The function of the digestive system changes according to the maturity level of the child; a phenomenon that may be abnormal in older children (such as reflux) is often normal in infants. Fetuses can swallow amniotic fluid as early as the 12th week of pregnancy, but the sucking reflex for feeding begins to appear in infants from the 34th week of pregnancy.
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| From the 4th month, children enjoy solid foods (Photo: TTO) |
At about one month old, infants begin to show a preference for sweet and salty flavors. From the 4th month, they start to enjoy solid foods. Current recommendations suggest introducing solid foods to children from the 6th month based on nutritional needs rather than the maturity of swallowing ability. When eating, infants often swallow air, so it’s important to help them burp to prevent stomach bloating.
Which oral structures are considered normal in small children?
A short tongue may cause concern for parents, but this condition rarely affects chewing or speech development and often does not require surgical intervention. A cleft in the tongue is also a normal morphological variation, as is a bifid uvula, even in cases where there is a short cleft at the back of the soft palate.
Reflux phenomena in children
In the first year, infants may exhibit signs of fluid flowing from the mouth, which can be either natural reflux or intentional reflux. In healthy children experiencing reflux, the volume of vomit is typically around 15-30ml, but it can be more. Most cases show that children remain happy after each reflux episode (though they may be hungry). In a single day, reflux episodes might not occur or may happen several times. About 80% of reflux cases generally resolve by the time the child is 6 months old, and 90% resolve by 12 months. If a child experiences complications from reflux or continues to have prolonged reflux after these ages, it is considered pathological rather than a normal developmental characteristic, necessitating evaluation of its impact and possible treatment intervention. Complications of reflux include failure to thrive, lung disease (such as breathing difficulties or aspiration pneumonia), esophagitis, and esophageal damage.
Eating habits in children
Toddlers often eat sluggishly or refuse to swallow food. It is generally recommended to offer toddlers and young children small amounts of food at each meal. Parents should assess the nutritional quality of meals over a few days rather than on a daily basis. Older children, who are in a rapid growth phase, need nutrient-rich and appetizing foods to stimulate their appetite. Young children, from toddler age to pre-school age, often experience a decreased appetite. It’s essential to regularly monitor and evaluate a child’s development using standardized growth charts.
Differences in stool color
The quantity, color, and consistency of stool can vary significantly within one child or among children of the same age and is not always explainable. The meconium, which is the first stool produced after birth, is dark and typically appears within 48 hours. After the child starts feeding, meconium is replaced by transitional stool, which is brownish-green and often contains curdled milk, lasting for 4-5 days, before being further replaced by yellow-brown stool mixed with milk.
In normal children, the frequency of bowel movements can be inconsistent, ranging from 0-7 times per day. In breastfed infants, stool is consistently small in volume with a soft consistency (transitional stool), and after 2-3 weeks, they may pass soft stool that is not always consistent. Breastfed babies may not have a bowel movement for 1-2 weeks and still maintain normal stool production afterwards. Stool color is generally not significant unless there is blood present or a deficiency in bilirubin (stool appearing white instead of yellow-brown).
The presence of plant particles (like beans or corn) in the stool of older children or toddlers is normal, indicating that they are not chewing their food thoroughly rather than being indicative of malabsorption issues. Occasional loose stools (often termed toddler diarrhea) frequently occur in children aged 1-3 years. This can also happen in healthy children who consume a lot of carbohydrate-rich drinks and snack foods during the day; these children typically have bowel movements during the day and less frequently at night, with a large volume of water in their stool. This type of loose stool can often be managed by giving the child non-carbohydrate beverages and fatty foods.
Common abdominal bloating in small children after a full meal
This phenomenon is due to a combination of factors: weak abdominal wall muscles, enlarged abdominal organs, and postural scoliosis. In the first year after birth, the liver can be palpated about 1-2cm below the right rib cage. A normal liver feels soft and homogeneous when lightly tapped. The Riedel lobe is a thin projection from the right liver lobe that can be felt under the outer margin of the right abdominal wall.
The soft outer edge of the spleen can also be palpated in normal conditions in infants. In thin children, the spine can be easily palpated, and the tissues protruding above the spine may be mistaken for tumors. Typically, the pulse of the aorta can be felt. It is normal to palpate stool mass in the lower left quadrant of the abdomen, where the descending colon and sigmoid colon are located.
Jaundice
Jaundice commonly occurs in newborns, especially in preterm infants, usually due to immature liver function and is associated with conjugated bilirubin pathology, leading to elevated indirect bilirubin levels. Prolonged indirect bilirubin elevation in breastfed infants may result from breastfeeding jaundice, which is typically benign in full-term infants and can often be managed by replacing breast milk with formula. Elevated direct bilirubin is never normal and often suggests liver pathology, although the child may have an infection outside the liver (for example, a urinary tract infection).
The level of direct bilirubin should exceed 15-20% of the total bilirubin component. Pathological elevations of indirect bilirubin (common in healthy newborns) often result in mild jaundice (golden yellow) of the sclera and skin, while elevations of direct bilirubin usually lead to darker jaundice.
Associate Professor, Dr. NGUYEN TRI DUNG
