How to help when kids get

How to help when kids get "GI Blues" 

Managing Common Pediatric Digestive Issues
Kathleen Zelman, MPH, RDN
Round up of tips and highlights from the Nutrition4Kids podcast 'Managing GI symptoms in children: What parents need to know' with Dr. Maria Oliva-Hemker

Parents often face difficult challenges when their kids experience digestive issues such as stomach aches, diarrhea, constipation, and vomiting. These common concerns can cause significant distress for children and worry for parents. The key lies in recognizing which symptoms require medical attention and knowing how to help at home. Dr. Maria Oliva-Hemker, Director of the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Johns Hopkins University School of Medicine, offers invaluable insights into managing these issues. Below are practical tips and advice inspired by the Nutrition4Kids podcast, "Managing GI Symptoms in Children: What Parents Need to Know."

Common Pediatric GI Issues

Dr. Maria highlights that vomiting and diarrhea are among the most frequent complaints in children, especially younger ones. These symptoms often occur together, usually triggered by viral infections, food poisoning, or new foods during travel. While these episodes typically resolve on their own, parents can take steps to manage them effectively to help the kids get through them safely

How to Managing Vomiting and Diarrhea in Children

Hydration Tips for Kids:

Maintaining hydration is crucial to prevent dehydration, especially when children experience vomiting or diarrhea. Recommendations differ by age:

  • Infants (Under 1 Year): Continue breastfeeding or formula feeding. Avoid plain water, as it lacks necessary salts and sugars. Instead, offer small, frequent amounts of commercial rehydration solutions, such as Pedialyte, about an ounce per hour.
  • Children Over 1 Year: Offer diluted juices such as apple or grape juice mixed half-and-half with water or sports drinks like Gatorade. Avoid sugary beverages as they can worsen diarrhea.  Aim for 4–5 cups of liquid daily.
  • Older Children: Aim for 7–8 cups of fluids per day, incorporating hydrating foods like watermelon soup or applesauce can also contribute to fluid intake.

Dietary Recommendations:

  • Children with mild diarrhea can generally continue eating their regular diet. Avoid overly processed or greasy foods and focus on balanced meals with fruits, vegetables, and whole grains.
  • The previously popular BRAT diet (bananas, rice, applesauce, and toast) is no longer widely recommended, as it lacks essential nutrients like fiber, protein, and fat.
  • If vomiting accompanies diarrhea, begin with small amounts of fluids and gradually reintroduce solid foods.

Recognizing Warning Signs

While most cases of vomiting and diarrhea resolve on their own, some symptoms may signal a more serious condition requiring medical attention. Parents should monitor for:

  • Signs of Dehydration: Look for fewer wet diapers, a dry tongue, or a lack of tears when crying.
  • Excessive Output: More than 10 stools daily or persistent vomiting that prevents hydration.
  • Unusual Symptoms: Vomiting with yellow or green bile, severe abdominal pain, or blood in the stool.

If these symptoms occur, consult a pediatrician if these signs are present.

Causes of  Abdominal Pain 

In Infants:
Abdominal discomfort in infants often stems from:

  • Colic: Linked to an infant's inability to self-soothe.
  • Gas: May result from feeding techniques or immature digestive systems.
  • Milk Protein Allergies: Caused by an immune reaction to proteins in breast milk or formula.

In Older Children:

Abdominal pain in older children can be caused by:

  • Emotional Stress: Anxiety about school or social situations.
  • Food-Related Issues: Conditions like lactose intolerance or sensitivities to certain foods.

Dr. Oliva-Hemker emphasizes maintaining hydration during these episodes and adjusting the child's diet to ensure it remains balanced and nutritious. Avoid high-sugar beverages, which can exacerbate symptoms.

Signs and Treatment for Constipation in Kids

Understanding and Preventing Constipation

Constipation is common in children, particularly in the United States, where low-fiber diets and inadequate hydration are prevalent.

Prevention Tips:

  • Encourage a fiber-rich diet including plenty of fruits, vegetables, beans, and whole grains.
  • Ensure adequate fluid intake to support digestion. Encourage children to drink water throughout the day to support digestion.

When to Seek Help:
If constipation persists for more than two to three weeks despite dietary changes, consult a pediatrician. Medical interventions like stool softeners or laxatives may be necessary.

Key Signs of Constipation:

• Infrequent bowel movements or painful stools.

• "Overflow diarrhea" (streaks of stool in underwear).

