Sometimes children who eat a balanced diet suffer from malnutrition. The reason for this may be malabsorption, the body’s inability to absorb nutrients from the digestive system into the bloodstream.
Normally the digestive process converts nutrients from the diet into small units that pass through the wall of the intestine and into the bloodstream, where they are carried to other cells in the body. If the intestinal wall is damaged by a virus, bacterial infection, or parasites, its surface may change so that digested substances cannot pass through. When this happens, the nutrients will be eliminated through the stool.
Malabsorption commonly occurs in a normal child for a day or two during severe cases of stomach or intestinal flu. It rarely lasts much longer since the surface of the intestine heals quickly without significant damage. In these cases, malabsorption is no cause for concern. However, chronic malabsorption may develop, and if two or more of the following signs or symptoms persist, notify your pediatrician.
Signs and Symptoms
Possible signs and symptoms of chronic malabsorption include the following:
Persistent abdominal pain and vomiting
Frequent, loose, bulky, foul- smelling stools
Increased susceptibility to infection
Weight loss with the loss of fat and muscle
Increase in bruises
Bone fractures
Dry, scaly skin rashes
Personality changes
Slowing of growth and weight gain (may not be noticeable for several months)
Treatment
When a child suffers from malnutrition, malabsorption is just one of the possible causes. She might be undernourished because she’s not getting enough of the right types of food, or she has digestive problems that prevent her body from digesting them. She also might have a combination of these problems. Before prescribing a treatment, the pediatrician must determine the cause. This can be done in one or more of the following ways.
You may be asked to list the amount and type of food your child eats.
The pediatrician may test the child’s ability to digest and absorb specific nutrients. For example, the doctor might have her drink a solution of milk sugar (lactose) and then measure the level of hydrogen in her breath afterward. This is known as a lactose hydrogen breath test.
The pediatrician may collect and analyze stool samples. In healthy people, only a small amount of the fat consumed each day is lost through the stool. If too much is found in the stool, it is an indication of malabsorption.
Collection of sweat from the skin, called a sweat test, may be performed to see if cystic fibrosis is present. In this disease, the body produces insufficient amounts of certain enzymes necessary for proper digestion and an abnormality in the sweat.
In some cases the pediatrician might request that a pediatric gastroenterologist obtain a biopsy from the wall of the small intestine, and have it examined under the microscope for signs of infection, inflammation, or other injury.
Ordinarily, these tests are performed before any treatment is begun, although a seriously sick child might be hospitalized in order to receive special feedings while her problem is being evaluated.
Once the physician is sure the problem is malabsorption, she will try to identify a specific reason for its presence. When the reason is infection, the treatment usually will include antibiotics. If malabsorption occurs because the intestine is too active, certain medications may be used to counteract this, so that there’s time for the nutrients to be absorbed.
Sometimes there’s no clear cause for the problem. In this case, the diet may be changed to include foods or special nutritional formulas that are more easily tolerated and absorbed.
Irritable bowel syndrome (IBS) is often referred to inaccurately as “colitis” and “mucous colitis.” But the suffix “itis” in a medical condition’s name denotes inflammation, which is not a hallmark of IBS. Rather than inflaming the colon, IBS sensitizes the nerves responsible for the contractions (called peristalsis) that propel partially digested food through the organ. As a result, the muscular inner wall overreacts to mild stimuli like milk products and emotional stress, and goes into spasm. Irritable bowel syndrome produces cramplike pains and bouts of diarrhea and/or constipation.
The more serious disorders, Crohn’s disease and ulcerative colitis, are both forms of inflammatory bowel disease. IBD damages the tissue of the small bowel and the large bowel, respectively, through the process of inflammation. As the body’s response to injury, inflammation is characterized by blood-carrying, infection-fighting white blood cells that rush to the site of the injury. Their presence accounts for the painful swelling, warmth and redness associated with an inflammatory reaction.
Among children, Crohn’s is two times more prevalent than ulcerative colitis. Whereas ulcerative colitis affects only the inner lining of the intestine and is confined to one section, “Crohn’s disease can penetrate the full thickness of the bowel and tends to occur in more than one area,” explains Dr. Alan Lake, a pediatrician and pediatric gastroenterologist at Baltimore’s Johns Hopkins University School of Medicine. In colitis, however, ulcers form where inflammation has destroyed the tissue. The open sores ooze blood, mucus and pus.
The cause of inflammatory bowel disease has yet to be discovered, although theories abound. Heredity is a factor: 15 to 30 percent of IBD sufferers have a relative with either disorder.
