Search for tag: "constipation"

Interviewer: Hirschsprung's disease is a rare intestinal disorder that can severely impact a child's ability to pass stool. What treatments are available and what you can expect for your child on The Scope.

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Interviewer: I'm here with Michael Rollins, a professor of surgery in the Division of Pediatric Surgery at the University of Utah Medical School and Primary Children's Hospital, and we're talking about Hirschsprung's disease. Am I pronouncing that right, Hirschsprung?

Dr. Rollins: Yeah, that's correct.

Interviewer: So what exactly is this disorder?

Dr. Rollins: Hirschsprung disease is a disorder where the nerve cells of the rectum and/or part of the colon don't form normally, and these nerve cells are responsible for relaxation of the rectum and colon to allow the passage of stool. So basically, a child is born with an intestinal obstruction because they're unable to pass stool.

Interviewer: So that can be pretty serious, I would think. How common is this type of disease?

Dr. Rollins: It occurs in about 1 in 5,000 live births, and yes, it is serious. It's a problem that most of the time will progress to severe abdominal distension or vomiting, feeding intolerance, and can even progress to a life-threatening infection called enterocolitis or an intestinal perforation if it's not recognized within the first few days of life.

Interviewer: What are some of the ways that physicians, surgeons kind of treat this disorder?

Dr. Rollins: The majority of babies will pass meconium, the first stool, within the first 2 days of life, up to 98%-ish. So probably the most common way that this is diagnosed is the baby is born and they don't pass stool in the first two days of life. Second most common way would be that the baby doesn't tolerate feeds in the first one to two days of life, becomes significantly distended, the abdomen becomes distended, or they're vomiting, and also probably not passing stool or passing very little stool.

Those are red flags and those prompt further either consultation to a pediatric surgical service or further investigation, which most commonly the first study would be plain abdominal x-ray or what's called a contrast enema, where a small tube is placed in the child's rectum and contrast fluid, contrast dye is infused to look at the rectum and colon.

Interviewer: And then how do you actually treat or correct? What intervention do you do with this disorder?

Dr. Rollins: Hirschsprung disease requires surgery for correction. So as I mentioned a little earlier, it's a spectrum of a disease. So the very end of the large intestine may be affected, so the rectum only may be affected, but variable lengths of the colon upstream, or even in more or the most extreme cases even part of the small intestine may be affected, so that stool can't pass. So the treatment options would be different really based on the level of the disease.

So 80% affect only the rectum, so what we call a short segment. And in those babies, the treatment option, they can be treated in three different ways. The first thing is a rectal biopsy is performed at the bedside to make a definitive diagnosis. So the pathologist won't see the nerve cells when they look at it under the microscope. And so once you have that definitive diagnosis, then you can either proceed to the operating room shortly thereafter and determine the level of the normal intestine, resect or take out the abnormal portion, and bring the normal intestine down to a small, little rectal cuff just above the anal canal. So a one-stage operation.

Another treatment method may be to perform daily irrigations or washout of the rectum and colon. Parents often do this at home. And then once the child has a chance to grow, get a little bit bigger, we'll come back around three months of age or so and do that one-stage operation at that point. Sometimes, it's technically a little bit easier, and then, you know, the babies had a chance to go home and be with parents and develop that normal relationship.

And then the third way to treat it would be with a colostomy at birth. So go to the operating room, determine the level of the normal intestine and bring that up to the abdominal wall so that stool empties into a bag. And then once the child has grown and gets older, go back for the definitive operation, where the abnormal portion is resected and the normal portion is brought down to the bottom.

Interviewer: And what kind of care should a parent expect after this procedure?

Dr. Rollins: So the tricky part of Hirschsprung's disease is intuitively you'd think that, "Okay, the abnormal intestine is gone, my baby is cured." And we thought that for a long time. But we've begun to realize that we as a surgical community, medical community have begun to realize that that's not actually the case.

