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Ask The Expert Archive

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Pediatric Gastroenterology Archive Questions

Below are Dr. Samra Blanchard’s answers to Pediatric Gastroenterology questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 29.

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Q : 1

My Son is 7.5 weeks old. He currently goes about five days without having a bowel movement. He is miserable by day four. His doctor says this is normal but I seem to think that it is not. Should I take him to see a specialist?

It is within normal range to have bowel movements every 4-5 days if the baby is breast feeding and passed mecinium(the baby poop) within 24 hours of life. On the other hand, I suggest to see specialist to make sure, there is no underlying Hirschprungs disease causing the constipation.

Q : 2

Both of my kids have gastritis and they are under 12 years old I don't know how to deal with this problem. Any suggestions?

It really depends on visual or microscopic gastritis and if it causes symptoms. Acid blocker therapy in children is enough to heal gastritis.

Q : 3

Are neocate and elecare the same? Currently I'm paying for neocate but have a resource where I could receive elecare for free (however, I'm unsure if it would last for the first full year while my son will need it). Is it bad to use elecare and then switch back to neocate?

Formulas are divided by their protein sources. Both elecare and neocate are used in cows milk protein and soy allergy when other formulas are not tolerated. They are all aminoacid formulas used in this condition. If you have Elecare, you can use it in cows milk protein and soy allergy states.

Q : 4

I have a 19-month-old preemie who tested positive for milk allergy (high), soy (low) and peanuts(low). She has not been gaining much weight and is in the 3 percent on the chart. It is recommended that we go forward with an endoscopy. Is that necessary?

There is no harm in trying a milk/soy/nut free diet, but she needs to drink elemental formula to gain weight. She should drink Elecare 30 cal/oz or Neocate 30 cal/oz to help her gain weight. If she is not better, then you should consider endoscopy. However, it is important to remember that she needs to gain weight because she is in the critical age for brain development and she needs nutrition.

Q : 5

We have a 10-year-old who was diagnosed with fructose intolerance via a breath test. What should we do?

There could be a small bowel bacterial overgrowth that makes him predisposed to fructose intolerance. Ask your doctor to test for that bacteria in the breath test. Otherwise, the child should be on a decreased fructose diet.

Q : 6

My 15-year-old daughter has several small gallstones. What is the course of treatment for someone this young?

If she has abdominal pain, I recommend she have her gallbladder removed.

Q : 7

Is it safe to give fresh cow's milk to a one-year-old infant?

It has to be pasteurized, otherwise infection is a risk.

Q : 8

At about 6.5 months old, my son started having constipation. He is now 8.5 months old and nothing is working. We have tried everything. Do you have any suggestions? Should he see a pediatric GI specialist?

Young infants should see a pediatric gastroenterologist to make sure there is no underlying problem for constipation. Constipation can occur as a result of the intake of formula or breast milk and baby food. Another indicator that is evaluated is whether or not the baby passed meconium (the first poop) within first 24 hours of life. If he requires stimulation to pass a bowel movement, like using a suppository, we need to rule out Hirschsprung disease.

Q : 9

My daughter had Nissen Fundoplication for a hiatal hernia at age 5. She is now 15 and she spits up mucus in the morning when she's having allergies or a cold. Is that normal?

As children grow up, they have tendency to grow out of their Nissen which is expected. It is normal to spit up mucus with allergy and cold symptoms.

Q : 10

Can intestinal malrotation be treated without major surgery in an 18-year-old girl?

Intestinal malrotation, if not treated surgically, has the consequence of volvulus which can lead into the loss of small bowel and short gut syndrome. Once diagnosed, I always refer my patients to surgeons to prevent the risk of this severe complication. Not treating malrotation has its own risks. Please discuss with your local surgeon.

Q : 11

My 15-year-old daughter has advanced intestinal metaplasia. Is there any preventative steps that I can do for her so it doesn't get any worse and turn into cancer? She is currently taking Nexium and Carafate.

It depends where the intestinal metaplasia is. If it is in esophagus, does she have Barrett's esophagus? Barrett's esophagus requires screening for dysplasia and if patients develop dysplasia, this may predispose cancer in the future. If it is in the stomach, acid blocker can help and there is no cancer risk.

Q : 12

My 3.5-year-old has just been diagnosed with receptive expressive language disorder. I'm currently doing research on whether or not a gluten-free diet may benefit him. Do you have any knowledge of this subject?

There are three clinical entities regarding gluten. Celiac disease, wheat allergy or gluten sensitivity. A food allergy or Celiac can easily be ruled out by blood work. Gluten sensitivity can be only diagnosed with elimination. You can eliminate for three months and see if there is any improvement in symptoms. If there is no change, I don't think it it is worth to do it.

Q : 13

My son is 2 years and 4 months and is suffering from lactose intolerance. What study or test can I do for diagnosis?

It is rare to see primary lactose intolerance at his age unless there is an underlying parasitic infection or Celiac disease. In general, to diagnose lactose intolerance, you do a breath test. However, you should also have him tested to see if he has cow's milk protein allergy, as this is more likely.

Q : 14

My 11-year-old daughter had her gallbladder removed two weeks ago due to biliary dyskinesia. Now she is experiencing pain under her right rib. Could this be SOD?

We rarely see SOD in children. If her initial complaint is abdominal pain and biliary dyskinesia is found during evaluation of abdominal pain, she may still continue to have abdominal pain. This may be an incisional pain or local irritation of nerves, you have to see your surgeon to make sure there is no surgical complication.

Q : 15

My 4.5-year-old daughter has struggled with her BMs for some time now, going maybe 2-3 days between, despite healthy eating, vegetables, raisins, water etc. She seems to become very quiet and will even go to a corner of the house when it is time for the BM to come. She doesn't necessarily complain of pain, but looks uncomfortable and often sits for a while. The most concerning part to us, however, is the size of the stool which can be very large. Part of it may be hard and part soft, or at times it is all a bit soft "pile" of stool. Her next check-up is in June. What should we do?

You are describing typical withholding behavior. You can have your PCP check for Celiac serology to make sure there is no underlying Celiac disease as a cause of constipation. Otherwise, I usually recommend a one day clean out regimen followed by daily stool softener (Miralax) to keep stools in pudding consistency so that she can not hold. Her colon is stretched out which is why she does not have the urge to go when she has regular sized stool so that by the time she has the urge, the size of her stool is quite large and she struggles.

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