Symptoms that Suggest Irritable Bowel Syndrome may include:
Cramplike pain and spasms in the lower abdomen
Nausea
Bloating and gas
Headache
Rectal pain
Backache
Appetite loss
Alternating bouts of diarrhea and constipation
Fatigue
Depression
Anxiety
Difficulty concentrating
Symptoms that Suggest Inflammatory Bowel Disease may include:
Crohn’s Disease
Cramping abdominal pain and tenderness, particularly after meals
Nausea
Diarrhea
General ill feeling
Fever
Appetite loss possibly leading to weight loss
Bloody stool
Swelling, pain, stiffness in the knees and ankles
Cankerlike sores in the mouth
Eye inflammation
Irritation or swelling around the rectum
Fatigue
Depression
Anxiety
Difficulty concentrating
Delayed growth and sexual development in younger teens, due to lack of nutrition
Ulcerative Colitis
Pain and cramping in the left side of the abdomen
Intermittent episodes of bloody, mucus-like stool
Swelling, pain, stiffness in the knees and ankles
Canker-like sores in the mouth
Fatigue
Depression
Anxiety
Difficulty concentrating
Growth retardation in younger teens, due to lack of nutrition
Acute attacks may include:
Up to twenty bloody, loose bowel movements a day
Urgent need to move bowels
Severe cramps and rectal pain
Profuse sweating
Dehydration
Nausea
Appetite loss
Weight loss
Abdominal bloating
Fever up to 104 degrees F
You can see that many of the symptoms overlap, making diagnosis complicated at times. In general, says Dr. Lake, “the patient with ulcerative colitis has more bloody bowel movements, and the patient with Crohn’s disease experiences more pain.” He goes on to say that while ulcerative colitis is usually picked up quickly, “with Crohn’s disease, many months can pass between the onset of symptoms and the time of diagnosis. Not only are the symptoms subtle, but they can be minimized by cutting back on eating. So it can be difficult for parents to recognize that something is the matter.
“Frequently, kids are diagnosed because they develop inflammation elsewhere, like the eyes, the mouth and the rectum. If your child has irritation or swelling around the rectum,” he advises, “never assume that it is hemorrhoids, which is all but unheard of in children. The concern should be that he or she has Crohn’s disease.”
How Irritable Bowel Syndrome is Diagnosed:
Physical examination and thorough medical history, plus one or more of the following procedures:
Urinalysis
Urine culture
Complete blood count
Erythrocyte sedimentation rate (sed rate) blood test
Stool blood test
Sigmoidoscopy
How Inflammatory Bowel Disease is Diagnosed:
Physical examination and thorough medical history, plus one or more of the following procedures:
Complete blood count
Prothrombin time blood test
Erythrocyte sedimentation rate (sed rate) blood test
Stool blood test
Urinalysis
Sigmoidoscopy or colonoscopy
Upper gastrointestinal (GI) series (also known as a barium swallow)
Still other laboratory tests may be ordered.
How Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are Treated
All of these chronic conditions are incurable but treatable, meaning that steps can be taken on several fronts to reduce the frequency and severity of symptoms.
Changes in diet: Boys and girls with IBS or IBD are able to eat relatively normally when the disease is in remission, which is much of the time. During flareups, though, they need to be conscientious about avoiding certain foods. Your pediatrician will work with a nutritionist or a GI specialist to tailor an eating plan for your youngster. In irritable bowel syndrome, adding roughage to the diet may be all that’s necessary to ease cramping and soften hardened stool or eliminate diarrhea. However, high-fiber foods induce the opposite effect in a teen with Crohn’s disease or ulcerative colitis, who should stick to easy-to-digest low-residue items like broth, gelatin, skinless poultry, fish, rice, eggs and pasta. Fried foods and dairy are also taboo when the disease is active. Memo to Mom and Dad: Help spare your son or daughter some of the unwelcome consequences of IBD by serving five or six small meals a day instead of the customary big three.
Drug therapy: If diet alone doesn’t bring relief from an irritable bowel, occasionally a pediatrician will prescribe an antispasmodic agent to slow down its activity. Medication is usually indicated in Crohn’s disease or ulcerative colitis, where the favored drugs include corticosteroids such as prednisone (“the cornerstone of treatment,” according to Dr. Lake), and the 5-ASA agents sulfasalazine, olsalazine and mesalamine. Should these fail to stem the inflammation, your pediatrician might prescribe one of the following immunomodulators: azathioprine, cyclosporine, methotrexate or 6-mercaptopurine. They work by altering the body’s immune response. An IBD patient’s medicine cabinet often contains antibiotics and antidiarrheal medicines as well.
Dietary supplements: From a child’s perspective, one of the most upsetting effects of inflammatory bowel disease is its suppression of growth and sexual maturity. Large doses of prednisone can decelerate physical development; accordingly, pediatricians lower the dose or gradually take young people off the drug once it has controlled the inflammation. The main cause of poor growth, however, is insufficient nutrition. Adolescents with IBD sometimes fall into the habit of skimping on breakfast and lunch in order to avoid repeated trips to the bathroom while at school. As a result, they may be lacking in calories, nutrients, vitamins and minerals. Protein is especially crucial for growth. Your pediatrician will monitor your child’s eating patterns. Most nutritional deficiencies can be corrected by tinkering with the diet. If necessary, though, she can prescribe oral supplements and/or high-calorie liquid formulas.
Surgery: Cases of inflammatory bowel disease that resist drug therapy or develop complications may require an operation to remove part or all of the colon. This route is rarely taken during the teen years.