You know, in the past, we would do the operation, we would see the child back a few weeks afterwards, everything looks great, great operation, you know, good to go. And those children would develop problems with infections of the intestine called enterocolitis, can get a bacterial overgrowth that can cause severe infection, which the symptoms of that are fever, abdominal distension, vomiting, severe explosive diarrhea. And the treatment for that is washouts, rectal washouts, which parents can do at home and which here, at Primary Children's in the university hospital, we teach all of our families how to do that so that if those symptoms develop, they can contact us, let us know, and begin that treatment at home.

So that's kind of the short term, you know, what we worry about after we're satisfied with the surgical side healing and things like that. So we worry about enterocolitis initially. Seems like that becomes less of a problem after the first couple of years of life.

And the issue that seems to be most common during childhood, and even into adolescence, is constipation. And it's constipation beyond what you think of when you think of constipation, maybe hard stool that's infrequent that the pediatrician or primary care provider treats routinely each day. This is constipation that requires often a formal bowel management program with a high-dose stimulant laxative therapy to get the large intestine to squeeze and empty normally. If this constipation is not recognized, left untreated, over time, it can result in a dysfunctional colon. So we stress to families that, you know, this is a long-term relationship with us as the care team in order to avoid these complications.

Interviewer: And with this kind of long-term care, what kind of quality of life can a parent expect for their child with this disorder?

Dr. Rollins: The great news is, as I mentioned, our thought process in the past was not complete. Now, we are recognizing these issues, and with early management, these children going to be highly functioning, you know, normal functioning children playing sports, going to regular school, sleepovers, camps, things like that, they just may have to take medication each day in the form of a laxative, which you know, I mean, I explain to children and to their families that you wouldn't think anything about taking your inhaler every day if you had asthma. So you know, this is the same thing.

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Dr. Gellner: Juice, especially a 100% fruit juice is healthy. It's made with fruit. Sorry, that's outdated thinking. I'll address this old wives' tale and give you the updated scoop on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Remember that one thing that one person told you that one time about what you should or shouldn't do with raising your kids? Find out if it's true, or not. This is Debunking Old Wives' Tales with Dr. Cindy Gellner on The Scope.

Dr. Gellner: I get asked this all the time. "How much juice can I give my baby, my toddler, my child?" Parents feel the need to give their child fruit juice. It's what they were raised on, so it's got to be good for their child. Right? A 100% fruit juice is healthy. Just like the fruit the juice was made from. Makes sense right? But that's wrong.

The bottom line is juice isn't all that healthy at all. In fact, unless I'm recommending it for constipation, I tell parents not to give babies under a year old any juice. For kids older than a year, I always say, "Drink juice in moderation. It's pure sugar and calories." In fact, store bought juice is nicknamed "liquid candy," just like soda is. Think about it.

Four ounces of lemon lime soda has 12.6 grams of sugar and 46 calories. Four ounces of apple juice has no fiber, 60 calories and 13 grams of sugar. Compare that to a 1/2 a cup of apple slices which has 1.5 grams of fiber, 30 calories and 5.5 grams of sugar. Big difference.

Real fruit has fiber, which makes it less likely to cause cavities and more helpful if constipation is an issue in older kids. Children need to learn how to eat fresh fruits and vegetables, not drink them. New guidelines for older kids are four ounces daily for children ages 1 to 3, 6 ounces daily for children ages 4 to 6, and only 8 ounces for children ages 6 to 18.

While some companies and organizations state that real fruit juice is a nutritious complement to whole fruit in balanced diets for older children, or even marketed as a way to add vitamin C and flavor variety to a baby's diet, the recent statement from the American Academy of Pediatrics states that juice has no essential role in healthy balanced diets of children. Studies also warn that infants currently drinking juice are more likely to want to drink soda and other sugar containing drinks when they get older.

Juice and other sugary drinks contribute to weight gain and tooth decay that we pediatricians see all the time in young children. By changing these guidelines and getting kids to cut down on juice, hopefully there will also be a decrease in cavities and obesity.

