chest pain

The scoop on poop…Could your kid be constipated??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 2 Comments

From infants to teenagers, constipation seems to be a problem for so many kids! I had a visit with a 9 year old and her mom about her stomach pain related to constipation problems. As soon as I left the room I realized that Dr. M was seeing a 2 month old for ongoing constipation issues. Then, at the end of the day, Dr. T’s first call of the evening came in before we ever left the office, and it was about a 3 month old with constipation problems. So, you see, this is a daily problem in pediatrics. Anyone that works in pediatrics will tell you that we talk about poop everyday, sometimes all day. Inadequate nutritional intake and hydration is usually the problem. 

In my house, my kids are 2 for 2 on this topic. Drew Elizabeth has been as regular as clockwork until just a few months ago. I’m sure most of you remember my Paranoid Mom post about Drew Elizabeth’s chest pain. She has never had a problem in the past, but in the past few months she hasn’t been eating her veggies as she should, and as she used to for the past 5 years. Kids…I can’t always explain why they do the things they do… I usually have more problems with my own than with yours! 😉

My poor Joshua has had constipation problems since he was an infant.  Joshua is the child that taught me all about children’s constipation. Well, Joshua and a PNP GI specialist ;-)!  Joshua eats an apple almost everyday. He loves apple slices with cinnamon; I highly recommend this, it’s great for the bowels.  Even with adequate fruits and veggies, Josh still doesn’t drink enough water (hence, the importance of hydration) to keep himself regular.

Most kids do not eat enough fruits and vegetables. For proper nutrition information, you can check out Let Them Eat Cake…For Breakfast??  Not only do most kids need to eat more fruits and veggies, they need to drink more water. Yes, I’ve tried to cover that too, you can read more about hydration in The Importance of Hydration. If adequate amounts of fiber and hydration don’t help your child with their constipation problems, I would recommend an evaluation with your child’s medical provider. Ongoing constipation can cause the large colon to expand and cause nerve damage and leaky gut and multiple other systemic problems that don’t even seem related to the bowels, but they are. Our immune system is centered in our gut, a healthy gut really matters.

By definition, constipation is having 3 or fewer bowel movements in a week that are hard, dry, and usually hurt.

A few facts about constipation:

  • When kids are constipated, they usually eat less.
  • When kids are constipated, they will usually have stomach pain, and usually on the lower left side.
  • When kids are constipated, they may have nausea and vomiting.
  • When kids are constipated, they may have more urinary incontinence (accidents), urinary frequency, and bedwetting.

So, what can you do to help your child with constipation? 

  • High fiber foods: fruits and vegetables (the crunchier, the better), beans, fresh popcorn, baked potato w/skin, berries, oatmeal. (The one fruit to avoid with constipation is bananas, they can make stools harder.)
  • Drink more water!!
  • Decrease processed foods, like carbohydrates made with white and wheat flour.
  • Getting normal exercise can help with bowel movements also.
  • Do not rush potty time. Children will often not take the time that they need to sit and eliminate their bowels.
  • Infants will frequently have temporary constipation problems when they are transitioning to new foods such as cereal, or  from breastfeeding to formula feeding. Do not give cereal under 4 months unless instructed by a medical provider.
  • In infants, try a couple ounces of 100% apple or pear juice, if this doesn’t work, you can try prune juice. Baby juice does not need to be diluted, adult juice should be diluted with half water.
  • Abdominal massage. I recommend abdominal massage to all the infants I work with that have constipation issues as a first line treatment! Massaging clockwise around the belly button and then doing the I Love You massage can work wonders for infants. With the I Love You massage, start with a few strokes of the I (left of belly button), then the L is upside down (above and to the left of the belly button), and then the U (around the belly button). This helps massage the large bowel, and can be quite helpful. Be sure to use mineral oil and apply a moderate amount of pressure. Most babies will enjoy this once they start to relax.
I hope you found some of this information helpful! Constipation can definitely make this parenting  journey a little painful for you and your child!
The ‘I Love You’ massage works! Ask the massage therapist that taught me about it when Joshua was an infant. 😉

Paranoid Mom…. It happens to the best of us!

/ Katie P. Tolley, RN, MSN, CPNP-PC / 7 Comments

Hi all! After the morning I had, I just had to share this one…. It’s alright to be a “Paranoid Mom” because the well being of your children is a HUGE responsibility! I thought you all would enjoy knowing that I can be that Paranoid Mom too! 😉

Drew Elizabeth told me last night that her chest hurt. Ok, no big deal, I was convinced that she just needed to burp, toot, poop, or all of the above. Very frequently children will have chest pain that is referred gas pains. She has complained of her chest hurting 2 or 3 times in the last month or so, but she also hasn’t been eating her veggies as well as she used to. She has decided after eating her veggies for the past 5 years that she just doesn’t like them anymore. She doesn’t get away with it, and I make her eat a little. Not getting enough fiber can certainly decrease the frequency of bowel movements and the consistency of said movements. She is displaying her independence, and this is something she can control. No biggie.

