Category: Abdominal

All babies spit up— and it often seems like everything they just ate comes right back up!

So, how do you know if your spitty baby’s symptoms are normal or part of a larger problem?

To help you sort it all out, the American Academy of Pediatrics (AAP) answers common questions about typical digestive functioning and explains the differences between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD).

What are the differences between GER and GERD?

Without getting too technical, spit-up (also called reflux, gastroesophageal reflux, or GER) is the movement of stomach contents into the esophagus, and sometimes through the mouth and nose. When reflux is associated with other symptoms, or if it persists beyond infancy, it is considered a disease and is known as gastroesophageal reflux disease or GERD.

GER in infants is not considered a disease and does not include a “D.” In fact, GER is considered normal. These infants are known as “happy spitters,” because they are not cranky and do not appear to be in a great deal of pain when spitting up. In fact, your baby may feel better after a good spit-up. Other symptoms of GER include mild feeding problems, such as occasional prolonged feeds or interrupted feeds.

When is spit-up or GER normal?

GER usually begins at approximately 2 to 3 weeks of life and peaks between 4 to 5 months. Most babies who are born at full term will have complete resolution of symptoms by the time they are 9 to 12 months old.

In most babies, GER disappears as the upper digestive tract functionally matures. In addition, normal development, including improved head control and being able to sit up, as well as the introduction of solid food, will help improve GER symptoms.

What are the causes of GER?

If your baby’s stomach is full or his or her position is changed abruptly, especially after a feeding, the stomach contents—food mixed with stomach acid—press against the valve at the top of the stomach. This is called the lower esophageal sphincter. This ring of muscle normally relaxes to let food pass from the esophagus into the stomach and then tightens again to keep the food there. When it is not fully developed or it opens at the wrong time, the stomach contents move back or reflux into the esophagus.

In older children, diet can play more of a role. Large meals and highly acidic or spicy meals, as well as carbonated or caffeinated beverages, can lead to increased GER symptoms. In addition, GER is more common in children who are overweight or obese.

How do I know if my child has GERD?

Unlike GER, GERD is associated with complications from acid reflux. Call your pediatrician if your child exhibits any of the following signs or symptoms:

• Refusal to feed
• Crying and/or arching the back during feeds (i.e., seems to be in pain)
• Blood or greenish color in the spit-up
• Increase in frequency or intensity of the spit-up (i.e., forceful)
• Belly is swollen or distended or feels hard
• Respiratory symptoms—including wheezing and coughing

In addition, let your pediatrician know if you notice that your baby doesn’t seem to be gaining weight or is having fewer wet and dirty diapers, as these may be signs that not enough of what he or she eats is staying down.

How will my pediatrician evaluate my baby for GER?

The AAP believes it is important for all pediatric health care providers to be able to properly identify and treat children with reflux symptoms, and to distinguish GER from more worrisome disorders to avoid unnecessary costs and treatments.

Your child’s pediatrician will review your child’s symptoms and feeding patterns and assess your child’s growth by plotting his or her weight and height on a growth chart. This information will help them determine whether your child is a “happy spitter” or has symptoms of GERD.

How is GER or GERD treated?

While we wish we had a “quick fix” for babies who spit up, the truth is that for a good many spitty babies, it is mostly a matter of time. Lifestyle changes—including feeding and/or position changes—are recommended as first-line therapy for both GER and GERD. If GERD is severe, treatment may include medication or surgery. The surgery to correct reflux is called fundoplication.

• Treatment options during infancy:
  • Burp at natural pauses in feeding and keeping your child upright for up to thirty minutes after feeding. If your bottle-fed baby spits up unusually often, your pediatrician may recommend thickening his or her formula with a very small amount of baby cereal. Never add solids to the bottle unless your pediatrician advises it.
  • Consider smaller and more frequent feedings, but be sure your baby is taking in enough to keep up typical growth and development.
  • Consider keeping your baby in an upright position for the first half hour or so after feeding. Always closely supervise your baby during this time.
  • Regardless of whether or not your baby warrants watchful waiting or medical intervention, the AAP does have additional and simple feeding suggestions that can help you deal with the situation at hand.
• Treatment options for an older child:
  • Avoid fried and fatty foods; they slow down the rate of the stomach emptying and promote reflux.
  • Peppermint, caffeine, and certain asthma medications can make the lower esophageal sphincter relax and allow stomach contents to reflux back into the esophagus. Some experts believe that tomato-based products have a similar effect. If any food seems to produce reflux or heartburn, keep it out of the diet for a week or two and then reintroduce it. If symptoms reoccur, avoid that food until your pediatrician recommends to reintroduce it into the diet.
  • Sometimes your pediatrician may recommend medications that neutralize or decrease the acid in your child’s stomach to treat symptoms associated with GERD.

When might my pediatrician refer my child to a pediatric gastroenterologist?