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Dr. Gellner: What's in your child's diaper? We'll discuss old wives' tales about baby and toddler poop today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Parents seem to be obsessed with their child's poop from the day their babies are born. Some of the most common concerns we get as pediatricians involve young kids and their bowel habits. The top three old wives' tales that we get questioned about include:

Number one, if my child doesn't poop at least once a day, something is terribly wrong.

Probably not. Babies have to have at least one bowel movement in the first 48 hours of life or they can't get sent home from the nursery. That's when to worry.

Breastfed babies can poop as often as every time they eat, or as little as once a week with a huge blowout, and lots of laundry for you.

Formula fed babies can poop several times a day to once every four days. Number two, my baby is constipated because they scream and turn red whenever they poop.

So there's something called dyschezia that most babies have. It's apparently painful pooping, but your child isn't really in pain, They're pushing, and grunting, and crying to increase pressure in their bellies to squeeze the poop out past the rectal sphincter, that's the muscle that controls poop flow. And unless the poops are rock hard, your child doesn't have true constipation.

Number three, my child's poop is green, or blue, or purple, or orange, is there something wrong with their digestion?

Unlikely. Chances are they ate something with natural or artificial coloring. Red foods can cause reddish or orange poop, purple can cause red or blue poop, green or blue can cause blue poop, iron in the formula can cause greenish poops. Quite honestly, the only colors we really worry about are pure white with the consistency of powdered chalk, very black like tar, and very stinky, and your child is more than a few days old, or if they have actual blood on the surface or mixed into their poops. We need to know about those right away.

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Interviewer: The most common health issues for individuals with autism and how to treat them, next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Daniel L. Coury is the medical director of the Autism Treatment Network of Autism Speaks. What is the mission of the Autism Treatment Network?

Dr. Coury: So our mission is to improve the medical care for individuals with autism everywhere and to develop evidence-based medical practices for treating their comorbid conditions. We're discovering that autism really affects many parts of the body, perhaps every part of the body, and it's these other medical problems that have been overlooked in many research studies and in clinical care. So we're out to try to shed better light on what these problems are, and how best to manage them.

Interviewer: What are some of the conditions that the Autism Treatment Network is concerned about?

Dr. Coury: So one of the most common areas has to do with GI disturbances. Many parents of a child with autism say that their child has a lot of GI problems, with abdominal pain, or excessive constipation or diarrhea, or reflux. A variety of GI problems. And for a long time people wondered whether these parents complained more, or if there was really more of this medical problem. And it turns out that they do have medical GI problems than people who don't have autism.

And that second part of that question is, are these GI problems different from the GI problems that other typically developing people have? And so we've been looking at that, and we find that it looks like they're the same GI problems. They occur more frequently, but they do respond to the traditional GI treatments in the great majority of cases.

Interviewer: And to some people hearing this, they might chuckle and go, "Well, of course they're the same." But there are concerns that a disease might manifest itself differently in different people, I suppose, and you want to really find out for sure if that's the case.

Dr. Coury: Well, that's correct. And what has happened with many primary care providers over the last 20 years or so is that parents of a child with autism come with information that they found on the internet about a diet that they should be trying, or some treatment that they should be trying, and many family doctors can't keep up with the variety of things that are published on the internet.

As a result, I think that a lot of these doctors started to lose confidence in their clinical skills, and started thinking, "Well, maybe this is more complicated than I can manage." And so they would refer them to specialists, or specialty centers, and not do the things that they actually were capable of doing that would help children. So I feel that we've done a lot to demystify that.

Interviewer: Yeah, that'd be very helpful for a physician. And also for the patients as well, to know that yes, I can go to my regular family physician and any advice or information they would have would help my child, just like it would help anybody else.

Dr. Coury: Yes, it would, because especially when the specialty centers are really overloaded and have long wait lists. And to wait a long time to see a specialist when in fact it was something that your primary care provider could have managed, is just a much more efficient way of getting services to families, and getting these children the help that they need.

Interviewer: What are some of the other conditions that you're concerned with?