Mental health care: Emotional stress does not cause IBS or IBD, but it can aggravate either condition. Therefore, patients may benefit a great deal from seeing a mental health professional who can teach them stress-reduction techniques such as progressive muscle relaxation and progressive guided imagery. As with other chronic ailments, inflammatory bowel disease can be frustrating for teenagers. Flareups often leave them more dependent on their parents than they want to be and make them feel different from their friends. They may feel as though their body has betrayed them. If you suspect that your son or daughter is having a hard time coping, ask your pediatrician for a referral to a suitable counselor.
An inguinal hernia happens near the groin area, between the belly and the thigh. With boys, you can often see a swelling in the scrotum. Does this mean girls are off the hook? Not exactly. Although girls don’t have testicles, they do have an inguinal canal and can get hernias, too.
About 3-5% of healthy, full-term babies are born with an inguinal hernia. In premature infants, the incidence is substantially increased―up to 30%!
If an inguinal hernia is not treated, it can cause serious problems. Learn more about the signs and symptoms of this condition and what to expect if your child needs hernia repair surgery.
What is an inguinal hernia?
The story of the inguinal hernia begins during a baby’s development. When a baby boy is growing in the womb, the testicles first grow in his belly. As he develops, his testicles travel down a tunnel into the scrotum. (This tunnel also exists in baby girls). Occasionally, the tunnel (called processus vaginalis) does not close, leaving an opening from the belly into the inguinal canal where a piece of bowel or an ovary can become trapped.
When this happens, what should stay safely behind the abdomen can pass through and enter the groin – fluid, intestines, or other tissues. To avoid potential complications, inguinal hernias require surgery to repair.
How do I know if my child has an inguinal hernia?
Hernias can occur at any age but are most common in newborns but may not be noticeable for several weeks or months after birth. When your child has an inguinal hernia, you can usually see a bulge in the groin or scrotum. The bulge will typically come and go. It may get bigger after your child is straining or crying. It may go away or get smaller during the night while your child is asleep or relaxed. (Straining and crying do not cause hernias despite some myths).
NEVER ignore signs of pain or distress or any bulge in an infant or child. Call your doctor as soon as possible for a professional opinion or go to the emergency room.
If the bulge becomes trapped even when your child relaxes, it may mean that organs from inside the belly are trapped inside the hernia. This is called “incarcerated hernia” and requires immediate medical attention. Your child will likely have pain or feel tenderness (or even have vomiting). The bulge may also become much firmer or even red when this happens.
If the blood supply of the contents of the hernia is cut off, it is call “strangulated hernia.” These symptoms include severe pain, vomiting, no appetite, redness or bruising around the bulge, and sometimes fevers and bloody stools.
This inguinal hernia is frequently confused with a more benign condition, a communicating hydrocele.
What is the difference between an inguinal hernia and a hydrocele? A hydroceleis a fluid filled sac in the groin or scrotum. Hydroceles can look like inguinal hernias, but no bowel or tissue is found in the sac. Fluid is made inside of the belly, so if there is a connection between the hydrocele and the inside of the belly, fluid can move back and forth from the scrotum into the belly, leading to change in size of the scrotum (“communicating hydrocele”). Swelling of the hydrocele may cause pain and tenderness to that area. A hydrocele does not require surgery right away unless it causes pain. Most can be watched until 12 to 18 months of age. If it is still large at that age, some doctors will recommend surgery because there may be an inguinal hernia there or it could turn into one over time.
Will any tests need to be done to see if my child has an inguinal hernia?
Most of the time, a doctor can diagnose an inguinal hernia by what he or she sees when examining your child―seeing a bulge in the groin when your child cries or strains and seeing it disappear when your child relaxes.
When what the doctor sees is different from what you have seen at home, or if the bulge is always there and the doctor is worried that it might be a mass and not a hernia, an ultrasound can be done to help make the proper diagnosis. However, ultrasounds are not always necessary.
How is an inguinal hernia treated?
Surgery is needed to fix the inguinal hernia. Once a hernia is noticed, your doctor will refer your child to see a pediatric surgeon or a pediatric urologist for the procedure. Surgery will be scheduled to close the tunnel. The timing of the surgery depends the severity of the symptoms and the type of hernia. An incarcerated hernia needs to be taken care of immediately.
What type of surgery is done?
In hernia repair surgery, a small incision is typically made near the bulge and the contents of the hernia are pushed back into the abdomen. The inguinal tunnel where the organs are exiting from the belly (hernia) is closed.
If a laparoscopic (scope) approach is used: Small cuts are made on the belly allowing the scope and instruments to be inserted to see and repair the hernia.
If bowel is trapped in the hernia (incarcerated or strangulated): The surgeon will first ensure that the blood supply to the bowel has not been cut off for too long. If it has, a small piece of bowel may need to be removed and the bowel sewn back together.
This surgery generally takes between 30 minutes to 1 hour.
What should I expect on the day of the hernia surgery?
Before surgery, you will meet the anesthesiologist. Inguinal hernia surgery is typically done under a general anesthetic although a regional anesthetic can be used. Your child will be asleep during the procedure.
As soon as your child wakes up after surgery, someone from the recovery room will call you and you will be able to be with your child again.