Your pediatrician may refer your child to see a pediatric gastroenterologist, a pediatrician who has specialized training in problems of the gastrointestinal tract—including GERD—for a variety of reasons including:

• Poor weight gain
• Feeding problems
• No response to medical therapy

A pediatric gastroenterologist will review your child’s history, examine your child and review his or her diet history and growth charts. Sometimes, it can be helpful for a pediatric gastroenterologist to observe your child being fed or self-feeding. Based on the visit, he or she will decide whether your child may benefit from additional testing or from the addition of or a change in medications.

Roughly one in five adults have gallbladder disease. Gallbladder problems such as gallstones are less likely in children and teens, but are becoming more common. Here’s what parents need to know.

What is gallbladder disease?

The gallbladder is an organ located on the right side of the body, under the liver. The liver makes bile, a fluid that helps to digest food. The gallbladder stores the bile. When your child eats, the gallbladder releases bile through ducts that connect it to the intestine.​​

G​allbladder disease often happens when bile hardens and forms stones. It may be caused by or related to:​

• A high fat diet or obesity​
• Blood diseases such as sickle cell anemia, hereditary spherocytosis or Beta-thalassemia
• Other conditions such as Crohn’s disease and cerebral palsy
• A history of needing IV (intravenous) nutrition
• Certain medications, such as birth control pills

What problems can gallstones cause?

Children with gallstones may have:

• Pain from stones in the gallbladder (biliary colic)
• Infection of the gallbladder (cholecystitis)
• Stones in the ducts draining the gallbladder that can block the flow of bile (choledocholithiasis)
• Inflammation of the pancreas (pancreatitis)

What are some symptoms of gallstones in children?

Gallstones do not always cause symptoms. However, children with gallstones may have pain in the upper right or middle part of the belly, just below the rib cage. The pain may feel sharp, crampy or dull and spread to the back or right shoulder. It may come and go, getting worse after eating—especially foods high in fat.

If a gallstone blocks a duct, a child may also have:

• Nausea or vomiting
• Fever, chills, or sweats
• Jaundice, which causes the whites of the eyes or skin to turn yellow

Can children have gallbladder disease without gallstones?

Children sometimes have gallbladder problems that do not result in stones. These may include:

Acalculous cholecystitis. Children sometimes develop gallbladder inflammation without gallstones.

Biliary dyskinesia. With this condition, the gallbladder has trouble squeezing to release the bile. Usually, children with biliary dyskinesia have no stones in the gallbladder.

What tests will be done to diagnose gallbladder disease?

If doctors think your child is having gallbladder problems, they may ask for:

• Blood tests
• An ultrasound to look at the gallbladder
• A magnetic resonance cholangiopancreatography (MRCP) to get detailed images of the bile ducts
• A CT scan, usually if blood tests show inflammation or infection of the pancreas
• A cholescintigraphy or hepatobiliary (HIDA) scan to look for infection or biliary dyskinesia

Note: diagnostic tests such as a cholescintigraphy or HIDA scan can have limited accuracy for non-gallstone gallbladder disease.

What can be done to make my child better?

​Observation. Many parents and kids know what foods will cause gallbladder pain. These foods are often greasy foods or foods that have a lot of fat. Sometimes, pain can be made better by not eating these foods.

Medicine. There is currently no reliable medicine to make gallbladder disease go away.

Surgery. The only dependable way to fix gallbladder disease is to remove the gallbladder with surgery, a procedure called cholecystectomy​. Gallbladder surgery, is usually done laparoscopically, using a video camera and a few tiny cuts or incisions. Your surgeon may recommend a procedure called a cholangiogram if the stones seem to be stuck in the ducts that drain bile into the intestine. This is done during surgery by putting dye into the bile ducts and taking x-rays.

Sometimes there is too much infection around the gallbladder and it is not safe to do the surgery laparoscopically. If this happens, your surgeon may need to do the surgery with one bigger incision.

Remember

Regular visits with your child’s pediatrician can help avoid gallbladder problems by keeping health conditions that can make them more likely under control.​

​​​Each year, roughly 48 million people in the United States get food poisoning (also called foodborne illness). It happens when germs such as viruses, bacteria and parasites, or toxins (poisons) produced by them, get into foods we eat.

Foods can become contaminated with harmful microbes before you buy them, or at home if they aren’t handled or cooked properly. As a result, food poisoning can affect individual families, or may be part of larger outbreaks. Here’s what you should know.

Symptoms of food poisoning

The symptoms of food poisoning often seem like those from other intestinal illnesses: abdominal cramps, nausea, vomiting, diarrhea, and fever. But if your child and other people who have eaten the same food all have the same symptoms, the problem is more likely food poisoning.

Some of the germs and other sources of food poisoning include:

Salmonella

Salmonella bacteria (there are many types) are a major cause of food poisoning in the United States. The most commonly contaminated foods are raw meat (including chicken), raw or undercooked eggs, and unpasteurized milk. Fortunately, Salmonella are killed when food is cooked thoroughly. Symptoms caused by Salmonella infection usually start between six to 48 hours after eating, and may last for 7 days.
Infant formula alert: In February 2022, the U.S. Food & Drug Administration issued an alert about powdered infant formula​ that may be contaminated with Cronobacter and Salmonella bacteria.

