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A liquid, frothy stool in the baby of yellow, green
Last reviewed: 23.04.2024
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Pediatricians always pay attention to any changes in the nature of feces in infants as a basic indicator of the state of the digestive system, on the correct functioning of which depends the development of the child. Therefore, the appearance of a symptom such as a foamy stool in a baby, requires clarification of its causes and taking appropriate measures.
Epidemiology
In the domestic pediatrics, the statistics of enzymatic pathologies among infants are practically absent. But experts in the field of endocrinology of the neonatal period emphasize that congenital deficiency of lactase is extremely rare, and much more common diagnoses: malabsorption of glucose-galactose (lactase deficiency) and allergy to milk protein.
In preterm infants born at the 28th week of pregnancy, lactase levels in the intestine are minimally low. But in almost 40% of infants born on the 34th week, the activity of lactase is much higher, which makes it possible to feed them with breast milk.
According to some reports, almost 4 billion people worldwide have malabsorption of lactose, but lactose intolerance symptoms rarely develop in children under six years of age.
Intolerance of lactoglobulin of cow's milk is noted in 2-5% of infants of the first three months of life.
Causes of the foamy stool in infants
Regardless of the type of infant feeding, the first signs of malnutrition appear with a slightly foaming green-colored stool; also the green frothy stool in the baby can be due to intestinal microbiota disturbance and the prevalence of pathogenic microbes in it.
In other cases, the reasons for the foamy stool in the baby are associated with genetically conditioned fermentopathies, as well as congenital intolerance to milk sugar (lactose), cow's milk proteins (lactoglobulins), gluten (wheat, rye, oats and barley) gluten.
According to the pediatricians, frequent bloating, colic and foamy stool in breastfed babies immediately leads to suspicion that the child has hypolactasia or secondary malabsorption of lactose (insufficient digestion), which is usually called lactase deficiency in children or allergy to lactose. It should be noted that the complete congenital absence of lactase, inherited as an autosomal recessive trait, is rarely diagnosed.
More often, the pathogenesis of a disturbed metabolism of lactose is associated with a decreased expression or activity of lactase (glycoside hydrolase), an intestinal enzyme that is localized in membranes of the epithelial mucosal enterocytes of the small bowel (microvilli) of the small intestine.
In this type of fermentopathy flatulence and yellow frothy stools appear as a result of the fact that in case of insufficient expression of lactase, the carbohydrate of breast milk lactose [β-D-galactopyranosyl (1-4) -D-glucose] is not practically digested, that is, it does not split in the small intestine, digestible monosaccharides, D-glucose and D-galactose, are digested by the body.
Studies have shown that partial deficiency of lactase due to immaturity of the intestine has premature babies, but it is impossible to increase the activity of this enzyme, since it refers to non-insulinable enzymes. However, as soon as the lactose digesting bacterium-symbionts Lactobacillus and Bifidobacterium appears in the intestine of the infant, its stool is normalized.
In addition, a decrease in lactase expression in infants may occur due to an excessively high level of the thyroid hormone thyroxine, although in all newborns the levels of triiodothyronine and thyroxine necessary for the development of the central nervous system are slightly increased.
Malabsorption of lactose is fraught with infectious enteritis and inflammation of the intestine of any etiology, medications (in particular antibiotics), congenital small bowel syndrome in an infant. Presence of any of these factors can be caused by a frothy stool with blood in the baby.
When there is a frothy stool in a breastfed on mixed feeding, the cause may be not only lactase deficiency or the reaction of the intestine to a new complementary product, but also an allergic reaction to gluten proteins of cereal crops - celiac disease. Its pathogenesis is the abnormal immune response of the body and the production of autoantibodies to gluten or gliadin, which leads to an inflammatory reaction in the small intestine epithelium with atrophy of a part of the microvilli.
Loss of appetite, bloating, chronic diarrhea and frothy stool in infants with artificial feeding can also be due to gluten intolerance.
The yellow frothy stool in the baby, and sometimes the liquid frothy stool with blood can be the result of milk allergy in children, more precisely, whey proteins of cow's milk.
And in the case of hereditary intolerance to sucrose, caused by a lack of intestinal enzymes of isomaltase and alpha-glucosidase, a watery frothy stool appears in the infants, whose diet contains sugar-containing milk formulas, fruit purees and juices.
Risk factors
The likelihood of foamy stools in infants increases if:
- the mother lacks breast milk;
- the child has disorders of the intestinal microflora;
- the baby was born before the term (preterm infants, except the immature intestine, differ in that they poorly suck their breasts and often suffer from underfeeding);
- parents incorrectly introduce complementary foods;
- in the family history there are enzymatic pathologies;
- in the genus of the child (blood relatives of the first degree) there is celiac disease;
- in the blood of the child the level of thyroid hormones is increased.
Complications and consequences
The inability of the intestine to digest lactose not only leads to a slowdown in the growth of useful bifidobacteria in it and the formation of a healthy microbiota, but also reduces the intake of galactose, which is part of lactose and is necessary for the formation of glycolipids of cell membranes.
Complications of milk intolerance - if the appointment of proper nutrition is not performed on time - lead to damage to the mucous membrane of the colon, chronic diarrhea and delayed development of children.
Lack of nutrients, B group vitamins, anemia and growth inhibition are possible consequences of allergy to gluten proteins.
Diagnostics of the foamy stool in infants
In pediatrics, the diagnosis of frothy stools in infants is based on anamnesis and complaints of parents, examination of the child, evaluation of its level of development and the dynamics of body weight gain.
Analyzes are given:
- stool analysis (microbiological, for carbohydrate components, pH level);
- general blood analysis;
- blood test for thyroid hormones (T3 and T4);
- ELISA blood for immunoglobulin IgE (for lactoglobulins of cow's milk) and antibodies to gliadin (IgA).
Differential diagnosis
Differential diagnosis is needed to accurately determine the nature of the existing pathology - enzyme or immune.
Who to contact?
Treatment of the foamy stool in infants
The only treatment for a foamy stool in a baby with the above pathologies of metabolism is a diet depending on the etiology: lactose-free, dairy-free, sucrose-free, gluten-free.
Read also - What if the baby does not tolerate lactose?
Recommended by pediatricians, probiotics help only in case of disturbance of the intestinal microflora.
Prevention
To date, preventive measures to prevent the development of malabsorption of lactose, congenital intolerance of milk proteins or gluten does not exist.
Forecast
Frothy stools in the baby comes back to normal, subject to the restrictions that are introduced into the child's nutrition system. In the case of celiac disease, these limitations must be observed throughout life.
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