteriological analysis. This is where the professionalism of the doctor comes into play. In a child, dysbiosis occurs differently. The microflora finishes forming at the turn of 1-2 years; before this, the quantitative indicators of the biota will not coincide with the tables constructed for adults. Researchers note differences depending on the diet: whether the child has to eat artificial food or whether the mother provides the nutrition the baby needs.

From this point of view, it is useful to study the indications of normal microflora:

1. Until the age of one year, a healthy breastfed child does not have E. coli with enzymatic properties. In other categories of the population, including adults, the percentage in the population can reach 10.
2. The same can be said about . Their number in the population reaches 5%.
3. The total density of E. coli in known cases can reach 100 million units.
4. With natural feeding, the bacterial background is free of Proteus and Candida fungi. With the use of mixtures, the number of these organisms can reach 1000 units.
5. Pseudomonas aeruginosa, clostridia, and Staphylococcus aureus are absent in children under 1 year of age.

Other representatives of the obligate flora are present in similar concentrations as in adults. Differences of an order of magnitude (from 1 to 10 billion units) are considered normal. In children who are bottle-fed, the number of bifidobacteria and lactobacilli can drop to 100 million. Enterococci (1 million), saprophytic and epidermal staphylococci (up to 10 thousand) are represented within normal numbers.

After 1 year, the infant’s microflora readings are equal to the adult’s biota readings.

Diagnostics

The doctor will not dare to diagnose intestinal dysbiosis in an infant based on the clinical picture. The reason is the heterogeneity of the microflora composition in an infant. The imbalance appears more often if feeding with artificial formulas is practiced. The symptoms are too universal, similar ones appear with:

• Food allergies.
• Malabsorption.
• Viral, bacterial infections.

It is enough to highlight one of the listed signs, suspecting dysbiosis in infants:

• Diarrhea, constipation, or alternation of symptoms.
• Rickets.
• Lack of weight.
• Avitaminosis.
• Circulatory disorders.
• Decreased appetite.

Rickets is a consequence of vitamin deficiency, or more precisely, a lack of phylloquinone. Circulatory disorders indicate a deficiency of B vitamins. On top of the mentioned factors are toxicoses and emergency conditions caused by them. Risk factors for suspecting dysbiosis in newborns:

• Any illness of the mother.
• Poor nutrition or artificial feeding.
• C-section.
• Prematurity.
• Condition after taking antibiotics or antiseptics (mostly broad-spectrum).
• Age up to 1 year.

Since the signs of dysbiosis in infants are difficult to discern, the doctor prefers to rely on research results.

Bacteriological analysis

To identify dysbiosis in infants, feces are collected and cultured. Based on the results of the growth of pathogenic and normal flora, a conclusion is drawn about the real situation. Outside Russia, the method is rejected for two reasons:

1. It is difficult to maintain the required sterility.
2. Culture provides information about a small area of ​​the colon.

Feces in an amount of at least 1 gram are collected in a sterile 50 ml container, tightly closed with a lid, or the anaerobic bacteria are immediately killed in the air. To place the sample, use wooden or glass utensils (forks, spoons). It must be submitted as soon as possible; the sample must be stored at a temperature of +4 degrees Celsius to block the growth of the original and airborne flora.

The details of the study are as follows. The feces are diluted and then sown on a nutrient medium. Based on the growth rate of bacteria, a conclusion is made about the presence of certain strains. Example environments:

1. Escherichia coli and other Enterobacteriaecae are sown on Endo, Levin, Ploskirev media, bismuth sulfite agar, and selenite broth.
2. Bifidobacteria - Blauroccus.
3. Lactobacilli – tomato.
4. Enterococci - bile-esculin agar with sodium azide.
5. Staphylococci - Chistovich.
6. Mushrooms – Saburo.
7. Blood agar is a universal medium.

The study lasts a week as experts wait for the strains to germinate. Today, the express method, which is more accurate, is often practiced. The evaluation principle is different. is already demonstrating quantitative changes in population density. At the second stage, atypical varieties of E. coli appear, and opportunistic flora is present.