Dr. Coury: Well, another one that I have known for some time has increased, is epilepsy. Seizure disorders occur in people with autism at a much higher rate than the general population. Most studies show that over the course of your lifetime, a person with autism is about 19% of the population is going to have a seizure disorder compared to less than 1% of the general population.

So again our question is, is there anything about this that we could have tried to predict? Are there certain kids with autism who are more prone to have this? And then, what is the best way to treat these seizures? Do we treat them the same as we do in typically developing individuals, or do they respond better to different medications?

Interviewer: And what did you find out when it comes to epileptic seizures?

Dr. Coury: Again, so far we haven't found that there is anything particularly different. They do respond well to the regular epilepsy medications. And, like people who don't have autism but have epilepsy, there are some who have very resistant seizures that are difficult to treat. And so there are all sorts of treatments being examined to try to help that population.

Interviewer: So once again, good news for parents or somebody with autism, that the regular standard procedures all seem to apply.

Dr. Coury: Yes, it does.

Interviewer: Are there any other things that you're concerned with at the Autism Treatment Network, as far as those comorbid conditions?

Dr. Coury: Well, the third most common one has to do with sleep. A large majority of parents of a child or a family member with autism complain that their family member has problems falling asleep or maintaining asleep, and getting up in the middle of the night, or is rising early in the morning. Some of these families report that their child only sleeps three or four hours a night. And so we've been very interested in that. At first it was thought that, well, because this person has a neurodevelopmental disorder, perhaps other parts of the brain affecting sleep have been affected, and that we need to use a medical treatment.

In fact, we've found that non-medical treatments, good behavioral habits surrounding sleep are effective about two-thirds of the time. What we also found is that it's very difficult for families to carry this out. At the end of the day, a parent of a typically developing child who has sleep problems still has the energy to engage in the behavioral changes that we recommend. But our families with a child with autism are often worn out from dealing with their child's behavioral and developmental issues all day long. So with a lot of support we can improve their sleep without medication, but it is difficult.

Interviewer: And it takes a team, it sounds like, not just a couple of parents. Other family members need to be involved in that.

Dr. Coury: They really do. And one of the things that we've really found with managing these children is that they really require team management from the medical side as well. The families need help with care coordination to get the services that they need, they need help with keeping those appointments, a variety of things, because it can be a pretty overwhelming experience, parenting a child with autism.

Interviewer: Are there any of these types of things that you do want to treat differently with somebody with Autism? We've already talked about how your GI problems, or epilepsy, or sleep can be treated in conventional ways. Is there anything that you need to use nonconventional ways to treat?

Dr. Coury: Not at this point. We're finding, again, it's maybe difficult to use our conventional treatments. So for example, we have difficulty treating constipation because the sensory problems that many people have with autism have, makes it difficult for them to take the medication. So we look for other ways that we might be able to get around that, or we look for ways to make the medicine more acceptable so that the patient can take it.

But so far the fortunate thing has been that we've found that these medical problems look very much like what they are in other people. We're still not sure what is causing them. We haven't identified if there is a different root cause that is part of the autism, but the good news is it looks like whatever that root cause might be, they respond to our traditional treatments.

Interviewer: In addition to learning that traditional treatments for those ailments do work for individuals with autism, does this research tell us anything else?

Dr. Coury: Well, another area of study that is just now becoming of greater interest has to do with immune problems, and we have found that the families of people with autism have a higher rate of autoimmune disorders. These are disorders like arthritis or diabetes, and we have found that people with autism have a higher rate of diabetes than the general population. These, again, give us an idea of what might be going on that causes autism.

So what we're doing with the network, the more we learn about these other medical problems, as we trace back what causes those problems, we feel we're learning more about autism, and eventually what causes it, and how we might be able to better treat it, or even try to prevent it. So these are exciting times.