Your child may have some pain where the incisions were made. Some surgeons inject medicine at that area to control pain or an anesthesiologist may inject medicine in the lower back (“caudal block”). Your child may also be given pain medicine to take at home.
When can we go home?
Typically, hernia repair surgery is an outpatient or “same day” surgery―meaning your child gets to go home a few hours after recovery. However, if your child has a medical condition or is a premature infant, an overnight stay may be required for observation and safety.
When it is safe for your child to go home you will review at-home care with your nurse or doctor.
How do I care for my child at home?
Home-care instructions can be different depending on the hospital or surgeon, age of the child, and how complex the surgery was. However, some general principles may be similar:
Most children can eat a regular diet right after surgery.
Recovery time depends on the child. Most can go back to normal, non-strenuous activities in about 1-2 weeks.
Your child will be restricted from bathing for 2-3 days post-surgery. Your surgeon may give you different or more specific instructions.
When should I call the doctor’s office?
You will receive specific instructions for follow-up with the surgeon when your child goes home after surgery, however, here are some key reasons to call:
Bleeding or drainage from the incision
Redness around the wound(s)
Fever above 101 F
Vomiting
Less peeing than usual or fewer wet diapers than usual
What problems might my child have as a result of having an inguinal hernia?
Having an inguinal hernia in one groin may increase the chance of a hernia on the other side. The surgeon will talk to you about how to care for this possibility.
After an inguinal hernia repair, most children do not have problems with this again. But rarely, a hernia can come back, and a surgeon will need to see your child again.
My baby vomits a lot. Is this a sign of a problem?
Because many common childhood illnesses can cause vomiting, you should expect your child to have this problem several times during these early years. Usually it ends quickly without treatment, but this doesn’t make it any easier for you to watch. That feeling of helplessness combined with the fear that something serious might be wrong and the desire to do something to make it better may make you tense and anxious. To help put your mind at ease, learn as much as you can about the causes of vomiting and what you can do to treat your child when it occurs.
Vomiting vs Spitting Up
First of all, there’s a difference between real vomiting and just spitting up. Vomiting is the forceful throwing up of stomach contents through the mouth. Spitting up (most commonly seen in infants under one year of age) is the easy flow of stomach contents out of the mouth, frequently with a burp.
Vomiting occurs when the abdominal muscles and diaphragm contract vigorously while the stomach is relaxed. This reflex action is triggered by the “vomiting center” in the brain after it has been stimulated by:
Nerves from the stomach and intestine when the gastrointestinal tract is either irritated or swollen by an infection or blockage
Chemicals in the blood (e.g., drugs)
Psychological stimuli from disturbing sights or smells
Stimuli from the middle ear (as in vomiting caused by motion sickness)
Causes of Vomiting
The common causes of spitting up or vomiting vary according to age. During the first few months, for instance, most infants will spit up small amounts of formula or breastmilk, usually within the first hour after being fed. This “cheesing,” as it is often called, is simply the occasional movement of food from the stomach, through the tube (esophagus) leading to it, and out of the mouth. It will occur less often if a child is burped frequently and if active play is limited right after meals. This spitting up tends to decrease as the baby becomes older, but may persist in a mild form until ten to twelve months of age. Spitting up is not serious and doesn’t interfere with normal weight gain.
Occasional vomiting may occur during the first month. If it appears repeatedly or is unusually forceful, call your pediatrician. It may be just a mild feeding difficulty, but it also could be a sign of something more serious.
Persistent Vomiting
Between two weeks and four months of age, persistent forceful vomiting may be caused by a thickening of the muscle at the stomach exit. Known as hypertrophic pyloric stenosis, this thickening prevents food from passing into the intestines. It requires immediate medical attention. Surgery usually is required to open the narrowed area. The important sign of this condition is forceful vomiting occurring approximately fifteen to thirty minutes or less after every feeding. Anytime you notice this, call your pediatrician as soon as possible.
GERD
Occasionally the spitting up in the first few weeks to months of life gets worse instead of better—that is, even though it’s not forceful, it occurs all the time. This happens when the muscles at the lower end of the esophagus become overly relaxed and allow the stomach contents to back up. This condition is known as gastroesophageal reflux disease, or GERD. This condition usually can be controlled by doing the following:
Thicken the milk with small amounts of baby cereal as directed by your pediatrician.
Avoid overfeeding or give smaller feeds more frequently.
Burp the baby frequently.
Leave the infant in a safe, quiet, upright position for at least thirty minutes following feeding.
If these steps are not successful, your pediatrician may refer you to a gastrointestinal (GI) specialist.
Infection
After the first few months of life, the most common cause of vomiting is a stomach or intestinal infection. Viruses are by far the most frequent infecting agents, but occasionally bacteria and even parasites may be the cause. The infection also may produce fever, diarrhea, and sometimes nausea and abdominal pain. The infection is usually contagious; if your child has it, chances are good that some of her playmates also will be affected.
Rotaviruses are a leading cause of vomiting in infants and young children, with symptoms often progressing to diarrhea and fever. These viruses are very contagious, but are becoming less common than in the past, due to the availability of a vaccine that can prevent the disease. The rotavirus is one of the viral causes of gastroenteritis, but other types of viruses—such as noroviruses, enteroviruses, and adenoviruses—can cause it as well.