If at the last stage a frankly harmful population of bacteria is found, it is not grade 2 dysbacteriosis that is diagnosed, but cholera, dysentery, etc. Classified by the type of pathogen. The listed diseases are not suitable for occurring at home; despite similar primary symptoms, the baby and mother are treated in a hospital.

When conducting analysis, researchers are guided by data on the population of the intestine. Minor deviations in the number of Escherichia, or the appearance of a small number of atypical species among the rods, are not considered dysbacteriosis. The lack of enterococci is not critical; the laboratory technician will not pay attention to the tiny population of opportunistic microflora. The alarm is sounded when the numbers of both the main (obligate) flora and the facultative component of the biocenosis are affected.

What is obligate microflora

Among specialists, it is customary to distinguish three components of the biocenosis:

1. Obligate microflora is represented by bifidobacteria, lactobacilli, and Escherichia coli. The components are clearly expressed, have a large number (see above), perform certain functions in the formation of immunity, the production of vitamins, the absorption of minerals, and maintaining the acidity of the environment at a level that prevents the development of pathogenic flora.
2. The facultative microflora is represented by opportunistic strains. The role comes down to preventing external “enemies” from entering the body. This includes bacteroids, many Enterobacteriaecae (excluding Escherichia coli). For example, Proteus, Klebsiella, Enterobacter, Citrobacter, Serration, Staphylococcus, yeast, Streptococcus.
3. Transient microflora does not stay in the intestines for a long time; the doctor does not expect to see such in a month-old baby. But pathogenic strains are being studied.

The classification does not include pathogens that are not part of the normal microflora of infants. This implies division according to the location of the bacteria. Thus, feces are represented by the cavity part of the population.

Functions of microflora

Obligate microflora (partially facultative) maintains the necessary environmental parameters, releasing formic, lactic, acetic, and succinic acids as metabolites. A low pH factor prevents the proliferation of pathogenic flora (gas-forming and putrefactive). This is a major factor in gut health. In such conditions, the body is not poisoned by toxins through the blood.

Incomplete list of microflora functions:

1. Production of B vitamins (B12, B2), folic and nicotinic acid, K.
2. Favors the absorption of vitamin D, calcium, iron.
3. Produces a lot of enzymes that complete the breakdown of polysaccharides, fats, cholesterol, bile acids, DNA, RNA, and proteins.
4. Participates in water-salt metabolism.
5. Deactivation of alkaline phosphatase, enterokinase.
6. Absorption of toxins.
7. Synthesis of immunoglobulins.
8. Accelerates the synthesis of amino acids.

Degrees of dysbacteriosis according to research results

1. In the first degree (mild form), changes concern the density of the E. coli population. Growth and decline are allowed. Opportunistic flora is recorded in concentrations of up to 1 million in two species maximum.
2. Medium-heavy form. A noticeable decrease in bifidobacteria and anaerobic flora. Atypical (for example, hemolytic) forms of Escherichia coli are recorded. Further increase in the concentration of representatives of opportunistic flora.
3. Severe form (grade 3). There is a decrease in the number of anaerobic bacteria as strains of opportunistic flora reach a threshold of 10 million units. Atypical forms predominate in the E. coli population.

In parallel, categories of manifestation of clinical signs are distinguished. The strength of external manifestations is individual. If the first patient is already holding his stomach, dysbiosis manifests itself in full force, while in the second patient a characteristic picture slowly begins to appear. Based on individual indicators, a decision is made to hospitalize the patient. List of categories:

1. Compensated form. There are no (or only briefly present) symptoms.
2. The subcompensated form is characterized by alternating attacks of illness with a state of relative health. Doctors call the clinical stage. You should consult a doctor.
3. The decompensated form necessarily includes the external manifestation of the disease. Depending on the specific cause, the symptoms take on a specific shade. For example, with the rapid proliferation of Pseudomonas aeruginosa, the feces become filled with mucus of the corresponding color.

