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November 18, 2019

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Doctor at the Desk

Ouchie Tummies

One of the most common childhood complaints is a painful tummy. Some are mild, some are not.
By: Lourdes Nena A. Cabison-Carlos, MD article_10

One of the most common childhood complaints is a painful tummy. Some are mild, some are not. When kids complain of painful tummies, we need to eliminate a gamut of reasons. Is the child hungry? Overfed? Gassy, perhaps? Or is the child just acting out? Are there any other warning signs, like vomiting, diarrhea or fever?

Diarrhea

Technically, diarrhea refers to increased frequency and water content of stools. How much is too much varies from person to person? For instance, a breastfed baby can pass soft stools up to 6 or more times a day, but the same frequency can be abnormal in a 10-year-old child. So it is more helpful to look at changes in your child’s bowel movement.

Diarrhea can be caused by a lot of factors aside from bacteria, parasites, and viruses. Sometimes, that antibiotic that your child is taking can be the culprit. Sometimes it’s because of lactose intolerance. Whatever the cause, the main goal of treatment is the same, which is to avoid dehydration. When your child has diarrhea, keep him/her adequately nourished and give lots of fluids, ideally with oral rehydration salts (ORS), which are readily available in drugstores.

When to see a doctor:

  • Presence of blood in the stool
  • Child urinates less than normal
  • Have no tears when crying
  • The child is always sleepy or refuses to eat
  • Painful bowel movements or cramps
  • Presence of fever

Vomiting

Children throw up for all reasons: motion sickness, infections, fever, excessive coughing, eating too much, or simply when they’re upset. Most of the time, vomiting is accompanied by diarrhea or fever.  Sometimes, vomiting is a sign of more serious stuff, like appendicitis, meningitis or intestinal obstruction. Just like in diarrhea, it’s important to keep the child hydrated but wait 15-30 minutes after the last vomiting episode before offering fluids to the child.

When to see a doctor:

  • There’s blood or bile (a greenish substance) in your child’s vomit
  • Has signs of dehydration, like dry lips or decreased urination
  • Can’t keep food down
  • Vomits twice or more in 24 hours

Gastroesophageal Reflux

Reflux happens when the contents of the stomach go back up the esophagus. This is common in infants, but what distinguishes normal reflux from one which is pathologic is how often it occurs, and if it results in discomfort or complications. Reflux in infants tends to get better once they get older due to the maturation of the gastrointestinal tract. For older children, reflux will present as stomach ache, chest pain, bitter or sour taste at the back of the mouth, or throwing up.

Most of the time, reflux can be managed by dietary modification. For infants, this means avoiding putting the baby in prone (tummy) or supine (back) position immediately after feeding, burping the baby after feeds and avoiding overfeeding. For older children, this includes eliminating spicy or fatty food, chocolates, and caffeinated beverages. 

When to see a doctor:

  • Your child/ infant has poor weight gain
  • Your child has a cough that does not go away
  • Problems in swallowing
  • Moodiness or incessant crying
  • Breathing problems

Constipation

Passing hard stools can be (literally) hard especially for kids. In newborns, constipation is almost always a red flag which needs immediate medical attention. For older children, constipation can be caused by low fiber and water intake, psychosocial issues or problems in the rectal area like fissure or hemorrhoids.

When to see a doctor:

  • Presence of blood in the stool
  • Your child complains of painful bowel movements
  • Decrease (fewer than normal) bowel movements

Colic

The cause of colic is not known, but most (lolos and lolas included) think that this is caused by gastrointestinal problems. An infant with colic would usually present with incessant crying despite being properly fed, burped and changed, and does not show any other signs that may point to an organic problem.

When to see a doctor:

  • When the baby has poor weight gain
  • Refusal to feed
  • Presence of fever
  • The baby looks unwell 

Picky Eating

Most children undergo a phase of eating too little or eating only a certain type of food (hello, hot dogs and tocino!). Toddlers, especially, are usually picky because they are going through a normal developmental stage where they learn to exert control over their environment. They will eventually develop a natural preference for food so the real challenge is to make healthy choices appealing.

When to see a doctor:

  • Your child has poor weight gain
  • The child complains of heartburn
  • Vomiting or abdominal pain during or after eating

There are tons of other digestive issues which we have left out, such as hepatitis, pancreatitis, bowel obstructions, and congenital anomalies.  Just the same, the take home message is that whenever (and I mean WHENEVER) you feel like something is not right, always trust your instincts and consult your pediatrician. Stay healthy!

“A heart can no more be forced to love than a stomach can be forced to digest food by persuasion.”- Alfred Nobel 


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Keywords: stomach, children, picky eater, babies, infants   
  
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