Occasionally infections outside the gastrointestinal tract will cause vomiting. These include infections of the respiratory system, infections of the urinary tract otitis media, meningitis , and appendicitis. Some of these conditions require immediate medical treatment, so be alert for the following trouble signs, whatever your child’s age, and call your pediatrician if they occur.
Blood or bile (a green-colored material) in the vomit
Severe abdominal pain
Strenuous, repeated vomiting
Swollen or enlarged abdomen
Lethargy or severe irritability
Convulsions
Signs or symptoms of dehydration, including dry mouth, absent tears, depression of the “soft spot”, and decreased urination
After a baby’s feeding, many new parents quickly learn, some of what goes down often comes back up. While occasional dribbles of spit-up after meals is common in infants and usually harmless, true vomiting is more concerning.
In some babies, frequent projectile vomiting can be a symptom of a condition called hypertrophic pyloric stenosis (HPS); it occurs in 1 out of every 500 or so babies.
What is pyloric stenosis?
Pyloric stenosis is a narrowing of the pylorus―a muscular valve at the bottom of the stomach. When it becomes too think (hypertrophied), breastmilk or formula can’t get through to the small intestines. This leads to excessive, projectile vomiting.
Symptoms of pyloric stenosis:
Infants with pyloric stenosis have a hard time keeping anything down after feedings―usually starting between 2 and 8 weeks of age.
Signs your baby may have hypertrophic pyloric stenosis: Vomiting after every feeding or only after some feedings. Because breastmilk or formula is blocked from passing through the stomach, the baby throws up—sometimes forcefully enough to launch their stomach contents several feet away! The vomiting may gradually get worse as the pylorus muscle thickens.Hungry all the time. Babies with pyloric stenosis may be hungry still (or again) after vomiting. It may seem like they are always hungry.Tummy tightening. After feedings, you may notice waves of contractions ripple across the top of your baby’s abdomen, from left to right, as the stomach tries to push food through the pylorus.Constipation. Because pyloric stenosis prevents what babies eat from reaching the intestines, they may become constipated.Dehydration and weight loss. Babies with pyloric stenosis do not get enough fluids and nutrients from feedings and may become dangerously dehydrated. They may have trouble gaining weight as they grow, or even lose weight.Be sure to talk with your pediatrician right away if your baby is vomiting a lot.
How is pyloric stenosis diagnosed?
Your doctor may diagnose pyloric stenosis by examining your baby’s tummy to feel the thick pylorus muscle―an olive-shaped mass in the upper belly, which is the abnormal pylorus. Imaging tests may be ordered to confirm the diagnosis:
Ultrasound can be used to take a picture of the pylorus, which will be thicker and longer than normal. An ultrasound can also show when milk or formula does not pass out of the stomach into the small intestine.
Upper gastrointestinal contrast study (or “upper GI”), an X-ray test, is sometimes done. In an upper GI, your baby drinks a liquid that lights up on X-ray. As with ultrasound, if your baby has pyloric stenosis, the upper GI will show only a very small amount of liquid passing through the pylorus.
Are some babies more likely to get diagnosed with pyloric stenosis than others?
The cause of pyloric stenosis is unknown, but researchers point to possible risk factors:
Gender. The condition is four times more common in boys than in girls.
Race. Caucasian babies are more likely to develop pyloric stenosis than other races.
Family history. Sometimes, pyloric stenosis runs in families. Siblings of children with the condition carry a 30 times greater risk than the general population.
Early antibiotic use. Babies given certain antibiotics in the first weeks of life—erythromycin to treat whooping cough, for example—have an increased risk of developing pyloric stenosis. Additionally, babies born to mothers who took certain antibiotics late in pregnancy may have an increased risk of developing the condition.
Smoking during pregnancy. Babies whose mothers smoked can have nearly double the risk of developing pyloric stenosis.
Hernias. Although most infants with pyloric stenosis are otherwise healthy, the condition is seen more often in infants born with inguinal hernias.
Bottle-feeding. Some studies suggest that bottle-feeding can raise the risk of pyloric stenosis. But it is not clear whether any rise in risk is related to formula or bottle-feeding itself.
Treatment for pyloric stenosis:
After your baby is diagnosed with pyloric stenosis, he or she will be fed through intravenous (IV) fluids rather than by mouth to stop the vomiting and replace needed nutrients. To cure the condition, the treatment of choice for pyloric stenosis is a surgery called a “pyloromyotomy.”
A pyloromyotomy is a safe procedure for most babies without other complicating medical conditions. (For babies with conditions that prevent surgery, a medication called atropine sulfate has been shown to help in some cases.)
Before surgery: Prior to surgery, blood tests will be checked to make sure your baby’s fluid and electrolyte levels are where they need to be.
During surgery: The thick pylorus muscle is cut which opens the muscle and allows food to pass out of the stomach. Just the muscle itself is cut, not the inner lining of the stomach. The surgery can be done one of two ways:
Laparoscopic pyloromyotomy: Three small incisions are made, and a camera is used to look in your baby’s tummy. Small tools are used to cut the pylorus.