Treatment of dysbiosis in newborns is necessary. Many parents can’t bear to wait; they need to check with the clinic’s reception desk to see if the clinic’s laboratory has the ability to implement a rapid analysis technique. Two criteria are selected for analysis:

1. The presence of tissue protein in feces.
2. Presence of bifidobacteria.

The first means the presence of inflammatory processes. The second indicator is measured quantitatively, allowing one to understand whether the presence of proteins is explained by dysbiosis. The absence of bifidobacteria means a positive answer to the question. The next step involves detecting an overgrown pathogen and examining the microflora for resistance to antibiotics. The first step of treatment will be the destruction of the harmful strain.

Newborns

According to the latest data, in the prenatal period the fetal gastrointestinal tract is already populated to a small extent by some bacteria that enter there through the translocation phenomenon. In the first weeks of breastfeeding or artificial feeding, the child will go through a stage of dysbiosis. Most bacteria transit through the intestines. The dominance of bifidobacteria is observed after several weeks. At the age of two months, a rapid analysis will show adequate results.

Depending on the method of feeding, the predominance of different strains has been established:

1. Natural – bifidum.
2. Artificial – longum, breve, infantis.

These strains are present in certain medications. Moreover, the very fact of its presence is important, allowing it to conduct analyzes and draw conclusions. After birth, it is advisable to immediately put the baby to the breast in the first 2 hours. This simple action doubles the amount of immunoglobulin A in the intestines.

As a result, the period of transient dysbiosis is successfully overcome, and the child gains weight. Human milk is rich in useful substances and contains not only immunoglobulins A. Other bacteria appear when complementary foods are introduced. For example, the population of lactobacilli begins to grow. The final formation of the biocenosis ends only by two years; at the age of 12 months, the composition of the microflora is already close in indicators to those of an adult organism.

Health criteria are highlighted and risk groups are outlined. A child must have a mother from the first hours of life. Preparing for childbirth will help you avoid a caesarean section. Natural nutrition is encouraged; after a few months it is allowed to start giving adapted milk formulas. Other factors, regardless of age, are undesirable:

1. Any troubles with the gastrointestinal tract in the baby or mother.
2. Incorrect use of medications. Taking the wrong pills for three days is enough to upset the microflora balance.
3. Impaired intestinal absorption caused by any pathology.
4. Chronic diseases.
5. Poor nutrition, imbalance of proteins, fats and carbohydrates.

In a baby it does not imply experimentation. Let the doctor decide how to treat the baby’s illness.

In older children, the causes of dysbiosis and its course differ from those in infants. Therefore, let's differentiate this problem by age and look separately at dysbiosis in older children and children under one year old. This will not only make the material easier to understand, but also easier in terms of practical use. In this chapter we will talk about dysbiosis in children after one year, including preschoolers and schoolchildren. You can read about dysbiosis in infants in the section “Diseases of newborns and children in the first year of life.”

Intestinal microflora in children

Intestinal microflora is a variety of microorganisms (mainly bacteria) that live in the large intestine, the final section of the human digestive system. Under normal conditions, gut bacteria do not cause disease and are not dangerous. On the contrary, they are friends and comrades of man. A warm relationship of mutual assistance is established between the body and microflora. Bacteria live excellently in the intestines: there are all conditions for nutrition and reproduction, since the waste products of the human body are an ideal habitat for them. And such cohabitation is beneficial for humans, because beneficial bacteria:

• Participate in digestion (with their help, the process of digesting food ends).
• They synthesize vitamins (B vitamins, vitamins C and K, folic acid, biotin), hormone-like compounds and enzymes.
• Promote the absorption of calcium, sodium, magnesium, zinc, copper, manganese, phosphorus, iron, vitamin D and other beneficial substances in the intestines.
• Participate in the regulation of metabolism.
• Stimulate gastric emptying and promote normal intestinal contractions necessary for food to pass through it. Thus, food does not stagnate in the body.
• Protect the body from harmful microbes, in particular pathogens of intestinal infections (Salmonella, Shigella, many fungi).