• Abdominal distension or bowel movements occurring only every three to five days.

Understanding and Managing Reflux in Infants

Understanding Spitting Up:
Two-thirds of four-month-olds spit up daily. This occurs due to an immature lower esophageal sphincter and the high liquid-to-stomach size ratio. Most cases are harmless and resolve as the baby's digestive system matures.

Managing Reflux:

  • Avoid Overfeeding: Let the baby guide feeding and stop when they appear satisfied.
  • Positioning: Keep the baby upright after feeding to minimize spit-up.  Avoid placing them in swings or car seats, which can cause slumping and worsen symptoms.
  • Dietary Adjustments: Breastfeeding mothers might eliminate dairy to see if symptoms improve.
  • Some formula-fed infants could try formulas with pre-digested proteins.

Thickening Formulas:

  • Adding a small amount of cereal (one tablespoon per one to two ounces of formula) can reduce regurgitation. Specialized thickeners for breast milk are also available.

Promoting Long-Term GI Health in Kids

Dr. Oliva-Hemker emphasizes the importance of fostering a healthy microbiome for long term digestive health.  A diverse and balanced diet can help achieve this.  

Key Components of a Gut-Healthy Diet:

A plant-rich diet fosters a healthy microbiome, which plays a crucial role in digestion.

  • Incorporate a variety of fruits, vegetables, beans, and whole grains
  • Lean proteins such as tofu, soy products, seafood, poultry, eggs and lean meat.
  • Water should be encouraged as the primary beverage, limiting sugary drinks and sodas.

Healthy Eating Habits

Establishing healthy eating patterns early helps support not only digestive health but also overall growth and development. Parents can model these habits by prioritizing balanced meals and reducing the consumption of processed foods at home.

Source:

Dr. Maria Oliver-Hemker is also the vice dean for the faculty at Johns Hopkins overseeing more than 5,000 faculty. She is also one of our distinguished members of the Nutrition for Kids Advisory Board.

She's a recognized leader in multiple organizations and has been honored with multiple awards. I encourage you to read her bio, which is linked in the podcast and this article. She was a Top Doctor from US News and World Report as just one of her many accolades. She has more than 110 peer reviewed publications and gives presentations all over the world. She's editor-in-chief of the book, Your Child with Inflammatory Bowel Disease, a Family Guide for Caregiving.

Resources:

Nutrition4Kids podcast episode: https://nutrition4kids.com/articles/kids-diets-affect-their-stomachs-and-intestinal-tracts-and-vice-versa/

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Vernon-Roberts A, Alexander I, Day AS. Systematic Review of Pediatric Functional Gastrointestinal Disorders (Rome IV Criteria). J Clin Med. 2021 Oct 29;10(21):5087. doi: 10.3390/jcm10215087. PMID: 34768604; PMCID: PMC8585107.https://pmc.ncbi.nlm.nih.gov/articles/PMC8585107/

Axelrod CH, Saps M. The Role of Fiber in the Treatment of Functional Gastrointestinal Disorders in Children. Nutrients. 2018 Nov 3;10(11):1650. doi: 10.3390/nu10111650. PMID: 30400292; PMCID: PMC6267171.https://pmc.ncbi.nlm.nih.gov/articles/PMC6267171/

Classen M, Righini-Grunder F, Schumann S, Gontard AV, Laffolie J. Constipation in Children and Adolescents. Dtsch Arztebl Int. 2022 Oct 14;119(41):697-708. doi: 10.3238/arztebl.m2022.0309. PMID: 36261928; PMCID: PMC9830679. https://pmc.ncbi.nlm.nih.gov/articles/PMC9830679/

James J Ashton, R Mark Beattie, Gastro-oesphageal reflux in infants: what are we treating?,The Lancet Child & Adolescent Health,Volume 2, Issue 7, 2018, Pages 475-476, ISSN 2352-4642, https://www.sciencedirect.com/science/article/pii/S2352464218301780

Santillanes G, Rose E. Evaluation and Management of Dehydration in Children. Emerg Med Clin North Am. 2018 May;36(2):259-273. https://pubmed.ncbi.nlm.nih.gov/29622321/

Friesen C, Colombo JM, Deacy A, Schurman JV. An Update on the Assessment and Management of Pediatric Abdominal Pain. Pediatric Health Med Ther. 2021;12:373-393. Published 2021 Aug 6. doi:10.2147/PHMT.S287719. https://scholarlyexchange.childrensmercy.org/papers/3730/