Stomach and Abdomen

Vomiting > 24 hours.

Vomiting is a non specific sign of many illnesses but it usually means there is some type of gastrointestinal infection. Call right away if your child is :

1. Very weak or fatigued and often associated with a temperature above 101°.

2. has bile stained (green colored) vomitus on two occasions.

3. has not urinated for 8 hours.

4. appears pale, and unaware of the surroundings.

Treatment to be started if your child vomits more than once in twelve hours:

Under 6 months use : Pedialyte ½ to 1 ounce every 30 minutes. If that is tolerated well after a few attempts, then increase the volume by one ounce every 30-60 minutes. Once they reach the amount of fluid that is about normal for them continue with Pedialyte for 12 to 24 hours. You should then return to breast milk or half strength formula for one day followed by full strength formula.

Older infants, children and adolescents can be given water, Gatorade, 7-up, tea, or Jello. Avoid milk for a few days if there is any sign of diarrhea. Milk sugars are not digested well and can produce more diarrhea. Advance their diet slowly over the next couple of days until you are back to normal. If they continue to vomit after 2 or 3 consecutive trial doses of clear fluids or they start #1, #2, #3 or #4 above - call me or go to Children’sal Hospit emergency room.

Diarrhea

Diarrhea means bowel movements, not of the regular consistency - usually watery, and more than once in 24 hours. Diarrhea is a non-specific sign of many illnesses but it usually means there is some type of intestinal infection.

Call right away if your child is:

1. very weak and has a fever over 101° degrees

or 2. has grossly bloody stools

or 3. has not urinated for 8 to 12 hours

or 4. appears very pale and unaware of her surroundings

Treatment

Under 1 year of age use Pedialyte or a similar hydration fluid for about 24 hours. If there is improvement with less frequent bowel movements or thicker stools, then use ½ strength Isomil or other soy formula; then in the following days you can try using full strength soy formula for about one week.

For older children or adolescents, begin with clear fluids with Gatorade, 7-up, tea, and even water. After about 24 hours and improvement in the diarrhea try the “BRAT” diet: Bananas, rice (cereal), apple sauce and toast. For older children baked or fried potatoes, crackers, simple broth or soup may be tried. Avoid regular non soy formulas until the stool returns to normal. Avoid milk or dairy products because milk sugars in dairy products can worsen the diarrhea. Also avoid fruit juices that can worsen diarrhea. If there is no response to treatment in 1 to 2 days or the symptoms worsen - please call me or go to Children’s Hospital emergency room (353-3000).

Constipation

Most infants have several bowel movements a day. Some will skip one or several days in their normal pattern. Most breast fed infants have loose stools, but some are prone to infrequent bowel movements. Many babies grunt and others turn bright red for a couple of minutes while they pass a stool or pass gas. The first appearance of this behavior may be startling for the parent. The baby is not in distress or is constipated.

The infant with a real bowel problem will have definite symptoms besides the infrequent bowel movement: Pain on the passage of stools, inability to complete a normal movement although the urge is strong and blood in the stools.

Constipation treatment

If you use formula, add more water and sugar (not honey) to the formula. Try one teaspoon to one tablespoon of Karo™ syrup per four ounces of liquid. If there appears to be a “crisis” (your baby is crying and trying to push but nothing is happening), you can buy over-the-counter medications at any pharmacy and use Babylax™ or glycerin suppositories until a BM can be obtained. If treatment is needed two or more times a week, please call my office.

Constipation in older children

Constipation can occur at any age. It can be very uncomfortable. Children can develop problems if constipation occurs on a regular basis. The problem may start innocently by controlling BM’s because they want to play longer, had a painful or bloody stool once or are embarrassed to use the school facilities. Holding their bowel movements in a chronic manner can eventually cause stretching of the intestinal lining. A vicious cycle of pain and withholding can develop. If this persists over months or years, leakage can cause embarrassing soiling of underwear and an accompanying odor.

I am impressed with the help a simple change in diet can achieve. Increase the amount of bulk in the diet. Leafy vegetables, fresh and cooked fruit and fruit juices or extra liquids work well. Keep dairy products down or stop all together.

When dietary changes don’t work, a more aggressive treatment may be needed but I will need to examine your child before using medications.

Rectal pain, itching or bleeding

Rectal bleeding is not a common problem in children. It is usually seen in a diaper change when a few streaks of blood are noticed over the surface of a stool. In infants, the cause is a small tear in the rectal opening. This is not serious and heals without special treatment. Hard stools cause the problem, but I have also seen it after straining on soft stools. Treating the constipation clears up the bleeding.

If the problem persists after several bowel movements or over several days, please call my office.

If rectal bleeding accompanies abdominal pain, there may be a blockage of the intestine or a bacterial intestinal infection. Either of these problems requires prompt attention.

A child may awaken in the evening with intense rectal pain or itching. This almost always means an infestation of pinworms which are seldom seen but are quite common. These very small worms live in the intestine near the rectum. The female emerges at night to secrete a sticky and irritating substance around the anus where she lays her eggs. The worms can move into the vagina causing pain and itching. Scratching can lead to secondary bacterial infections.

Pin worms are easily treated with a chewable drug that effectively kills both the worms and eggs. (see also the section on Pin Worms)