The fact is that beneficial bacteria that populate the intestines compete for nutrition with pathogenic microbes. If there are a lot of beneficial bacteria, there will not be enough food for the harmful ones. Therefore, they do not have the opportunity to grow and develop. In addition, beneficial microorganisms produce special substances that prevent the proliferation of pathogenic microbes.

• Participate in immunity.
• They protect the body in poor environmental conditions: they neutralize the toxic effects of heavy metal salts, nitrates, pesticides, and some drugs, in particular antibiotics.

Thus, the human microflora has enormous benefits for humans and provides complete protection and support for its owner.
What bacteria normally populate the intestines?

Composition of normal microflora:

• Main microflora (90%): bifidobacteria.
• The accompanying microflora (8-10%) is also useful: lactobacilli; non-pathogenic E. coli (with full enzymatic properties); enterococci.
• Opportunistic microflora (less than 1%). The very name of these microorganisms contains the whole point: they become pathogenic under special conditions when their number exceeds a certain threshold. And in small quantities they are not only not dangerous, but also useful: Klebsiella; Proteus; pseudomonas aerogenosis; non-pathogenic streptococci and staphylococci; enterobacter; clostridia; yeast-like and mold fungi; citrobacter and others.

Causes of intestinal dysbiosis in children

There are 2 main conditions for the normal coexistence of beneficial bacteria and humans:

1. Beneficial bacteria must be present in a certain amount. There should be no more opportunistic bacteria than normal, and the main and accompanying microflora (bifidobacteria, lactobacilli, non-pathogenic Escherichia coli, etc.) should be less.
2. A certain composition of bacteria. The intestines should not contain harmful microbes that cause intestinal infections in humans and spoil the normal life of beneficial bacteria.

Various unfavorable factors can disrupt the peaceful coexistence of bacteria and humans. Some bacteria in the intestines become more numerous, others less, and those that should not exist appear (intestinal dysbiosis). When harmful microbes multiply, they displace useful ones and there are automatically fewer of them. Such disorder in the microcosm definitely leads to changes in its owner, the person. Opportunistic microorganisms, having multiplied in unacceptable quantities:

• Become pathogenic and cause illness (stool disorders, abdominal pain, etc.);
• They promote allergization of the body, therefore they can provoke any allergic reactions;
• Suppress local immunity, reducing the activity of interferon and lysozyme.
• They provoke an inflammatory process in the intestines, which increases the permeability of the intestinal walls. A large amount of toxic products are absorbed into the body, which should normally be excreted in the feces. The general condition of a person suffers. And since the removal of toxins is still necessary, the process of their removal will go through other organs, in particular through the skin. Therefore, dysbiosis is very often accompanied by various skin manifestations (dermatitis, diathesis, acne, etc.).

In some cases, clearly pathogenic pathogens appear in the intestines that should not exist (for example, Staphylococcus aureus, Candida fungi, hemolytic Escherichia coli). And when Shigella, Salmonella or other microorganisms that cause intestinal infections appear, not only the intestines suffer, but the patient’s general condition also sharply worsens. In this case, there is no talk of dysbacteriosis, but a diagnosis of intestinal infection is established.

Factors contributing to the development of intestinal dysbiosis

Changes in normal microflora are always secondary, developing as a result of the influence of various unfavorable factors that change the condition of the intestines or the whole organism.