Open pyloromyotomy: An incision is made on the right side of your baby’s tummy or around the belly button. The surgeon then cuts the pylorus.
Surgery risks and outcomes: As with any surgery, there are risk of complications from anesthesia, bleeding, infection, or damage to other organs. Sometimes, the inner lining of the pylorus may be cut. If this happens, it will be fixed. If the pylorus muscle is still too narrow, another surgery may be needed to cut it more. However, complications are rare. There usually are no long-term problems after a successful surgery.
What to expect after your baby’s pyloromyotomy surgery:
After surgery, your baby will be allowed to eat by mouth. Infants should be given breast milk or formula every 3 to 4 hours, starting around 4 to 6 hours after the surgery. Your surgeon will discuss the feeding plan with you after surgery. Know your baby may still have some vomiting, but it usually gets better after a few feedings.
Most babies can go home from the hospital within one day after surgery. However, some may stay longer if they are not eating well. After leaving the hospital, your baby can go back to all normal activities, including tummy time.
Once home, be sure you:
Know how to care for your baby’s wound. Keep surgical cuts on your baby’s tummy clean and dry for 3 days. Afterwards, the wounds may be washed with soap and water but not soaked for about 7 days after surgery. Most of the time, the stitches used in children are absorbable and don’t need to be taken out. After 3 days, your baby can go back to usual bath routines.
Give medicines as directed―including infant acetaminophen if your baby seems uncomfortable.
Make any needed follow-up appointments. Your baby’s surgeon and pediatrician will want to make sure your baby is eating well, gaining weight, and recovering fully.
Be sure to call the doctor if:
Your baby gets a fever; this could be a sign of a post-op infection. In infants, a fever means a rectal temperature reading of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or an oral reading of 99 degrees Fahrenheit (37.2 degrees Celsius) or above.
You’re concerned about the incision―especially if the cuts on your baby’s tummy and the skin around them become red, bleed, or start to have yellow or green discharge (see Staphylococcal Infections).
Your baby is vomiting often or after most meals.
Your baby’s belly appears to be swelling.
Your baby is not wetting as many diapers as usual.
Remember:
Pyloric stenosis is the most frequent surgical condition in infants in the first few months of life. It is important to diagnose pyloric stenosis early, before a baby becomes dehydrated or malnourished. With prompt treatment, babies will soon be able to keep down what they eat so they can grow and thrive.
When children have hepatitis, it means that they have an “inflammation of the liver.” Hepatitis often is caused by a virus. In the United States, the most common viruses that cause it are hepatitis A, hepatitis B and hepatitis C. Other viruses can cause hepatitis. Medications, toxins, alcohol use, drugs and other medical problems can cause hepatitis, too.
Here’s what parents should know about types of hepatitis, causes, symptoms and how hepatitis is treated.
What to know about the hepatitis outbreak in kids
Recently, there have been reports of severe hepatitis (inflammation of the liver) among children that may be associated with a common type of virus called adenovirus. Children in several U.S. states and other countries have been affected. These cases are very rare. Parents should ask their pediatrician if they are concerned about their child’s symptoms.
Acute & chronic hepatitis: what’s the difference?
Acute hepatitis occurs in a previously healthy child, without preexisting liver injury.Leading causes of acute hepatitis in children are due to medications and infections.
Chronic hepatitis occurs in children with underlying liver disease.Children may have signs of advanced liver disease such as cirrhosis, bleeding, fluid build-up and poor weight gain.
Common causes of acute hepatitis
Virus
How it spreads
Time between exposure and symptom onset
Prognosis
Is there a vaccine available?
Hepatitis A
Contaminated food/drinking water
15-40 days
Full recovery is expected
Yes
Hepatitis B
Blood, needles, sexual activity
50-180 days
90% of newborns develop chronic infection.10% of older children develop chronic infection
Yes
Hepatitis C
Blood, needles
2-6 months
70-80% of acute infections become chronicNew drugs are effective at curing the virus in 95%-98% of children.
No
Hepatitis D
Blood, needles, sexual activity
Unclear, since it is a co-infection with hepatitis B
Rare in the U.S.Makes hepatitis B infection worse
No
Hepatitis E
Contaminated food/water
5-60 days
Rare in the U.S.Full recovery is expected, but infection may be severe for pregnant people
No
Epstein Barr Virus (EBV)
Contact with bodily fluids, especially saliva
Weeks-months
Common infection that causes mononucleosis (also called mono or the kissing disease)Can cause hepatitis in rare casesFull recovery expected
No
Cytomegalovirus (CMV)
Contact with body secretions
Weeks-months
Very common, over 50% of adults aged 40 have had the virus, which sometimes causes hepatitis Full recovery expected
No
Adenovirus
Droplets the air (e.g., coughing or sneezing); contaminated bodies of water – like swimming pools and lakes
Days-weeks
Common infection, that causes hepatitis in rare casesFull recovery expected
No
Signs and symptoms of acute hepatitis in children include:
Dark urine
Light colored stools (pale)
Itchy skin
Yellow skin or eyes (jaundice)
Fatigue
Fever >100.4°F
Nausea or vomiting
Abdominal pain
Loss of appetite
Joint pain
Children may also be symptom free. If you are concerned that your child has any of these symptoms or your child has known contact with someone with active viral hepatitis, call your pediatrician.
