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What are gastrointestinal disorders?


Gastrointestinal disorders are problems that affect any part of your gastrointestinal tract (sometimes called the GI tract). This includes the esophagus (inside your throat and chest) that connects your mouth with your stomach, and your stomach to your intestines. Food travels through that tract after eating.

Gastrointestinal problems fall into two groups. Something in the GI tract that doesn't work the way it is supposed to -- but looks normal -- is called a functional disorder. The second group is structural disorders, and the GI tract looks abnormal.

There are many different types of gastrointestinal disorder. Since gastrointestinal problems can affect many different parts of the body's system for using and disposing of food, it can affect your child in many ways.


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What are the symptoms of a gastrointestinal disorder?


Symptoms of a gastrointestinal disorder in babies can include:
  • Pain, irritability or crankiness.
  • Constant or sudden crying (signs that may be mistaken for colic) after eating.
  • Frequent spitting up or vomiting  after eating.
  • Vomiting more than one hour after eating.
  • Regular spitting up that continues after the first year when most children grow out of it.
  • Unable to sleep  soundly.
  • "Wet burp" or "wet hiccup" sounds.
  • Poor weight gain or weight loss.
Symptoms in children can include:
  • Stomach ache or feeling of discomfort.
  • Feeling as though you will "throw up" (called nausea) after eating.
  • Frequent loose or watery stool.
  • General tiredness or being unable to be physically as active as friends.
  • Depression, feelings of sadness and seeming upset.
  • Blood in the stool.
  • Vomiting.
  • Not eating well.
  • Heartburn that feels like a pain in the chest.
  • Fever.
Less common signs for babies and children include:
  • Constant eating and drinking.
  • Inability to eat certain foods.
  • Refusing food or accepting only a few bites despite hunger.
  • Swallowing problems (such as gagging or choking).
  • Hoarse voice.
  • Frequent sore throats.
  • Frequent respiratory problems (such as pneumonia, bronchitis, wheezing or coughing).
  • Bad breath.
  • Drooling.



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What can I do to help my child now?


You have made an important first step by reading about gastrointestinal disorders. Remember that the more you know about your child's condition, the better the results for your child and family. Below are some checklists of things to help your child. Remember that you are not alone.

"GETTING STARTED"
THINGS I CAN DO TO HELP MY CHILD WITH A GASTROINTESTINAL DISORDER


 Getting Started:

Get your child tested for gastrointestinal disorder: Specialists can help your child with gastrointestinal problems. Have your child tested to find out what type of problem he or she has. Then get regular checkups to make sure your child stays healthy. (See the section on Professionals for a complete list.)

IN THE STATE OF FLORIDA:
 Contact Children's Medical Services (CMS): For medical care for your child:



Get more information: Visit more websites. Read a book. Watch a video. Include your child and family. Talk with another parent or join a support group.




 Talk with my child's teacher: Keeping your child's teacher updated on your child's medical condition is vital. Flare-ups of your child's condition can mean missing school. Frequently missing school means more difficulty learning.

Have a plan with the teacher about your child's homework and class. Falling behind in school can bring anxiety and embarrassment. The added stress heightens emotions. You may need to ask your child's teacher to make accommodations for your child's medical needs. This may include allowing your child easy and timely access to the bathroom, water if they needed, or other things recommended by your child's doctor.

 To help your child with stomach symptoms:
  • Have your child lie down after eating if heartburn is a problem.
  • Allow your child to drink a lot of water to avoid getting dehydrated (dangerously thirsty).
  • Encourage your child to participate in activities, but make sure he or she paces himself or herself and doesn't get too tired or dehydrated.


WHAT ELSE I CAN DO TO HELP MY CHILD WITH A GASTROINTESTINAL DISORDER?


 Monitor what foods cause your child problems or stomach symptoms:
Keep a log of the foods that your child eats and when problems occur. This is very useful, especially for Irritable Bowel Disorder. Help your child avoid the foods that seem to cause difficulties.