In children over one year old, preschoolers and schoolchildren:

• Poor nutrition. The predominance of meat products and excess sugar and sweets in the child’s diet.
• Bad ecology: chemical pollution of the environment, radiation exposure.
• Intestinal infection.
• Diseases of the digestive system, any, but especially: chronic pancreatitis, lactase deficiency, liver disease, constipation, colitis.
• Worms, in particular - giardiasis.
• Long-term or frequent treatment with antibiotics and hormones. The antibiotic ampicillin and drugs containing it (ampiox) have a particularly detrimental effect on the intestinal microflora. Moreover, dysbiosis can be caused by both antibiotics given orally and those administered intramuscularly and intravenously. Very often, after taking antibiotics, pathogenic fungi begin to grow in the intestines.
• Chronic diseases.
• Frequent ARVI and colds. Frequently ill children.
• Operations: gallbladder removal, gastric surgery, etc.
• Allergic diseases. Atonic dermatitis.
• Vegetative-vascular dystopia.
• Puberty (hormonal changes in the body).
• Stress.
• Immunodeficiencies.

Dysbacteriosis in older children often “comes” from infancy, when it was missed or not treated.

Symptoms and signs of intestinal dysbiosis in children

• Unstable stool: constipation alternates with diarrhea.
• Flatulence.
• Metallic taste in the mouth.
• Abdominal pain (monotonous, pulling or bursting, worsening in the afternoon).
• Dysbacteriosis is often accompanied by: allergic reactions, skin diseases, frequent acute respiratory viral infections, and deterioration in general well-being.

Analysis for dysbiosis in children

To confirm the diagnosis, a bacteriological study of the microflora of the digestive tract is carried out. To do this, feces are collected under sterile conditions and sown on nutrient media. After 7-10 days, they look at what bacteria have grown and in what quantity. If the growth of any pathogenic microbes is detected, the sensitivity of the microflora to antibiotics and bacteriophages is usually additionally determined. This is important for the doctor to accurately select the medications the patient needs.
Stool analysis for Dysbacteriosis is carried out by many bacteriological laboratories. In particular, in Moscow the analysis can be taken at the Institute named after. Gabrichevsky, Gamaleya Institute, etc.
On the form of the test result for dysbacteriosis, every self-respecting laboratory will definitely indicate:

• List of detected microorganisms.
• Number of microorganisms detected.
• Age standards.
• Sensitivity of pathogenic microflora to antibiotics and bacteriophages.

Based on the results of stool analysis for dysbiosis and the severity of clinical manifestations, the degree of dysbiosis is determined.

For additional examination of the patient, the doctor may prescribe:

• Scatological analysis of stool to find out how the patient’s food is digested.
• Ultrasound examination (ultrasound) of the abdominal cavity.

Treatment of intestinal dysbiosis in children

Therapy for dysbiosis should be comprehensive and consistent. Courses of treatment are prescribed by a pediatrician or gastroenterologist, depending on the clinical manifestations and results of analysis for dysbacteriosis. Thus, in case of dysbacteriosis of the 1st degree, it is sufficient to prescribe bacterial preparations, but in the presence of opportunistic microorganisms (Klebsiella, Proteus, Staphylococcus, etc.) the task will be more difficult. Do not expect recovery to occur immediately; this is only possible with a mild degree of dysbiosis. Sometimes a complete cure requires a lot of patience and time, and repeated courses of therapy.

First of all, it is desirable to eliminate the factors that led to disruption of the intestinal microflora: improving the quality of nutrition, stopping taking antibiotics, treating helminthiasis, digestive pathologies, etc.

I. Diet.
Prescribed depending on clinical manifestations:
For constipation.
For loose stools and diarrhea.
With flatulence.

Also useful:

• Lactic acid products, especially those containing beneficial bacteria: Bifi-kefir. Bifi-ryazhenka, “Bifidok”, yoghurts, “Imunele”, “Activia”, “Narine”, yogurt, etc.
• Vegetables and fruits containing a large amount of essential vitamins and microelements: watermelon, apricot, barberry, lingonberry, fan, strawberry, dogwood, cranberry, onion, raspberry, carrot, black radish, rowan, capsicum, rose hips, dill, garlic, horseradish , apples. Fresh squeezed juices of vegetables and fruits are very useful.
• Brewer's yeast. Cereal sprouts, wholemeal bread.
• Nuts.