To diagnose acute hepatitis, your pediatrician may order blood work to check for hepatitis. If the test shows that they have hepatitis, your child may need more blood tests and an abdominal ultrasound.
What is the treatment for hepatitis?
Treatment depends on the underlying cause of hepatitis. If your child has hepatitis from an infection, treatment generally is supportive: rest, staying well-hydrated and supporting their immune system so it can recover from the virus. Talk with your pediatrician before giving your over-the-counter medicine for pain or fever because medicines like acetaminophen (Tylenol) may cause problems. . If hepatitis is caused by a medication, then talk to your pediatrician about stopping that medication. Rarely, if liver inflammation is severe, it can cause liver failure which may require a liver transplant.
What are the long-term effects of hepatitis?
Most children with hepatitis due to viruses or medications recover fully. Although uncommon, chronic hepatitis can occur with hepatitis B or C infections, or if due to an underlying disease and the child will need to be monitored by a doctor.
How do I prevent hepatitis?
There are vaccines to protect children from two of the common virus types: hepatitis A and hepatitis B.
The hepatitis B vaccine (3-dose series) is given to infants at birth and twice again over the next several months. The Hepatitis B vaccine also protects against Hepatitis D, as you cannot develop hepatitis D unless a hepatitis B infection is present.
The hepatitis A vaccine (2-dose series) is recommended for infants once they are 12 months old. The hepatitis A vaccine is especially important because there are areas of the country with high hepatitis A infection rates and for anyone traveling to areas where it spreads.
Here are other ways to prevent or avoid hepatitis:
While eating and drinking: Wash hands with soap and clean water for at least 20 seconds when preparing food and drinks. Hepatitis spreads through food, making frequent hand washing during meal preparation especially important for children and caregivers. Don’t share utensils or food, and avoid contaminated food and water.
At daycare: Check that your child’s daycare center practices good hand washing, especially with diaper changes and food preparation.
Before traveling to other countries: Ask your pediatrician about the risk of hepatitis and what precautions to take. In some instances, your pediatrician may recommend a hepatitis A vaccine before traveling.
At home: Keep medications locked and out of reach from children, and always check the label and dosing instructions before giving medicine to your infant or child.
If your new baby has only rare bowel movements, his stools are hard, and his abdomen appears bloated, your pediatrician will examine him to determine whether retained stool is swelling the abdomen while the rectum is empty. This group of symptoms can indicate Hirschsprung disease, a rare condition in which the baby lacks the nerves needed for having bowel movements.
Hirschsprung disease is treated with surgery. Left untreated, it can lead to life-threatening complications, so be sure to bring early constipation that occurs just after birth or in early infancy to your pediatrician’s attention.
Hepatitis C virus (Hep C or HVC) is a virus that can cause liver disease. Although most children and adolescents recover from the initial phase of HCV infection, 60-80% of them may develop signs of chronic liver infection. This can lead to much more serious liver problems and possibly death. Hepatitis C virus is the cause of approximately 10,000 deaths each year in the United States.
Symptoms of HCV infection
Infection with HCV is usually causes no symptoms in infants and children. For children and adolescents, it may begin as nothing more than a mild flu-like illness. Some people may experience one or more of the following:
Flu-like symptoms (body aches, fever, diarrhea, or nausea)
Extreme tiredness
Lack of appetite or weight loss
Dark yellow urine
Light, clay-colored bowel movements
Stomach pain, especially in the upper right side of the abdomen
Jaundice (a yellowing of the eyes and skin)
Infants with HCV infection also may have an enlarged liver or spleen, grow more slowly, or fail to gain weight.
If your child has some of the symptoms of HCV infection, or if your child has been exposed to anyone with HCV, contact your pediatrician. To diagnose HCV infection, your pediatrician will examine your child and test your child’s blood for the virus.
How HCV is spread
Hepatitis C virus cannot be spread by touching, hugging, or kissing. So, children with HCV infection can participate in all normal childhood activities and should not be excluded from child care centers or schools. However, because it can be spread through contact with blood, parents of children with HCV infection should make sure household items such as toothbrushes, razors, nail clippers, or other items that may contain small amounts of blood, are not shared.
Most infants acquire hepatitis C at birth from a mother who has hepatitis C. The risk is about 1 in 20 for an infant born to a mother with hepatitis C.
Hepatitis C virus can be spread through sexual contact. Infected teens and young adults should be strongly advised to avoid having sex. If they are going to have sex, they need to use latex condoms to prevent the spread of HCV. Hepatitis C can also be spread through sharing needles. Drinking alcohol also should be avoided by anyone with HCV infection because alcohol can speed up liver damage.
Long-term effects of HCV infection
In some children, HCV infection can lead to persistent liver disease that can lead to cirrhosis or advanced scarring of the liver. Cirrhosis occurs when the liver cells die and are replaced by scar tissue and fat. The liver eventually stops working and can no longer remove wastes from the body. Children and adolescents who develop cirrhosis of the liver because of chronic HCV infection may require a liver transplant to survive. Children infected with HCV also are at risk for developing other serious liver diseases, including liver cancer.