 For young children create a time to use the bathroom (a toileting schedule): Develop and maintain a toilet schedule for your child. Include a toilet break after meals and snacks. Compliment your child when the schedule is followed.

 Reduce my child's stress: Stress can worsen symptoms. Reduce your child's stress by:
  • Asking your child's teacher to make accommodations at school.
  • Teaching your child ways to reduce stress.
  • Taking your child to self-help groups or psychotherapy (perhaps talking with a psychologist).
  • Reducing social stress, such as feeling different or anxious about needing to use the bathroom or about eating. Talking with your child about feelings relieve stress.

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What are some other ways to describe gastrointestinal diseases?


Some children may have more than one type of gastrointestinal diseases. You may hear one or more of the terms below from your doctor or others.

Gastrointestinal diseases can be either functional disorders or structural disorders.

Functional disorders affect how the GI tract works. The tract looks normal but does not work normally. In children, functional disorders include:

  • Functional Fecal Retention happens when a child avoids having a bowel movement (going to the bathroom) on purpose. It can last for weeks or years and can lead to children developing negative thoughts about themselves.

    Functional Fecal Retention may lead to constipation (not being able to go to the bathroom). A child is constipated when he or she has a difficult time passing stool, passes stool less than three times a week, or can't pass stool completely. Some easy ways to help relieve constipation are eating more food containing fiber-like vegetables and fruit; drinking more fluids; exercising regularly, and going to the bathroom as soon as you feel the need.


  • Non-Retentive Fecal Soiling is involuntary passage of bowel movements in their underwear or other inappropriate places. Often this condition accompanies Functional Fecal Retention.
Structural disorders are conditions or diseases in which some part of the gastrointestinal tract does not look normal and doesn't work properly. Sometimes, the structural problem must be removed or repaired with surgery. Structural gastrointestinal diseases usually can be found by using such common exams as x-rays or blood and urine tests. Structural disorders include the following:

  • Irritable Bowel Syndrome is abnormal bowel consistency (runny or watery stools) combined with stomach pains that are usually relieved by passing the stool.

  • Gastroesophageal reflux disease is a condition in which food or liquid travels from the stomach backward into the esophagus. This is called reflux. The esophagus connects the mouth with the stomach. When a child swallows anything, it goes into the esophagus. If the lower esophageal sphincter (the muscle that connects the esophagus with the stomach) relaxes or is weak, it can allow stomach contents to reflux. Reflux can cause heartburn which feels like a pain in the chest or stomach. Some foods thought to make this worse are chocolate, peppermint, fried or fatty foods and caffeine. Many sodas have caffeine in them. Read the labels to see.

    Reflux also can cause a child to vomit or throw up food during feedings. It's common in children with cerebal palsy and can occur twice or more weekly.

  • Inflammatory Bowel Diseases (IBD) can be very different for each child and for each type of problem. They include:

    • Crohn's Disease: Can affect any part of the digestive system from mouth to anus, in particular the small intestine and colon.

    • Ulcerative Colitis: Affects the lining of the colon only. Children with Ulcerative Colitis have diarrhea and bleeding from the bowel. Inflammation in the large intestines may cause abscesses or pockets of infection. These abscesses can cause a child to have bloody diarrhea, a stomach ache, sudden bowel movements, fever, weight loss, joint pain and skin sores (wounds or blisters).
Other Functional Gastrointestinal Disorders include:

  • Lactose intolerance where a child cannot digest lactose, a type of sugar found in milk, milk products such as cheese, infant formulas and medicines. Lactaid is a readily available medicine.

  • Food allergies or intolerances that happen when a child's body does not react normally to a particular food such as peanuts or wheat, and so should avoid these foods. If the effect is severe, a child may need a shot to prevent serious reactions. If your child has a severe allergy problem, ask your doctor about getting an EpiPen (a fast treatment for severe allergic reactions).

  • Celiac disease, also called celiac sprue, acts like an allergy to gluten. It is listed here because it acts like a gastrointestinal illness (a problem with the intestines and stomach). But it is not a true allergy reaction or gastrointestinal disease. This problem is actually an autoimmune disease (meaning it causes a piece of the immune system not to work).

