Common Problems in Paediatric Gastroenterology
We specialise in diagnosing and treating a wide range of allergies and immune system disorders in children. Our paediatric allergy and immunology specialist is dedicated to providing compassionate, evidence-based care tailored to the unique needs of your child.
Chronic Abdominal Pain in Children
Functional abdominal pain is a chronic or recurring type of abdominal pain that occurs without any visible abnormalities in the digestive tract, unlike pain caused by obvious issues like tissue damage or inflammation. Functional abdominal pain can be intense and debilitating, often occurring alongside other gastrointestinal symptoms such as alteration of bowel habits like in irritable bowel syndrome (IBS). The causes of functional abdominal pain are multifaceted, involving genetic, and environmental. In some cases, past injuries or infections may leave the gut’s nerves hypersensitive, causing normal sensations to be perceived as painful. Functional gastrointestinal disorders are also known as disorders of the gut-brain interactions, it is therefore psychological factors, stress and emotional distress can trigger the pain, but also amplify this pain due to the brain’s role in processing and modulating pain signals.
Making the diagnosis is made by clinical impression and excluding other causes for pain. Treatment for functional abdominal pain includes different interventions including medication and dietary changes. It often includes specific types of antidepressants, which, at lower doses than used for treating depression, can help manage pain by affecting the brain’s pain pathways. Behavioural therapies, such as cognitive-behavioural therapy and gut-directed hypnotherapy, are also effective in reducing pain by teaching coping strategies and reducing stress responses. The goal of treatment is not necessarily to cure the pain but to find the most effective tools and strategies for managing it, improving the patient’s quality of life.
As Paediatric gastroenterologists, I work closely with families to identify the root cause of the pain and develop a comprehensive, individualised treatment plan that addresses both the symptoms and underlying causes.
Toddler’s Diarrhoea
Toddler’s diarrhoea is a frequent, non-serious condition in young children characterised by loose stools. This condition often does not cause discomfort or interfere with growth and development. It is usually related to the child’s diet, particularly the high intake of sugars found in fruits and fruit juices, and resolves on its own over time. Management focuses on dietary adjustments, such as reducing certain sugars, increasing fibre and fat intake, along with providing reassurance to parents that the condition is self-limiting and generally not a cause for concern. Diagnosis is based on clinical findings, and importantly on exclusion of other possible causes.
Constipation
Constipation in children is a common and often distressing condition, characterised by infrequent, hard, and painful bowel movements. However, constipation can also be presented with a child with chronic abdominal pain, who reports on normal bowel habits. It can be caused by dietary factors, poor toilet habits, or less commonly, an underlying medical condition. If left untreated, constipation can lead to complications like faecal impaction or encopresis (involuntary leakage of stool). Treatment usually involves regular toilet routines, and use of stool softeners or laxatives. Educating families about healthy bowel habits is a crucial part of the treatment process.
Eosinophilic Oesophagitis (EO)
EO is a chronic inframammary condition of the oesophagus (gutter). It is characterised by infiltration of eosinophils, which is a specific type of white blood cell, to the mucosa lining the oesophagus causing inflammation, difficulty swallowing, and food impaction. In younger children it can present with feeding difficulties and vomiting. This condition is often associated with food allergies and may coexist with other allergic conditions such as asthma or eczema. The diagnosis of EO typically involves endoscopy (gastroscopy) and biopsy. Treatment may include dietary modifications (like elimination diets), proton pump inhibitors (Omeprazloe), and corticosteroids to reduce inflammation. Long-term management aims to prevent complications and improve quality of life.
Functional Rumination Syndrome
Rumination syndrome is an often misunderstood condition in which children and adolescents repeatedly regurgitate food after eating, without nausea or involuntary retching. The regurgitated food is often rechewed and swallowed again or spit out. It is a functional condition, distinct from vomiting disorders, and is often triggered by stress or anxiety, but can also start after an episode of a gastro-bug, or with no clear trigger. Treatment focuses on habitual and behavioural therapy, including diaphragmatic breathing exercises, to help the child gain control over the regurgitation reflex. Support from a multidisciplinary team, including psychologists and gastroenterologists, is essential for successful treatment.
Infantile Colic
Infantile colic is a condition that causes significant distress in both infants and their families. It is characterised by excessive, unexplained crying in an otherwise healthy baby, often occurring in the late afternoon or evening. While the exact cause of colic is unknown, it is believed to be related to digestive discomfort, such as gas or indigestion. Management strategies include soothing techniques, dietary changes for breastfeeding mothers,. Although colic typically resolves on its own, over supportive care can help manage the symptoms during this challenging period.
Coeliac Disease
Coeliac disease is an autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. In children, it can cause a range of symptoms, including chronic diarrhoea, abdominal pain, weight loss, and growth delays. However, it can be completely asymptomatic. The only effective treatment is a strict, lifelong gluten-free diet, which helps to heal the intestine and prevent further damage. Early diagnosis and dietary management are crucial to prevent malnutrition, anaemia, and other complications. Diagnosis is based on blood tests for coeliac serology, if markers are elevated, the gold standard for confirming the diagnosis is a gastroscopy and tissue biopsies. In certain conditions, the blood markers are high enough, for making the diagnosis without duodenal biopsy, but in any case consultation with a paediatric gastroenterologist is recommended.
Inflammatory Bowel Disease (IBD)
IBD, which includes Crohn’s disease and ulcerative colitis, is a chronic condition characterised by inflammation of the gastrointestinal tract. Symptoms can be severe and may include abdominal pain, diarrhoea, fatigue, and weight loss. In children, IBD can also affect growth and development. Treatment typically involves dietary modifications, medication to control inflammation, and sometimes surgery. The goal is to achieve and maintain remission, allowing the child to lead a normal, active life. A multidisciplinary approach is often required, involving paediatric gastroenterologists, dietitians, and sometimes surgeons and psychologists.
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