Current treatments are very effective
While at the present time there is no vaccine to prevent hepatitis C, there are very effective treatments available. Recent medical advances have resulted in the approval of several new drugs for HCV infection for children 3 years old and up that can cure the virus in 95-98% of children and adolescents.
Most people, including doctors, used to believe that ulcers (sores) in the stomach or duodenum (the first section of the small intestine) were caused by stress, alcohol, or spicy foods. Now we know that this isn’t the case. In fact, these ulcers, called peptic ulcers, are most often (although not always) caused by bacteria—specifically, an organism called Helicobacter pylori.
H pylori infections occur at a low rate in children in the United States, but may infect more than 75% of children in developing countries. Although infections increase in frequency as people get older, most children and adults with H pylori will never develop an infection. No one is certain how H pylori is contracted, but person-to-person contact could play a role, as could transmission through contaminated food and water. The incubation period is also unknown.
Signs and Symptoms
When H pylori causes an ulcer, the intensity of the symptoms can vary. In some cases, there will be no symptoms at all. Ulcers can cause a burning or gnawing pain in the stomach that may come and go, often happening a few hours after eating, as well as during the night, and then actually subsiding while eating food and drinking water.
Other symptoms may include:
Bloating
Burping
Nausea and vomiting
Loss of appetite
Weight loss
Bloody vomit and dark stools from bleeding in the stomach or duodenum
What You Can Do
In the past, doctors treated peptic ulcers by recommending a bland diet as well as bed rest. But today, these lifestyle strategies appear to be inappropriate approaches to managing ulcers.
When to Call Your Pediatrician
Contact your pediatrician if your child
Has burning stomach pain that is worse between meals and in the early morning hours and feels better when he eats
Has persistent abdominal pain, vomiting, loss of appetite, or weight loss
Has bloody stools or bloody vomit
How Is the Diagnosis Made?
Your pediatrician will take a medical history of your child and may perform some simple tests. Your pediatrician may sometimes refer your child to a specialist to conduct the more complicated and invasive tests needed to make the diagnosis of an H pylori infection. These tests include analyzing a small piece of tissue (a biopsy) obtained through a device called an endoscope, which is threaded down the throat to the stomach. The tissue is then examined under the microscope and tested for evidence of H pylori infection. Your pediatrician can also look at the esophagus, stomach, and duodenum with x-ray film (an upper GI series). There are noninvasive tests that can determine whether bacteria are present by analyzing a child’s blood, stool, or breath. The breath test can detect carbon dioxide released by a product made by H pylori.
Treatment
Doctors only prescribe treatment for H pylori infections if they have progressed to an actual ulcer. Combinations of antibiotics such as amoxicillin, clarithromycin, and metronidazole can be taken by your child to kill the bacteria. Make sure he takes the full course of these antibiotics as directed by your pediatrician. They are usually prescribed in combination with drugs called proton pump inhibitors or histamine receptor blockers that interfere with the production of acid in the stomach.
What Is the Prognosis?
An H pylori infection increases the risk of developing stomach cancer later in life.
Prevention
There is no known way to prevent H pylori infections. However, a vaccine that could someday prevent the infection is currently being researched.
Giardiasis is the name doctors give to infections caused by a microscopic parasite called Giardia Intestinalis. This organism may be found in the stools of an infected person. It can be transmitted by person-to-person contact in places like child care centers and among family members who have not properly washed their hands after using the bathroom or changing diapers. Giardia may also be present in contaminated food and water and is a risk for campers drinking untreated water from mountain streams, which can be contaminated by stool from infected animals and campers.
Signs and Symptoms
Most children with a Giardia infection have no symptoms at all. A few have abdominal pain and watery, foul-smelling diarrhea that can lead to dehydration. They may also have excessive gas and bloating and could have a poor appetite, leading to weight loss. Fever is uncommon. Most often, symptoms begin 7 to 14 days after exposure to the Giardia parasite and can last, without treatment, for about 4 to 6 weeks.
How Is the Diagnosis Made?
A stool sample from your child will be examined for the presence of Giardia Intestinalis.
Treatment
To keep your child well hydrated, she should drink plenty of liquids recommended by your pediatrician, such as over-the-counter or homemade oral rehydrating solutions. Your doctor may also prescribe prescription medicines (most commonly, metronidazole, furazolidone, or nitazoxanide) that cure most cases after 5 to 7 days of treatment. If your child has Giardia organisms in the stool but does not have symptoms, no treatment is needed.
Prevention
When a child attends a child care center, parents should make sure the staff members practice good hygiene and encourage children to wash their hands frequently with soap and water.
Toys that a child puts in her mouth should be washed and disinfected before another youngster plays with them.
It is a good idea to wash and peel raw fruits and vegetables before they are eaten.
Children should avoid drinking untreated water from streams, lakes, rivers, and ponds.
Take bottled water on camping trips or boil, filter, and treat your drinking water with chemical tablets before drinking it.