    Gluten is a type of protein found in wheat, rye and barley. In celiac disease, gluten destroys part of the lining of the small intestine. This can cause problems ranging from severe and painful to mildly annoying. You may be unable even to notice the symptoms. Gluten can make it hard or impossible for the body to use and break down nutrients in food. Even a small amount of gluten can cause damage. Treatment is simple -- a completely gluten-free diet. (This means not ever eating anything with wheat, rye or barley.) For more information on this problem, see one of these websites: Celiac Disease Foundation  or the Celiac Sprue Association .
MedlinePlus 2005


Nutritional problems include:

  • Malnutrition: When a child is not eating and drinking enough of the right foods to grow and develop.

  • "Failure to thrive": When a child is not growing well even when eating all the right foods needed to grow and develop. This can be caused by many different problems affecting the digestive system and other body systems.

  • Obesity: When a child has extreme weight gain. That can be caused by not eating the right foods, too much food or not exercising enough. Sometimes a child's metabolic condition causes extreme weight gain. Metabolic conditions are caused by the body not processing food or medicines in a typical way.

    American Academy of Pediatrics 2005 The Australian Crohn's & Colitis Association Inc., ACCA, 2005, Fletcher-Janzen & Reynolds, 2003, International Foundation for Functional Gastrointestinal Disorders, IFFGD, 2005, & The UNC Center for Functional GI & Motility Disorders



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    What causes gastrointestinal disorders?


    The main causes for functional disorders include but aren't limited to:
    • Eating a diet low in fruits and vegetables.
    • Not drinking enough water or other fluids.
    • Not getting enough exercise.
    • Traveling or other changes in normal habits.
    • Eating large amounts of dairy products such as cheese.
    • Being stressed or upset.
    • Not going to the bathroom despite feeling the need to go. Sometimes children are too busy at play to take the time.
    Kidshealth.org 2005

    For children with structural disorders, the causes may never be known. There may have been some interruption of development before the baby was born, but also could be genetic, meaning a disorder passed from parents to children.


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    Do many children have gastrointestinal disorders?


    Research indicates that 10-20% of school children often have severe stomach aches affecting daily activities. Here are the rates for some gastrointestinal illnesses mentioned above:
    • Only a very small amount of children suffer from fecal soiling (about 2%). For almost all these children, fecal soiling is due to functional constipation.
    • Irritable Bowel Syndrome in children is close to the rate in adults, 5-20%. It happens most often in teenagers and adults between 15 and 35.
    • Gastro Esophageal Reflux Disease affects about 5-7% of children around the world.
    • Cases of Crohn's disease are increasing in children and adolescents, but remains fairly rare (about 1%).
    • Ulcerative Colitis also is very rare (about 1%) and mostly affects girls and women between 14 and 38.
    The Virtual Children's Hospital: FFS, 2003; The Australian Crohn's & Colitis Association Inc., ACCA, 2005, Fletcher-Janzen & Reynolds, 2003, International Foundation for Functional Gastrointestinal Disorders, IFFGD, 2005



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    What does a gastrointestinal disorder mean for the health of my child?


    What a gastrointestinal disorder means for your child will vary with the disorder. Some of the more common problems and treatments:
    • Functional Fecal Retention and Nonrentive Fecal Soiling: The most common treatment goals are to help the family understand that there is no medical disease. Soiling is a symptom of emotional issues, not just bad behavior or a disease. Doctors will ask parents to accept a referral to mental health. Treatment can include education, medication and teaching a child normal bowel habits.

    • Irritable Bowel Syndrome and Functional Dyspepsia: The main treatments are to relieve symptoms and lessen inflammation in the bowel. Changing what your child eats might ease the symptoms. Treatments also can include regular exercise or medications before meals.

      In more serious cases, doctors may give medications to stop the diarrhea. Side effects include an increase in appetite, weight gain and mood swings. Some children also have a hard time concentrating, or have headaches. Some children need counseling to help them worry less or feel less anxious. Some children need counseling for depression.