Contact your pediatrician and get immediate medical care if your baby has symptoms of Cronobacter or Salmonella infection. These may include poor feeding, irritability, temperature​ changes, jaundice​, grunting breaths, abnormal movements, lethargy, rash or blood in the urine or stool.

To check if your powdered formula is part of the recall, enter the product lot code on the bottom of your package on the company’s website​.

E. coli

Escherichia coli (or E. coli) is a group of bacteria that normally live in the intestines of children and adults. A few strains of these bacteria can cause food-related illnesses. Undercooked ground beef is a common source of E. coli, although raw produce and contaminated water have caused some outbreaks.

Symptoms of an E. coli infection typically include diarrhea (which can range from mild to severe), abdominal pain, and in some cases nausea and vomiting. Some E. coli outbreaks have been severe and have even caused deaths in rare instances. The best treatment for an E. coli–related illness is to get plenty of rest and fluids. But if symptoms are more severe, talk with your pediatrician.

Staphylococcus aureus (Staph)
Staphylococcus aureus contamination is a leading cause of food poisoning. These bacteria ordinarily cause skin infections, such as pimples or boils. They can be transferred when foods when handled by someone who is infected. When food is not kept hot enough, staph bacteria multiply and produce a toxin that ordinary cooking will not destroy. The symptoms begin one to six hours after eating the contaminated food, and usually lasts about a day.

Clostridium perfringens

Clostridium perfringens (C. perfringens) is a type of bacteria often found in soil, sewage, and the intestines of humans and animals. It usually is transferred by someone handling food to the food itself, where it multiplies and produces its toxin. C. perfringens often is found in school cafeterias. This is because it thrives in food that is served in large amounts and left out for long periods at room temperature or on a steam table. Foods most often involved are cooked beef, poultry, gravy, fish, casseroles, stews, and bean burritos. The symptoms of this type of poisoning start six to 24 hours after eating, and can last from one to several days.

Shigellosis

Shigella infections, or shigellosis, are intestinal infections caused by one of many types of shigella bacteria. These bacteria can be transmitted through contaminated food and drinking water, as well as through poor hygiene in places such as child care centers. The germ invades the lining of the intestine, and can lead to symptoms such as diarrhea, fever, and cramps. Shigellosis and its symptoms usually start one to three days after exposure, and get better two to three days after the start of symptoms. In the meantime, your child should consume extra fluids. Your pediatrician may also recommend a rehydrating solution. In severe cases, your doctor may prescribe antibiotics, which can shorten the length and intensity of the infection.

Campylobacter

Campylobacter is a type of bacteria that can often found in raw or undercooked chicken, unpasteurized milk or contaminated water. Children with Campylobacter typically have symptoms such as watery (and sometimes bloody) diarrhea, cramps, and fever, about two to five days after consuming contaminated food. To diagnose this infection, your doctor will need a stool sample for laboratory testing. Campylobacter infection usually runs its course without formal treatment, other than making sure that your child drinks plenty of fluids to replace those lost from diarrhea. When symptoms are severe, however, your pediatrician may prescribe antibiotics. In most cases, your child will be back to normal in about two to five days.

Botulism

This is the rare but serious food poisoning caused by Clostridium botulinum. These bacteria normally can be found in soil and water. However, they don’t often cause illness because they need very special conditions in order to multiply and produce poison. Clostridium botulinum grows best without oxygen and in certain chemical conditions. This is why improperly canned food is most often contaminated, especially low-acid vegetables such as green beans, corn, beets and peas.Honey also can be contaminated with Clostridium botulinum and cause severe illness, particularly in children under one year of age. That is why honey should never be given to an infant before their first birthday.

Botulism attacks the nervous system and causes double vision, droopy eyelids, decreased muscle tone, and difficulty in swallowing and breathing. It also can cause vomiting, diarrhea, and abdominal pain. The symptoms usually develop within 12 to 48 hours and can last weeks to months. In infants, the incubation period may be longer. Without treatment, botulism can be fatal. Even with treatment, it can cause nerve damage.

Cryptosporidiosis

In very uncommon situations, watery diarrhea, low-grade fever, and abdominal pain may be caused by an infection known as cryptosporidium. This infection is of special concern in children who do not have a normal immune system.

Other sources of food poisoning

Food poisoning may also be caused by poisonous mushrooms, contaminated fish products, and foods with special seasonings. Young children do not care for most of these foods and so will eat very little of them. However, it still is very important to be aware of the risk. If your child has unusual gastrointestinal symptoms, and there is any chance she might have eaten contaminated or poisonous foods, call your pediatrician.

