Trust Your Gut: When Your Child Needs To See a GI Specialist

Children across the U.S. suffer from digestive and nutritional disorders ranging from minor issues like constipation to more serious conditions like Crohn’s disease.

While every child will occasionally have digestive problems, more serious issues could be lurking in your child’s gut: diagnoses of gastrointestinal disorders are on the rise for children, and can include infantile colic, recurrent abdominal pain, gastroesophageal reflux, vomiting, nutritional intolerances, celiac disease, malabsorption syndromes, acute diarrhea, persistent diarrhea, chronic constipation and more.

"We see a wide variety of GI problems in children, but they often differ depending on the child’s age," says Dr. Maryam Shambayati, a former pediatric gastroenterologist at INTEGRIS Health. "In infants, we often see infantile reflux, or spitting up. Constipation is common with school-age children and chronic abdominal pain can be an issue for school-age children up to teens."

Luckily, the treatment and management of these pediatric digestive conditions are getting more sophisticated. When it comes to deciding whether it’s time for your child to see a GI specialist, Dr. Shambayati says to "trust your gut."

Constipation

Children ages one to four years old will often poop once or twice a day, and according to GIKids.org, more than 90 percent go at least every other day.

But those who go every other day or even less may be at risk for chronic constipation. According to the Centers for Disease Control, constipation makes up three percent of all visits to the pediatrician and 25 percent of all visits to a pediatric gastroenterologist. "We see many, many constipation cases," Dr. Shambayati says. "We have numerous large impaction removals quite often."

Sometimes, it’s hard to identify true constipation, so we've highlighted some signs and symptoms.

• Less than three bowel movements a week
• Hard, dry and difficult-to-pass movements
• Large-diameter stools
• Pain while pooping
• Abdominal pain
• Blood on the surface of hard stool

While uncomfortable, constipation in children isn’t usually serious, but chronic constipation can lead to other complications. Talk to your doctor or specialist if your child is constipated for longer than a week or has exhibited the signs of constipation.

Celiac Disease

Celiac disease is an autoimmune disorder caused by an intolerance to gluten. Gluten is the general name of the proteins found in wheat, rye, and barley and other grains derived from them. Celiac disease occurs when the finger-like villi in the small intestine is damaged by consuming gluten. When the villi is damaged, the body can't absorb nutrients the body needs to grow. If that happens, a child can become malnourished.

Infants may not gain weight and height as expected. Older kids can have diarrhea, abdominal pain and bloating, weight loss, fatigue, or painful skin rashes.

Doctors don't know for sure what triggers the immune system to react to gluten in people who have celiac disease. There is no cure, but if your child is diagnosed with celiac disease, there are ways to minimize symptoms and damage to the intestines. The disorder can be managed by adhering to a gluten-free diet.

Diagnosing the disorder is the first step. It usually begins with a simple blood test that measures the level of antibodies to gluten and other proteins in the lining of the intestine. If high levels of these antibodies are found, the doctor will likely order a biopsy of the small intestine and send it to a laboratory for testing.

"We don’t have one answer as to why we are seeing more disorders like this in children," says Dr. Shambayati. "We have seen a link to diet, we have seen a link with hormones and we are seeing studies on how gut bacteria is changing due to changes in the environment."

Symptoms

According to the Celiac Disease Foundation, the most common symptoms found in children are listed below. If your child has any of these symptoms, you should visit your doctor.

• Abdominal bloating and pain
• Chronic diarrhea
• Weight loss
• Fatigue
• Vomiting
• Constipation
• Pale, foul-smelling or fatty stool
• Painful skin rashes
• Irritability and behavioral issues
• Dental enamel defects of permanent teeth
• Delayed growth and puberty
• Short stature
• Failure to thrive
• Attention deficit hyperactivity disorder (ADHD)

Children are at higher risk for celiac disease if they have existing disorders like type 1 diabetes, autoimmune thyroid disease and Turner syndrome, or if they have a relative with celiac disease.

Inflammatory Bowel Disease

The two most common forms of inflammatory bowel disease (IBD) are ulcerative colitis and Crohn’s disease.

Ulcerative Colitis

In ulcerative colitis, the inner lining of your child’s large intestine (colon or bowel) and rectum gets inflamed. This causes diarrhea or frequent emptying of the colon. As cells on the surface of the lining of the colon die and fall off, open sores form. This causes pus, mucus and bleeding.

The most common symptoms of ulcerative colitis in children and teenagers are diarrhea, blood in bowel movements and abdominal pain. Children may complain about pain prior to a bowel movement or frequent bowel movements up to 10 times per day or more.

Crohn's Disease

Crohn's disease is when there is redness, swelling and sores along the digestive tract. It may come and go at different times in your child’s life. In most cases it affects the small intestine but sometimes both the small and large intestines are affected, or even the whole digestive tract. This includes the mouth, the esophagus, the stomach, the first part of the small intestine, the appendix and the anus.

The symptoms of Crohn’s disease may mimic ulcerative colitis or may be worse. The common symptoms of Crohn’s in children are abdominal pain, diarrhea and weight loss. Poor growth or lack of weight gain are important signs of pediatric Crohn’s disease.

While an estimated million people in the U.S. live with IBD, nearly one in four patients is under the age of 20. "The fastest-growing age group for inflammatory bowel disease is age 14 to 24," Dr. Shambayati says. "The exact cause of IBD is unknown, but both genetic and environmental factors may be involved."

According to Dr. Shambayati, IBD in children can often be managed effectively through medication and other treatments, reducing the need for surgery. "The good news is that because these disorders are receiving a lot of attention, there are a lot of new treatments," she says. "In the past, if you were diagnosed with inflammatory bowel disease, the first thing doctors would do is perform surgery and remove part of the bowel. There are other options now."

Today, treatment for IBD is often more focused on dietary therapy or treatment that targets specific parts of the immune system that cause IBD. "It can be discouraging to have a lifelong diagnosis like IBD, but you have a lot of great options for treating it," Dr. Shambayati says.

When to See a Gastrointestinal Specialist

Dr. Shambayati says parents who suspect their child may have a digestive disorder should look for specific symptoms. "Growth is a good indicator, especially in young children," she says. "If your child is getting the nutrition he or she needs but is not gaining weight, that would be the time to ask for a referral to a specialist. Blood in the stool is always a red flag as well."

Many children in Oklahoma suffer some sort of bowel or digestive problem, and Dr. Shambayati says getting the correct diagnosis is the most important step to treatment. "I’m not saying every stomach ache is a serious condition, but it is important to look for signs," she says. "A lot of times, people think medical conditions can’t happen to kids, but children can have a whole range of GI problems, like gallstones and pancreatitis, just like adults."

If you think something is being overlooked with your child, especially with gastrointestinal issues, trust that feeling and visit a specialist.