II. Drug treatment.
Bacterial preparations:

• Containing beneficial bacteria (probiotics). Consist of living microorganisms. Restore the number of bifidobacteria and lactobacilli, non-pathogenic Escherichia coli:
• Containing bifidobacteria: bifidumbacterin, bifidumbacterin forte, bifiform, normoflorin V. biovestin, bifiliz, etc.
• Containing lactobacilli: lactobacilli, normoflorin L, biovestin lacto.
• Lactobacilli have a pronounced antagonistic effect - they displace harmful bacteria from the intestines.
• Containing Escherichia coli: colibacterin.
• Containing bifidobacteria, lactobacilli and Escherichia coli: bificol, bifi-lact, linex, primadophilus, lactovit forte.
• Containing microorganisms that have antagonistic activity (displace harmful bacteria from the intestines): bactisubtil, enterol.

Non-microbial substances that create favorable conditions in the intestines for the growth of beneficial microorganisms:

• Hilak-forte. Creates a nutrient medium for the growth of beneficial bacteria.
• Lactulose (Duphalac). Stimulates intestinal contractions and successfully helps with constipation. Creates favorable conditions for the growth of bifidobacteria.
• Lysozyme. A protein substance obtained from chicken egg white. Suppresses the growth of harmful bacteria, promotes the growth of bifidobacteria.
• Para-aminobenzoic acid. Promotes the growth of bifidobacteria and E. coli.

Antibiotics. Prescribed if bacteriophages are ineffective. It is necessary to use antibiotics in the treatment of intestinal dysbiosis with extreme caution, since they destroy, along with pathogenic pathogens, beneficial microflora (bifidobacteria and lactobacilli). Lost beneficial microflora after treatment with antibiotics must be persistently restored with bacterial preparations. You cannot give your child antibiotics on your own without a doctor’s prescription.
Antifungal drugs. Prescribed for candidiasis and the presence of other fungi.
KIL (complex immune preparation). This drug contains antibodies (immunoglobulins) to various pathogens. Its action is based on increasing local immunity in the intestines.
Sorbents: pecto, pekcecom, polyphepam, entegnin, enterodes, enterosgel, phytosorbovit, activated carbon, smecta, etc.
Sorbents (or enterosorbents) are necessary to remove toxins, a number of pathogenic microorganisms and viruses, and other aggressive components from the intestines, as well as reduce gas formation. Assigned taking into account the fact that:

• If you are prone to regurgitation and vomiting, it is better to use enterodesis.
• Activated carbon, polyphepam, entegnin, smecta contribute to constipation. Therefore, if you are prone to constipation, their use is not recommended.
• Enterosgel and Pekcek do not have a constipating effect.
• Long-term use of sorbents for more than 2 weeks is undesirable, since they remove not only toxins from the body, but also useful substances.

Vitamins. B vitamins and vitamin C are shown.

III. Symptomatic treatment:
For constipation: lactulose, duphalac, pekcecom, dietary supplement "Rekitsen RD", etc.
For diarrhea: pecto, enterosorbents.
For flatulence and intestinal colic: no-spa, duspatalin, espumizan, subsimplex, etc.
In case of impaired digestion of food (presence of undigested foods and lumps of fat in stool, changes in scatological analysis of stool) - enzymes: mezim-forte, creon, festal, panzinorm, abomin, etc.

IV. Homeopathy.
For a tendency to diarrhea: Diarheel (Heel, Germany).
For constipation with spasmodic pain: Nux vomica Homaccord (Heel, Germany).
For heartburn, nausea, loss of appetite, feeling of fullness after eating: Edas 114 (Edas, Russia).
For chronic constipation: Edas 124 (Edas, Russia).
When intestinal dysbiosis is combined with atonic dermatitis: Edas PO (Edas, Russia).
To improve immunity: Echinacea compositum (Heel, Germany), Engistol (Heel, Germany), Edas 150 (Edas, Russia), Edas 308 (Edas, Russia).
Classical homeopathy is also perfect. For individual selection of therapies in accordance with the constitutional characteristics of the child, it is necessary to consult a homeopathic doctor.