Treatment for food poisoning

Most children with food-borne illnesses will get better on their own after a brief break from eating and drinking. Infants can tolerate three to four hours without food or liquids; older children, six to eight. If your child is still vomiting or her diarrhea has not decreased significantly during this time, be sure to call your pediatrician. Also notify the doctor if your child:

• Shows signs of dehydration
• Has bloody diarrhea
• Has diarrhea with high fever (over 102°F)
• Has continuous diarrhea with a large volume of water in the stool, or diarrhea alternating with constipation
• May have been poisoned by mushrooms
• Suddenly becomes weak, numb, confused, or restless, and feels tingling, acts drunkenly, or has hallucinations or difficulty breathing

Treatment depends on your child’s condition and the type of food poisoning. Tell the doctor the symptoms your child is having, what foods she has eaten recently, and where they got them. If your child is dehydrated, fluid replacement is key. Sometimes antibiotics are helpful, but only if the specific bacteria are known. Antihistamines help if the illness is from an allergic reaction to a food, toxin, or seasoning. If your child has botulism, they will need hospitalization and intensive care.

Remember

Fortunately, food contamination and food poisoning can be prevented with some basic guidelines. (See “Food-Borne Illness Prevention.”) Talk with your pediatrician if you have any concerns about food poisoning, what to do if you notice symptoms, and ways to prevent food-borne illness.

For vomiting children, the main risk is water loss, or dehydration, especially if fever causes them to sweat more or they are also losing fluid through diarrhea. When vomiting is severe or prolonged, a child may lose sodium, potassium, and chloride. These minerals have a crucial role in the transmission of nerve impulses and the contraction of muscles, and in regulating the body’s fluid balance.

While missing a meal or two will cause no harm to an otherwise healthy child, it’s important that a sick child continue to drink water to take care of normal daily needs, plus extra to make up for fluid loss and prevent dehydration. Young children are especially susceptible to dehydration because they are less efficient at conserving water than older children and adults. In addition, small body size means that it takes less fluid loss to lead to dehydration.

Offer frequent sips of water or, if your child doesn’t feel like drinking, ice chips to suck on. Build up to 1 oz an hour, then 2 oz an hour until the child is able to drink normally.

Your pediatrician may recommend a commercial rehydration solution to help replace lost sodium and potassium in a young child. These come in liquid and Popsicle-like forms to make them more appealing to children. It also makes certain that the liquid is taken slowly. Older children may ask for commercial sports drinks, but these should be used with care. They replace salts, but they also contain large amounts of sugar, which can make diarrhea worse. A child who wants a change from plain water may enjoy sips of fruit juice diluted half-and-half with water or flat soda. If your child is too sick to drink or listless, or shows signs of progressive dehydration such as dry mouth, fewer tears, or urinates less frequently, seek urgent medical attention. Contact your pediatrician immediately.

When children suddenly get loose, watery and more frequent bowel movements, they have diarrhea. Diarrhea is a common symptom of illness in young children. In the United States, children younger than 4 years may have diarrhea 1 or 2 times each year.

Here are some questions you may have if your child has diarrhea, tips to help manage it, and when to call the doctor.

What’s the best way to treat or manage diarrhea?

• Mild diarrhea without vomiting. Diarrhea often goes away in a couple of days on its own. Most children with mild diarrhea do not need to change their diet and electrolyte solutions are usually not needed. You can keep giving human (breast) milk, formula, or cow’s milk. However, if your child seems bloated or gassy after drinking formula or cow’s milk, ask your child’s doctor if these should be avoided.
• Mild diarrhea with vomiting. Children who have diarrhea and are vomiting will need to stop their usual diets. Electrolyte solutions should be given in small amounts, often until the vomiting stops. In most cases, they’re needed for only 1 to 2 days. Once the vomiting has lessened, slowly return to your child’s usual diet. Some children are not able to tolerate cow’s milk when they have diarrhea and it may briefly be removed from the diet by your child’s doctor. Breastfeeding should continue.
• Severe diarrhea. Call your child’s doctor for severe diarrhea. Children who have a watery bowel movement every 1 to 2 hours, or more often, and signs of dehydration may need to stop eating for a short period (such as 1 day or less) to focus on drinking to replenish fluid lost in those stools. They need to avoid liquids that are high in sugar, high in salt, or very low in salt (ie, water and tea). For severe dehydration, children may need to be given fluids through the vein (IV) in the emergency department.

Diarrhea and dehydration

Children with viral diarrhea have a fever and may vomit. Soon after these symptoms appear, children get diarrhea. The most important part of treating diarrhea is to prevent your child from becoming dehydrated.

Call your child’s doctor right away if your child shows any signs and symptoms of dehydration.

Also, call your pediatrician if your child has diarrhea and:

• Fever that lasts longer than 24 to 48 hours
• Bloody stools
• Vomiting that lasts more than 12 to 24 hours
• Vomit that looks green, tinged with blood, or like coffee grounds
• Abdomen (stomach, belly) that looks swollen
• Will not eat or drink
• Severe abdominal (stomach, belly) pain
• Rash or jaundice (yellow color of skin and eyes)

Does my child need electrolyte solutions?

Most children with mild diarrhea do not need electrolyte solutions. Electrolyte solutions are very helpful for the home management of moderately severe diarrhea.

Electrolyte solutions are special fluids that have been designed to replace water and salts lost during diarrhea. Soft drinks (soda, pop), soups, juices, sports drinks, and boiled milk have the wrong amounts of sugar and salt and may make your child sicker.Do not try to prepare your own electrolyte solutions at home. Use only commercially available fluids—store brand and name brand work the same. Your child’s doctor or pharmacist can tell you what products are available.