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updated: April 10, 2019
originally published: July 29, 2015

Your child comes to you and says they have a bellyache. Tummy aches are a common issue with kids. When to worry about that and what to do to help your child. Common Causes for Stomach Pain

So abdominal pain is something we see very often and there's a whole bunch of reasons why kids can have abdominal pain. They can have abdominal pain because they're overeating; we see that a lot usually around holidays, like Halloween, they eat too much candy. Christmas, they eat too much of the good yummy stuff that we see around the holidays. They can also have gas pains if they're drinking too much soda. They can have indigestion from spicy foods. For example, I see a lot of kids that eat hot Cheetos and then they come in and tell me that their stomach hurts. The hot Cheetos are the cause of that stomachache.

Quite often as well, I see kids coming in for stomachaches because of constipation. They'll say their stomach hurts around their belly button and then when you start asking questions about their bowel movements, it turns out they haven't gone for awhile or when they go, it's hard to get out. So ask your child if they have a stomachache, if they've pooped recently.

We are also seeing a stomach virus going around and a lot of kids will come in and say they have a stomachache, but they haven't had the vomiting or diarrhea because the stomachache just started that day and the parents are concerned. But the vomiting and diarrhea start within 24 hours of the stomachache.

A serious cause of abdominal pain that is always one that we worry about is appendicitis. And you need to worry about appendicitis if the pain is on the low right side of your child's abdomen. Your child won't hop up and down and they prefer to lie still, unable to move, even the slightest, without holding on to the lower right side of his or hers stomach.

We often see a lot of kids coming in with stomachaches at the beginning of the school year. Those stomachaches that keep coming back, they also say they're around the belly button, they feel like they're in the, quote, "pit of their stomach." That's because of stress. And kids can't really explain stress that well, they just say their tummy hurts. And kids that have recurrent stomachaches often have some sort of stressors, whether it's something going on at school or something going on at home that they're worried about. So your child continues to talk about belly pain around their belly button, ask them if they're worried about anything.

So how long does stomach pain normally last? Well, that all depends on the cause. With harmless causes, the pain is usually better or gone in about two hours. Either that or you'll see new symptoms, like the vomiting, the diarrhea, usually they'll pass gas if it's from gas pains, things like that. What if they have stomach pain from indigestion? Well the first thing they should do is just lie down. Quite often lying down and not focusing so much on the belly pain does make it better. You can give them belly rubs, you can have a warm washcloth or a heating pad on their stomach and that will make them feel better, too.

Avoid giving your child any solid foods and allow only sips of clear fluids if they're vomiting. If they continue to try and eat normally, the vomiting will continue and their stomach pain will get worse. If your child hasn't gone to the bathroom for a little while, have them go sit on the toilet and see if having a bowel movement will help with their belly pain.

And finally, we usually don't recommend giving any medication for stomach cramps unless you know the cause. Obviously if it's because of constipation and this is a chronic problem, give them their constipation medication. But if you don't know what the cause is, don't give your child Tylenol or Motrin to help the stomach pain. Try and figure out with your pediatrician what the cause of the stomach pain is so that you can help them if this happens again.

If your child has stomach pain because of stress or worry and it's something going on at school, be sure to talk with the child about what's going on and then relay those concerns to the officials at the school. Talk to the teachers, talk to the principal, see if you can resolve the problem that was causing their stomachache.

So when should you call your child's health care provider? Call immediately if the pain is severe and has lasted more than an hour or its constant and has lasted more than two hours. Or if you are worried about appendicitis or if the pain actually extends into the scrotum or testicles of boys. You may be advised to go to the children's emergency room for further testing that may not be able to be done in your doctor's office to evaluate for those serious causes that may need a surgeon.

So abdominal pain is something that again, we see very often and there are so many things that could cause it. By working with your child's doctor, you can figure out what the cause of the pain is and a plan to help your child.

updated: May 24, 2021
originally published: December 15, 2014

Dr. Gellner: Feeding your baby step by step, that's what we'll talk about today on Dr. Cindy Gellner, on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists that you can use for a happier and healthier life. You're listening to The Scope.