V. Aromatherapy.
Microclysters (for diarrhea). Add essential oils to 100 ml of oil (sesame, olive, etc.): tea tree oil 5 drops, lavender oil 5 drops, fennel oil 5 drops, basil oil 3 drops.
Inject 5 ml into the rectum daily. The course of treatment is 10 days. Microclysters (for constipation). Add essential oils to 100 ml of oil (sesame, olive, etc.): tea tree oil 2 drops, sage oil 2 drops, lavender oil 3 drops, fennel oil 2 drops, geranium oil 1-2 drops.
Inject 5 ml into the rectum daily. The course of treatment is 14 days.

Prevention of intestinal dysbiosis in children

Intestinal dysbiosis is the result of an illness or unhealthy lifestyle, and, as a secondary phenomenon, is spontaneously reversible. When the health of the body is restored, the composition of the intestinal microflora will also improve.
Therefore, to prevent intestinal dysbiosis it is necessary:

• Maintaining a healthy lifestyle: balanced nutrition, daily routine and rest, absence of stress and nervous shock, playing sports, hardening.
• Rational use of antibiotics and other drugs.
• Treatment of chronic diseases, especially digestive pathologies.
• Prevention of intestinal infections, compliance with sanitary and hygienic standards.
• Prevention of ARVI and colds.

Digestive problems in children are not uncommon today, because so often babies and even infants are prescribed antibiotics that kill all intestinal microflora. Therefore, it is often necessary to carry out treatment of infectious diseases in children after the next treatment.

Is treatment necessary?

Usually, doctors begin to talk about disturbances in the composition of the intestinal microflora after they have been carried out on the child. Their essence is to examine the baby’s stool for:

• Quality of digestion and assimilation of food (scatology). Therefore, if undigested muscle fibers and other large food debris are found in the stool, this indicates disturbances in the digestive processes, which may be caused by an imbalance in the composition of the microflora.
• Worm eggs, since the symptoms of enterobiasis often coincide with the signs of dysbiosis. Such a study is usually indicated from 1.5 years.
• Carbohydrates. With frequent bloating and diarrhea, evaluate the level of carbohydrates in the stool, since its increase may be a sign of lactase deficiency.
• The presence of intestinal infections, since they also have similar symptoms to dysbacteriosis.
• Dysbacteriosis. The results of this study largely depend on the quality and speed of collection of the material, but since many microorganisms that thrive in the intestines quickly die in air, some doctors do not consider this examination to be informative. If an analysis is carried out for dysbiosis in an infant, the most important indicators will be the number of lactobacilli and bifidobacteria, as well as the number of pathogenic microorganisms. All other information in this case may be considered irrelevant.

As for the treatment of dysbiosis in infants, it is more often required for babies who are bottle-fed, since breast milk is an excellent source of lactose. It is this carbohydrate that is processed and used by them for growth and reproduction. The end product of lactose decomposition is lactic acid, therefore, with a normal number of bifidobacteria in the intestine, an acidic environment is created in which it is extremely difficult for opportunistic and, even more so, pathogenic microorganisms to survive.

Unfortunately, the most modern milk formulas are not able to satisfy all the needs of beneficial bacteria, so dysbiosis in formula-fed children is observed many times more often than in babies fed on mother's milk.

Attention! The absence of measures to normalize the intestinal microflora in children under one year of age can cause the development of chronic diarrhea, rickets and developmental delays. The most serious consequence of this is dehydration from debilitating diarrhea, which can be fatal for babies.