Should my child with diarrhea fast (not eat)?

Fasting is not a treatment for diarrhea. However, some children may benefit from reducing their intake of solid food if they are vomiting. It is appropriate to continue to offer small amounts of fluids, particularly electrolyte solutions, in these cases. As children recover, it is fine to let them eat as much or as little of their usual diet as they want.

Does the BRAT diet help?

The bananas, rice, applesauce, toast (BRAT) diet, once recommended while recovering from diarrhea, is no longer considered useful. Because BRAT diet foods are low in fiber, protein, and fat, the diet lacks enough nutrition to help a child’s gastrointestinal tract recover. Some pediatricians believe that it may actually make symptoms last longer. Ideally, children can resume eating a normal, well-balanced diet appropriate for their age within 24 hours of getting sick. That diet should include a mix of fruits, vegetables, meat, yogurt, and complex carbohydrates.

What about antidiarrheal medicines?

Over-the-counter antidiarrheal medicines are not recommended for children younger than 2 years. They can also be harmful in older children. Always check with your child’s doctor before giving your child any medicine for diarrhea.

Also, do not give your child homemade remedies. Some may not be effective and some may actually make things worse.

Do probiotics help diarrhea?

Probiotics are types of “good” bacteria that live in the intestines. They may have beneficial health effects with regard to diarrhea, although more studies are needed.

How can I reduce my child’s risk of diarrhea?

Most diarrhea in children is caused by viruses. Diarrhea can also be caused by bacteria, parasites, changes in diet (such as drinking too much fruit juice), problems with the intestines (such as allergy to foods), and the use of some medicines. Here are some ways to help prevent diarrhea:

• Stop germs from spreading. Wash hands frequently with soap or using a hand sanitizer. Try to keep your child away from children who have diarrhea or are vomiting.
• Do not give your child raw (unpasteurized) milk or foods that may be contaminated.
• Avoid medicines, especially antibiotics, if they are not needed.
• Breastfeed your baby. Breast milk has many substances that formulas don’t have that help protect your baby from many diseases and infections.The American Academy of Pediatrics recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. When you add solid foods to your baby’s diet, continue breastfeeding until at least 12 months. You can continue to breastfeed after 12 months if you and your baby desire.
• Limit the amount of juice and sweetened drinks.
• Make sure your child has received the rotavirus vaccine.The rotavirus vaccine protects against the most common cause of diarrhea and vomiting in infants and young children.

Constipation is a common problem in children. Children with constipation have stools (also called poops or bowel movements—BMs) that are hard, dry, and difficult or painful to get out. Some children with constipation have infrequent stools. Although constipation can cause discomfort and pain, it’s usually temporary. If left untreated, symptoms could get worse.

Read on for more information about constipation (signs and symptoms, causes, treatment) and how to help your child develop good bowel habits.

What is a normal bowel pattern?

Bowel patterns (when and how often stools are passed) vary from child to child just as they do in adults. What’s normal for your child may be different from what’s normal for another child. Most children have BMs 1 or 2 times a day. Other children may have BMs every 2 to 3 days.

What are signs and symptoms of constipation?

Signs and symptoms of constipation may include

• Hard or painful stools
• Many days between BMs​
• Bleeding from the child’s bottom where stool comes out
• Stomachaches, cramping, and nausea
• Soiling (brownish wet spots in the underwear) (See “What is encopresis?” below.)

Your child may also

• Have BMs that stop up the toilet.
• Make faces while they pass a BM, as if they are in pain.
• Clench their bottom when having a BM. Although this behavior may look like your child is trying to push the stool out, they may be really trying to hold it in because it hurts to come out.

Call or schedule a visit with your child’s doctor if your child doesn’t have a BM at least every 2 to 3 days or if passing a stool hurts your child.

What is encopresis?

Sometimes a child with bad constipation may pass BMs that look like diarrhea. When a child holds back stools, the stools build up and get bigger. They may get so big that the rectum stretches. Then the child may not feel the urge to go to the bathroom. The stool gets too big to pass without an enema, laxative, or other treatment.

Sometimes only liquid stool or solid smears can come out, and they leak onto the underwear. This is called encopresis. Talk with your child’s doctor about treatment. It can get better, but it takes months.

What causes constipation?

Here are some causes of constipation.

• Holding back, or withholding, stool.
  • Your child may not want to have a BM for different reasons.
  • Your child may try not to go because it hurts to pass a hard stool. (Diaper rashes can make this worse.)
  • Children aged 2 to 5 years may want to show they can decide things for themselves. Holding back their stools may be their way of taking control. This is why it is best not to push children into toilet training.
  • Sometimes children don’t want to stop playing to go to the bathroom.
  • Older children may hold back their stools when away from home (such as camp or school). They may be afraid of or not like using public toilets.
• Illness. If your child is sick and loses his appetite, a change in his diet can throw off his system and cause him to be constipated. Constipation may be a side effect of some medicines or may result from certain medical conditions, such as hypothyroidism (underactive thyroid gland).
• Diet. Not enough fiber or liquid in your child’s diet doesn’t cause constipation. However, not consuming enough of the recommended amounts of healthy foods from the 5 food groups, including foods that are good sources of fiber, may affect your child’s bowel patterns. (See the How much fiber does my child need? section.)
• Other changes. In general, any changes in your child’s routine, such as traveling, hot weather, or stressful situations, may affect his overall health and how his bowels function.