When she didn’t even want the ice cream I had taken her to get, I was a little more concerned, but still thought she probably needed to go sit on the potty for a few minutes. I decided I would grab my stethoscope and take a listen to make her feel better. She will tell me she needs me to take care of her like I take care of the sick kids at work, so I didn’t want to deny her. Well, I took a listen……

I think I have mentioned before that we shouldn’t go looking for problems, because we may not be prepared to deal with what we find. Much to my surprise, I found that my daughter’s heart sounded like it was skipping a beat. Naaa, I must be hearing things, or it is just fluctuating because of her breathing, or something….. It is not unusual for heart rate to slow or increase on inhalation and exhalation. I listened a little longer…..Yep, there was definitely a skipped beat every 3rd or 4th or even 8th beat!! WTH?!? Interestingly enough, I have a cardiac history, and both of my children have had an EKG (electrocardiogram) because of it, and they were perfectly fine! Drew has even had an echocardiogram because she had a benign (innocent) murmur when she was 1 year old. So, here I am listening to my 5 year old, and her heart is skipping a beat! Yes, I looked quite calm on the outside, but the inside kept thinking, “What the He!! is going on???” I am fortunate enough to be able to call my colleagues that are close by. The PA I used to work with lives one mile down the road, and our Pediatrician (that I used to work with) lives a mile away in the other direction. I knew I could take her to either of them for a second opinion. No, I am not my kids Pediatric provider, I am their Mom! As soon as something is abnormal with either of them, I second guess my assessment skills and diagnostic skills. It is unusual for a child to have chest pain that is cardiac related, actually only 4% of pediatric chest pain is cardiac.

I broke down and called our Ped, Dr. Denise. She is awesome!! I can call her anytime for anything! She is a wealth of information, like an encyclopedia of pediatrics. Denise gave me some advice, we didn’t think the pain was cardiac related, as I first assumed, but we concluded that Drew needed an EKG first thing in the morning, but she was probably alright. BTW- she pooped and tooted and the pains went away, but the skipped beat was still there. So, my plan was to take her to the office in the am, get her evaluated, and they would say, “Oh, Katie, you were over reacting, we don’t hear anything.” Well, that was my plan, I was ready to be the crazy paranoid mom! No problem, it was my lack of skill, not her heart! I was good with that!

Well, I went to the office, told them I needed an EKG and we got started.  I love my kids pediatric office, they are the best! I worked there for almost 8 years before I was a PNP. My friend, T.,RN did her vital signs and asked what was going on. I said to just listen to her heart and tell me what you think. I watched her listen and start counting Drew’s heart rate, she nodded as she counted, 1, 2, 3…1, 2, 3… T looked at me with big eyes and a strange face… I said, “So, you hear it too?” She did! Oh, $#!+! I didn’t want her to hear it, I would rather be crazy! So, we finished vital sign, height, weight, and I waited for Karen, my friend the PA. Karen is a great PA! I adore her and we take our kids back and forth the mile between each others houses when we need a second opinion after diagnosing our own children. Drew really likes Karen, and did whatever Karen asked. So, Karen listens….. She looks at me, and nods her head! Dammit!! I wanted her to tell me she didn’t her it! But, of course she did.

My girl with all of her EKG wires attached! She ROCKS!

Well, this started the procedure for the 1st of 2 EKGs and 60 second rhythm strip (which recorded and showed her heart beat for a full minute). The first EKG was at the office, and then Karen sent us to the Diagnostic Center for a repeat EKG and the rhythm strip. Drew was so good during all of this! My sweet girl, this was going to have to be OK, I couldn’t deal with anything being seriously wrong with my girl’s heart! I’m sure you all know exactly how I felt! During the 2nd EKG and strip, the tech looked at me and said, “I know exactly what you are looking at, it’s right here and here and here…” OK, now my heart rate was up a little, too many people are confirming that I am not crazy, I REALLY PREFERRED CRAZY at this point!! I looked at the results, normal QRS, that’s reassuring, each individual beat had the proper electrophysiology, the conduction controlling her heart beat was doing it’s job, there was nothing abnormal about how the heart was beating, but there were obvious pauses between some of the beats.

So, as soon as I left, I called Denise (she was home because she had been on call all weekend). She said this is probably ok, we talked about the details, and she told me what she thought we should do. I called Karen back at the office, and Karen put a call in to “The BEST” Pediatric Cardiologist in the the Mid-Atlantic region. I am so grateful to have friends that take care of my kids, and know how to get answers, and get answers from the Experts! Dr. Ruckman of Children’s National Medical Center is one of the BEST in the nation! Karen spoke to him 2 times before lunch and called me.  Dr. Ruckman confirmed without a shadow of a doubt that this was a “normal abnormality” in children Drew’s age.

 HALLELUJAH,  HALLELUJAH…..HALLELUJAH, HALLELUJAH, HHHHAAAAALLELUUUU-JAHHHH!!!!

I could hear the angels singing in the background with me! THANK YOU, GOD! 🙂

I know this is a pretty personal post, and rather specific situation that I hope NONE of you ever face. What are the odds of listening to your daughter’s heart, just to make her feel better, because you are convinced she just needs to poop, burp, or toot, and there is an abnormal heart rate…. Hopefully, never! Drew was a trooper and got 3-4 lollipops during the whole ordeal, and even a chocolate donut on the way to school. As for me, I went on to work, and had a normal busy afternoon. I was happy with normal, busy! 🙂 

I can do without another day like this morning for the rest of my life! I know it won’t be that easy, something else will come up that makes me worry about my kids, and I pray that it will turn out just fine.  I thought it would be nice to share so that you know even the professionals get a little worried every now and then! Today was one of the days on this journey that I could have lived without! I am thrilled that at the end of the day everyone is happy, healthy, and Drew has no idea of the stress that was going on inside her mother for a few hours as I waited to be sure she was ok.

So, today, I enjoyed the journey a little less than some days; but all in all, “It is a wonderful life!” 😉