Treatment of dysbiosis

In general, treatment of intestinal dysbiosis in children consists of:

1. Eliminating the causes that provoked the development of the disease. Without targeted measures to eliminate the causes of dysbiosis, all other measures will be completely useless.
2. Creating favorable conditions for full growth and development. First of all, this concerns the normalization of the psycho-emotional state of the baby and the elimination of the reasons that cause his overwork, since most often dysbiosis develops precisely against the background of chronic fatigue and frequent stress. Therefore, it is worth creating normal conditions for the child to study and relax, spend as much time as possible in the fresh air, eliminate psychologically traumatic factors from his life and provide free time for games and entertainment, even if this means sacrificing some activities.
3. Nutrition corrections. Of course, bowel function mainly depends on the quality of food, especially in infants. Therefore, for babies, together with a doctor, it is necessary to select a suitable milk formula if breastfeeding is not possible, and the menu for older children must be compiled in such a way that it is completely balanced and contains all the substances required for full growth and development.
4. Prescribing replacement therapy. Its essence lies in the use of medications that contain living representatives of normal intestinal microflora (probiotics) or special nutrients in concentrated form necessary for the rapid growth of one’s own bifido-, lacto-, and other beneficial bacteria (prebiotics).

Attention! Parents should be prepared for the fact that the treatment of dysbiosis is quite complex and, most importantly, a long process. Therefore, they need to be patient and persistent.

Diet

For dysbacteriosis in children, it involves a varied but balanced diet, and the child should be fed at least 5 times a day in small portions, and even more often for infants. But in order to give the flora the opportunity to recover naturally, it is necessary to completely abandon or minimize the amount of consumed foods that stimulate the growth of pathogenic microorganisms. These include:

• bread, pastry and other flour products;
• chocolate;
• sweets;
• carbonated drinks;
• fatty food;
• whole milk;
• canned food;
• ice cream and so on.

Any sweets are a source of food for pathogenic microorganisms, so you should avoid them during treatment

Attention! You also need to give up condensed milk, beloved by many children, as well as fast food and any fast food dishes that are sold in abundance on the streets of any city.

On the contrary, the child’s diet should be dominated by:

• low-fat fermented milk products;
• cereals;
• baked goods made from wholemeal flour;
• lean varieties of meat and fish.

Also, depending on the nature of the stool, patients may be prohibited or, conversely, recommended to consume certain foods. For example, if you have constipation, you should not eat mucous soups or rice, but rather give preference to vegetables and fruits. At the same time, completely opposite recommendations can be given in the presence of diarrhea. All patients are usually recommended to drink jelly and compotes prepared without added sugar based on rowan and rose hips.

As for how to treat, in such cases specialized medicinal fermented milk products are usually prescribed, which are prepared in children's dairy kitchens. Most often, acidophilus-yeast milk, colibacterin, Narine, and so on are used to normalize the microflora. But often, making changes to the child’s diet is enough to normalize the microflora in the initial stages of dysbiosis, and in more complex cases, replacement therapy is usually prescribed.

Important: the nature of the diet largely depends on the type of existing concomitant diseases, if any, so more detailed recommendations on the composition of the diet can be obtained from a gastroenterologist.

Medicines

Although most existing probiotics and prebiotics can be dispensed from pharmacies without a doctor’s prescription, how long and how to treat dysbiosis in a child should always be decided by a specialist. Only a doctor will be able to correctly calculate the dose and select a specific drug or medicinal milk formula for a baby of any age.

In more severe cases, treatment is not limited to taking bacterial drugs. To destroy pathogenic microorganisms, antifungal agents, antibiotics or bacteriophages can be used - drugs of viral origin that destroy bacteria by penetrating into them.

Important: only a doctor can prescribe, cancel, change or adjust the dose of antibacterial drugs, since any amateur activity can not only worsen the child’s condition, but also lead to the development of resistance to the drugs used in pathogenic bacteria. Therefore, it will be much more difficult to destroy them in the future.

In addition to drugs for direct impact on the composition of microflora, depending on the indications, the following are used:

• vitamins;
• enzyme preparations;
• sorbents;
• homeopathic remedies and so on.

Folk remedies

Many parents, despite the safety of modern bacterial preparations, prefer to use. So, if tests have shown a predominance of colibacteria in the intestines, products based on:

• cinquefoil;
• plantain;
• knotweed.

If a child has coccal or putrefactive microflora, products based on it will be useful.