How is constipation treated?

Treatment is based on your child’s age and how bad the problem is. Usually no special tests are needed.

Constipation can get worse if it isn’t treated. The longer stool stays inside the large intestine (or colon), the larger and drier it gets. Then it hurts to pass it. This starts a cycle. The child becomes afraid to have a BM and holds it in even more.

For babies

Constipation is not commonly a problem in babies. It may become a problem when starting solid foods, and your doctor may suggest changes in diet or prescribe a medicine to help soften and pass the stools. Inability to pass stools in a newborn (younger than 1 month) can be a serious concern, and you should see your baby’s doctor.

For children and teens

Your child’s doctor may prescribe medicine to soften or remove the stool. Do not give your child laxatives or enemas unless you check with the doctor. These drugs can be harmful to children if used wrong.
After the stool is removed, your child’s doctor may suggest ways you can help your child develop good bowel habits to prevent stools from backing up again.

How can I help my child develop good bowel habits?

Here are tips to help your child develop good bowel habits.

• Help your child set a toilet routine. Pick a regular time to remind your child to sit on the toilet daily (such as after breakfast). Put something under your child’s feet to press on. This makes it easier to push BMs out.
• Make sure your child is consuming the recommended amounts of healthy foods from the 5 food groups, including foods that are good sources of fiber.
• Encourage your child to play and be active.

How much fiber does my child need?

There are different fiber recommendations for children based on energy needs, age, and weight. A normal fiber intake is recommended in children with constipation. The following can be useful strategies:

• Eat 5! A simple way to make sure your child is getting enough fiber is by making healthful food choices. If your child is eating at least 5 servings of fruits and vegetables each day along with other foods that are good sources of fiber, there is really no need to count fiber grams.
• Add 5! If you find it helpful to keep track of total grams of fiber that your child is eating, add 5 to your child’s age. For example, a 5-year-old would need about 10 grams of fiber each day. (The total daily recommended amount of up to 25 grams for adults can be used as a general guideline for children.) Some foods are high in fiber. Beans, vegetables, fruits, and whole grains are good sources of fiber.

Remember

If you have any questions or concerns about your child’s health, contact your child’s doctor.

If the opening between the abdominal cavity and the scrotum has not closed properly and completely, abdominal fluid will pass into the sac around the testis, causing a mass called a communicating hydrocele. As many as half of all newborn boys have this problem; however, it usually disappears within one year without any treatment. Although most common in newborns, hydroceles also can develop later in childhood, most often with a hernia.

If your son has a hydrocele, he probably will not complain, but you or he will notice that one side of his scrotum is swollen. In an infant or young boy, this swelling decreases at night or when he is resting or lying down. When he gets more active or is crying, it increases, then subsides when he quiets again. Your pediatrician may make the final diagnosis by shining a bright light through the scrotum, to show the fluid surrounding the testicle. Your doctor also may request an ultrasound examination of the scrotum if it is very swollen or hard.

If your baby is born with a hydrocele, your pediatrician will examine it at each regular checkup until around one year of age. During this time your child should not feel any discomfort in the scrotum or the surrounding area. But if it seems to be tender in this area or he has unexplained discomfort, nausea, or vomiting, call the doctor at once. These are signs that a piece of intestine may have entered the scrotal area along with abdominal fluid. If this occurs and the intestine gets trapped in the scrotum, your child may require immediate surgery to release the trapped intestine and close the opening between the abdominal wall and the scrotum.

If the hydrocele persists beyond one year without causing pain, a similar surgical procedure may be recommended. In this operation, the excess fluid is removed and the opening into the abdominal cavity closed.

Clostridium difficile is a cause of diarrhea in children. It is also responsible for producing a serious form of colitis (inflammation of the colon) called pseudomembranous colitis. These infections are often contracted in the hospital while a child is receiving antibiotic treatment, although illness may develop days or weeks after leaving the hospital. These anaerobic bacteria are often found normally in the gut of newborns and young children. The disease is caused when the bacteria produce a toxin (poison) that damages the lining of the gut. This happens most often when your child is taking antibiotics that kill other bacteria in the gut, permitting C difficile to multiply to very high numbers. The incubation period for this illness is not known. The bacteria can live in the gut for long periods without causing illness.

Signs and Symptoms

C difficile causes diarrhea with stomach cramps or tenderness, fever, and blood and mucus in the stools.

How Is the Diagnosis Made?

To make a proper diagnosis, your child’s stool can be tested for the presence of toxins produced by C difficile.