Dr. Gellner: We talk about feeding your baby at pretty much ever single visit that you come to with your pediatrician. Quite often we'll talk about the different things that you should be feeding your baby depending on their age. For babies who are 0 to 4 months old, breastfeeding on demand or formula feeding if you're not able to or not wanting to breastfeed, is all that your baby needs. Your baby should not have any solid foods before 4 months old. Their digestive system isn't quite ready for it. Make sure that you're not trying to over feed your child. As long as your child is having six wet diapers or more a day, your baby is getting enough fluids.

Most babies who are between 0 and 1 month old will have about 2 to 4 ounces in their bottle. Usually 2 closer to the first two weeks of life and then they can advance to 4 ounces. Between 1 and 4 months your baby could have anywhere between 3 and 6 or 7 ounces. You want to make sure that your baby is letting you know when they've had enough. When they start not showing as much interest in the bottle or the breast or they're sort of pushing it away, then they're done. Babies will let you know when they're done. Don't make them finish the formula bottle if they don't want to. If you're nursing and the baby is done nursing but you still feel full, go ahead and pump that extra breast milk and store so you can have it later on.

For babies that are 4 to 6 months old, we still recommend for babies who are breastfeeding to just have the breast milk until about 6 months old. If they're formula feeding, sometimes we go ahead and say, you can have baby foods. For babies, we usually say to do rice cereal as one of the first foods. Rice cereal will actually add an iron source to the diet of a breast fed baby. It's important for those. Babies who are formula fed and have rice cereal, that's sometimes, since they both have an iron in them, causes a little bit of constipation. You can back off on the rice cereal for formula fed babies if it's a problem.

For babies who are 4 to 6 months old, we recommend one of the Stage 1 baby foods per day. We want to make sure that you know not to put the baby's cereal or foods in the bottles. They need to be fed on the spoon. We don't recommend putting rice cereals in the bottles to make babies sleep more anymore because it actually was shown not to be a big factor. For babies who are 6 to 9 months old, we recommend doing the Stage 2 foods. They can have two jars a day. Continue to give breast milk and formula but you will notice that your child's liquid content will decrease as their solid intake increases.

When babies start to turn 9 months old, then you'll start introducing table foods. You can have the Stage 3 foods as well three times a day, or you can start giving the table foods. The big thing with the table foods is you want to make sure they are not choking hazard size. You want to make sure that the fruits and vegetables are strained or mashed. If they're having meat, then they're tiny, tiny, tiny pieces of meat or that they're strained chicken or beef or beans. Never give hotdogs to a baby under a year old. Actually you should give hotdogs to anyone that is not able to chew their food really well because that is one of the biggest choking hazards.

As far as sippy cups, most people will try to introduce a sippy cup with breast milk or formula in it around 9 months old. Babies also will take water from a sippy cup but you want to make sure not to have them take too much water. They should only have about 4 ounces of water a day. More than that, and they're going to slow down on all the other things that have more nutritive value.

When your baby gets to be about 8 months old, you want to make sure that they're sitting in a highchair as well, because then they're going to get used to sitting at the table with you. As far as little snacks, those are really good for sitters, so 8 months and up. Make sure that they're the dissolvable kinds, like the puffs, things like that, things that babies can learn how to pick up that helps with their fine motor skills and start feeding themselves little finger foods. But they're not choking hazards as much as crackers and things. You also still want to make sure that you're by your baby at all times whenever you're giving any sort of food.

Babies can also start having yogurt and cheese at about 9 months old as well to start advancing their diet. You do not want babies to have whole milk until they are 12 months old. Continue the formula or breast milk until their first birthday. After they turn 1, you'll want whole milk until they're 2, so that they can have the fat content in the milk for brain development.

Things that you should not give to a baby under the age of 1, anything that's really acidic. That's going to hurt their stomachs, so like orange juice, things like that a lot of babies find they can't handle very well, and honey. Honey can cause a serious disease called botulism in children that are less than 1 year old.

As your child comes in for their well visits as a baby, when it's time for a vaccines and seeing how their growing and everything, they are due to adding. Your pediatrician should talk to you about the types of foods you can add to your child's diet at that time. If you have any questions, feel free to ask your pediatrician. We're always there to help.

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