      Complications happen when bleeding in the stool is persistent and can lead to anemia. Blockage of the intestine is another complication. Surgery may be required for severe issues.

    • Crohn's disease: Some children with this disease may grow later than normal and develop skills later than usual. They also may not grow normally.

    • Gastroesophageal reflux disease: Treatments for children may include having them lose weight, having them sit up after meals, or having them take medication. Avoiding certain types of food and drinking lots of water also helps. Postural therapy also is used to position the child to prevent reflux.
    ACCA, IFFGD, Memorial Health Care System, 2004, & National Digestive Diseases Information Clearinghouse, 2005



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    What does a gastrointestinal disease mean for my child’s intelligence and learning?


    Gastrointestinal diseases do not directly cause problems with intelligence and learning. However, children sometimes have problems in school. Some problems that can happen are:
    • Emotional difficulties affecting the ability to learn can sometimes be a side effect of long-term illness.

    • Embarrassment about having a problem with "the bowels" may cause teenagers not to take their medicine. This can lead to such problems as loss of school time, failing performance, and missing activities -- and, hence, more stress and frustration.

        Children with some types of gastrointestinal problems may not get the proper nutrition because the condition affects the way the body uses nutrients in foods. It may cause problems with growth and developing bodies. It also can lead to low energy and depression and affect learning.

        Children, especially teenagers, with Irritable Bowel Disorder have more behavioral and emotional problems than other children. These children do not express their problems and worries. Not talking about worries seems to mean they worry more, not want to be with other children, and have symptoms of depression.
    Haran, 2003



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    Who are some professionals my child may need to see?


    Your child may need to see many different health care specialists. For example:

    Pediatrician: A doctor specializing in treating children. The word "pediatric" in front of a professional's title means he or she works with children.

    Pediatric gastroenterologist: A doctor who specializes in treating children's gastrointestinal diseases, who also treat bleeding, swallowing and other problems related to the intestines

    Pediatric psychologist: A doctor trained to evaluate and test children as well as do counseling.

    Pediatric speech-language therapist: a professional who evaluates and treats communication disorders and swallowing problems. A speech-language pathologist is sometimes called a speech therapist or speech pathologist.

    Social worker and counselor: A professional who provides counseling and emotional support for the child and family, and may help coordinate services, too.

    Care coordinator: An individual responsible for organizing the details across agency lines and serving as your contact to help you and your family get services and assistance.


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    What are some websites where I can learn more about gastrointestinal diseases?


    National Institute of Diabetes and Digestive and Kidney Diseases http://digestive.niddk.nih.gov This site provides fact sheets, medical information, research and clinical trials.

    KidsHealth.org http://kidshealth.org/parent/system/surgical/gerd_reflux.html Great site for general information on children's diseases and conditions.

    Medicinenet.com http://www.medicinenet.com/digestion/focus.htm Great website for general information on medical issues.

    NIH MedlinePlus: http://www.nlm.nih.gov/medlineplus/digestivediseases.html A comprehensive source of links, this is a service of the U.S. National Library of Medicine and the National Institutes of Health.

    Bandaids and Blackboard http://www.lehman.cuny.edu/faculty/jfleitas/bandaides/sitemap.html A great site for children, teens and parents of kids with medical challenges.

    Australian Crohn's and Colitis Association http://www.nevdgp.org.au/geninf/gastro/acca.htm This site provides publications on Crohn's disease.

    International Foundation for Functional Gastrointestinal Disorders http://www.iffgd.org This site provides a great deal of information on gastrointestinal diseases.


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    What are some special books I can read to my child with a gastrointestinal disorder?


    Little Tree: A Story for Children with Serious Medical Problems by Joyce C. Ph.D. Mills, Michael Chesworth (illustrator). A story of hope and inspiration for children with serious illness or injury and providing relaxation exercises to teach the children. (Ages 4-8)

    Colitis & Me: A Story of Recovery by Raman Prasad. The author shares his battle with ulcerative colitis. An inspirational story of how he fights back to take control of his health and life. (Ages 14 and up)


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