Treatment

Because antibiotic use and overuse is associated with C difficile infections, children on antibiotics should be taken off these medicines as soon as possible. In mild cases, children may get better once they stop taking the antibiotics. Some children, however, may need to be given particular medicines such as metronidazole or vancomycin that fight the bacteria. Most children make a full recovery. If a relapse of the illness occurs, which happens in up to 10% to 20% of patients, the same treatment is often repeated.

Prevention

It may be possible to prevent or reduce the risk of C difficile disease through proper hand washing, as well as the proper handling of dirty diapers and other waste matter. Also, the use of antibiotics should be limited to only those circumstances in which it is absolutely necessary.

People are thinking about celiac disease and the possibility of a gluten intolerance more often now than they have in the past. About 30% of people living in the United States are following some form of a gluten-free diet—either by choice or due to a medical condition.

In this article, the American Academy of Pediatrics (AAP) answers common questions about celiac disease, gluten-related disorders, and following how children can follow a gluten-free diet.

What is celiac disease?

Celiac disease is a life-long condition affecting the small intestine. When a person with celiac disease eats, or is exposed to gluten (a protein found in food that contains rye, barley and wheat), his or her body destroys the intestinal villi—small, finger-like projections in the small intestine that absorb nutrients from food. Damage to the villi means that nutrients from food cannot be properly absorbed by the body and can lead to gastrointestinal symptoms, poor absorption of nutrients, and potentially to poor weight gain. No matter how much a person eats, he or she remains malnourished. When this happen to children, it can affect their growth and development. Once a child stops eating gluten, the villi heal and can absorb nutrients normally.

Who is at risk for celiac disease?

Approximately 35-40% of people carry one or both celiac genes—called HLA-DQ2 and DQ8. Those who carry one or both genes are considered to be “at risk” of developing celiac disease, although only a small percentage will actually develop the condition. In addition, children with certain conditions and/or syndromes may be more at risk for celiac disease.

Children with one or more of the following are at an increased risk of developing celiac disease and should be considered for testing:

• First-degree relatives (children, siblings) of a person with celiac disease
• Down syndrome
• Type 1 diabetes
• Selective IgA deficiency
• Turner syndrome
• Williams syndrome
• Autoimmune thyroiditis

What are the symptoms of celiac disease?

The symptoms of celiac disease vary widely and are influenced by age.

• Very young children may have poor growth, which begins at the time that they start eating any gluten-containing solid foods—about 6 months of age. Other classic symptoms in children this age are diarrhea and gas.  
• Older children and teens may have other symptoms such as abdominal pain, vomiting, and constipation. Non-gastrointestinal symptoms include delayed growth during puberty (short stature), skin rashes, iron deficiency anemia that does not respond to iron supplementation, elevated liver function tests, and bone problems (osteoporosis).

Note that some children, particularly those in high-risk groups, will not show any symptoms and are typically found to have celiac disease through a blood test.

What is the difference between celiac disease and gluten sensitivity?

In addition to celiac disease, there are two other classes of gluten-related disorders: wheat allergy and non-celiac gluten sensitivity.

• Wheat allergy is an immediate, allergic response to wheat protein (IgE-mediated). It can lead to gastrointestinal symptoms and other symptoms seen with celiac disease.
• Non-celiac gluten sensitivity is not well defined, and some doctors believe it may only be caused by an intolerance to wheat and not to all gluten-containing grains. The type of intolerance seen in non-celiac gluten sensitivity does not lead to intestinal inflammation, as is seen in celiac disease.

How do I know if my child has celiac disease or another gluten-related disorder?

• For celiac disease: Several tests are done to officially diagnose celiac disease. The first step is a blood test to look for certain antibodies—including tissue transglutaminase IgA. The level of these antibodies is usually high in people with celiac disease, but it is almost never increased in people without it. If the test is positive, a biopsy of the small intestine is recommended to confirm the diagnosis of celiac disease. The biopsy is usually collected during a test called an upper endoscopy—where a tube with a small camera on the tip is passed into the mouth and down the gastrointestinal tract and removes small pieces of the surface of the small intestine. The biopsy is not painful and is performed by a pediatric gastroenterologist while a child is sedated.  

​Other testing may include additional blood work for other antibodies such as deamidated gliadin IgG and endomysial IgA. Genetic testing may also be performed by taking a swab of the cheek; this is done in certain circumstances if the diagnosis of celiac disease is not certain.

• For a wheat allergy: Blood tests or skin- prick tests can be done to see if there is an elevated wheat IgE blood level or a skin reaction to the presence of wheat antigen on the skin.
• For non-celiac gluten sensitivity: There are no accurate tests available for evaluating.

A child should continue to eat foods containing gluten until all testing is complete. Starting a gluten-free diet or avoiding gluten before testing may make it difficult to confirm the diagnosis.

What is the treatment for celiac disease?

The only available treatment for celiac disease is a strict life-long, gluten-free diet. It is important to limit cross-contamination—even crumbs containing gluten can lead to symptoms and intestinal inflammation. Additionally, gluten may be found in certain medications and in some non-food items such as shampoo and make-up—but these are not harmful unless they are eaten. Talking to a knowledgeable dietitian can help parents and children make the needed adjustments to a gluten-free lifestyle. Without treatment, children with celiac disease can go on to develop anemia, osteoporosis, and other complications.

Is the gluten-free diet healthy?

Just because a food is labeled “gluten-free” does not mean it is better for you. Therefore, reading labels may not always be the most efficient way to remain healthy and symptom-free.

• ​Processed gluten-free foods are not vitamin fortified. For example, they may lack B vitamins and iron and be high in fat and sugar and low in protein.
• Eat naturally gluten-free and healthy foods. These include fruits, vegetables, meats and fish, as well as a variety of grains including amaranth, millet and quinoa.
• Some children with celiac disease may also need a daily multivitamin.

What accommodations can be made for a child with celiac disease?

Parents of children who are newly diagnosed with celiac disease will need to speak to their child’s teacher or child care provider about the condition, what foods are safe, and what to do in case of inadvertent exposure to gluten.

• School lunches: Schools are required by law to provide substitutions to the school meals for children with celiac disease—if their needs are supported by a statement signed by a licensed doctor. The doctor’s order may require certain products to be purchased for the child. Schools may not charge children with certified special dietary needs more than they charge other children for program meals or snacks. In other words, children who receive free lunches cannot incur any charges for their meals and children who pay full-price cannot be charged extra for the special foods the school must purchase.
• Classroom management: Children with a 504 plan or those who can document their condition are entitled not only to lunch, but to a plan for classroom management of their celiac disease. That might mean young children with celiac will not have access to glue or other gluten-containing art class items they might taste or put in their mouths. It might mean older children will not have field trips where they might encounter gluten, such as a tour of a bread factory.

Campylobacter are a type of bacteria that produce infections in the GI tract. They are a major bacterial cause of diarrheal sickness among children in the United States. You may hear your pediatrician use the names Campylobacter jejuni or Campylobacter coli, which are the most common Campylobacter species associated with diarrhea. Common ways that a child can get the infection are from contaminated food, especially undercooked chicken; unpasteurized milk; and household pets, most often puppies, cats, hamsters and birds. Infection can also spread by person-to-person contact. The incubation period is usually 2 to 7 days.

Signs and Symptoms

Illness caused by Campylobacter infections includes diarrhea, stomach pain, and fever. Blood may be present in the stools. In young infants, bloody diarrhea may be the only sign that an infection is present. Severe diarrhea can cause dehydration, with symptoms such as excessive thirst and a decline in the frequency of urination. Campylobacter can also enter the blood stream and infect other organs, though this is not common.

In rare cases, complications caused by the body’s immune system may develop. The antibodies made against Campylobacter can react against the child’s body, causing an uncommon form of arthritis called reactive arthritis, a skin sore called erythema nodosum, and a serious condition of the nerves called Guillain-Barré syndrome. With Guillain-Barré syndrome, the child develops weakness that usually starts in the legs and moves up the body.

What You Can Do

If your child has blood in his diarrhea or stools, you should call your pediatrician. Children with Campylobacter infections tend to get better on their own without any particular treatment. Until your child’s diarrhea goes away, make sure he drinks lots of fluids. Rehydration fluids are sold in stores, but can also be made at home. Talk to your pediatrician about how to include the proper amount of salt and sugar.

How Is the Diagnosis Made?

The blood and feces can be tested in the laboratory for the presence of Campylobacter bacteria. This will help your pediatrician give you an exact diagnosis of the cause of your child’s diarrhea.

Treatment

Sometimes, particularly when a Campylobacter infection is severe, antibiotics may be given. If taken early in the course of the illness, antibiotics such as erythromycin and azithromycin can eliminate the bacteria from the stool in 2 to 3 days and shorten the length of the illness. When your pediatrician gives these medicines, make sure your child takes them as instructed. Over the counter antidiarrheal medicines may make your child sicker and should not be taken if there is blood in the stools.

What Is the Prognosis?

If your child has a mild Campylobacter infection, the illness may last only for a day or two. In other cases, youngsters may recover within a week, although about 20% have a relapse or a prolonged or severe illness.

Prevention

Many cases of Campylobacter infections are connected with touching or eating undercooked poultry. Therefore, proper food handling and preparation are important.

To prevent these infections in your family:

• Wash your hands thoroughly after handling raw poultry. Also, wash cutting boards and utensils with soap and water after they’ve been in contact with raw poultry. It is important to cook poultry thoroughly before eating.
• Drink only milk that has been pasteurized.
• Because pets can be carriers of Campylobacter bacteria, members of your family should wash their hands thoroughly after having contact with the feces of dogs, cats, hamsters, and birds.
• Wash your hands carefully after touching the underclothes or diapers of young children and infants with diarrhea.
• Children should always wash their hands before eating.
• If a child that attends child care has diarrhea, you should tell the caregivers right away.

Preventing Gastroenteritis

• Wash your hands.
• Don’t share utensils.
• Wash and/or peel raw fruits and vegetables.
• Cook meats thoroughly.
• Avoid contaminating foods eaten raw (eg, fruit, salad) with foods that get cooked (eg, chicken, turkey, beef, pork).