dehydration

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. 😉

Yuck, the “throw ups”…Do I need to be worried because my child is vomiting??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 1 Comment

Well, tonight’s post wrote itself when friends of mine called to make sure they were doing the right thing for their daughter that had been vomiting all day. I saw kids of all ages today that had nausea, vomiting and diarrhea.  So, it sounds like the best parenting advice right now would be on managing that nasty stomach virus also know as gastroenteritis.

Poor little Maddie has been vomiting all day.  Her brother had vomiting and diarrhea a few days ago, and now it sounds like it’s her turn.  One question her Dad had; could it be something else? Well, maybe…but, probably not.  Dad told me he had been giving Maddie about a 1/2 ounce of Gatorade every 20 minutes or so.  She had been doing fairly well, then started having really bad stomach cramps. It seems that Maddie took a big drink of Mom’s tea, which wasn’t a good idea, but who can blame her, she was probably really thirsty.  Maddie probably had more than her stomach was able to tolerate.  It probably didn’t help that the tea had caffeine in it, which can be irritating to an empty stomach.  Drinking too much or eating or drinking the wrong thing can cause the pain and vomiting to start again. With rest and small amounts of fluids, Maddie will probably get throght this stomach virus just fine.  Slowly staying hydrated, and then eating small amounts of bland foods.  No doubt, she will be back to her happy playful self, and keeping up with that brother of hers.

Most vomiting spells will usually last 8-12 hours, but can come and go for a few days.  If your child vomits for more than 24-48 hours, you might want to consider having them evaluated by their pediatric provider.

Most children will have diarrhea with or after vomiting. This is just another way for the virus to exit the body.  Do not give children medication to stop the diarrhea or vomiting.  If this is necessary, medication should be prescribed and supervised by your provider.

Dehydration is usually the worst complication of gastroenteritis. Keeping your child hydrated after the initial vomiting spell is very important.  If your child is vomiting, don’t give anything by mouth the first couple hours; then give small sips of pedialyte or Gatorade (1/2 oz.) every 15-20 minutes.  For young children, Pedialyte popsicles can be really helpful.

If children tolerate fluids after several hours, try bland foods such as saltine crackers and toast.  Slowly, increase the diet with bland, salty foods over the next few days.  Do not give your child milk products, acidic products, or greasy foods. French fries and chicken nuggets are NOT a good idea.  Yes, too many parents of 3 or 4 years old children will come into my office and say, “Well, she said she would eat chicken nuggets” (or hot dogs, you can fill in with either)…. I want to scream “Are you kidding me?”   Fortunately, I learned to bite my tongue a few years back.  Trust me, it took some practice, I usually say what I think, but have learned that I just can’t do that sometimes.  Those of you that know me are smiling and laughing right now, no doubt. 😉

So, What else could it be??

  • Some people are concerned that their child could have appendicitis.  Believe me, that is the first thing I want to make sure a child doesn’t have either.  Appendicitis does need to be ruled out if a child is having severe or ongoing abdominal pain.  Appendix pain is usually in the lower right quadrant of the abdomen, but the pain can radiate elsewhere.  If you are worried your child may have signs of appendicitis, please see your provider.  This is not an easy diagnosis to make, even with physical exam.
  • Sometimes children will have vomiting, with a fever, sore throat and headache; beware, this can be strep throat.  Some children with strep throat will vomit.  My poor Joshua is one of these kids.  He has only had strep twice in his life,  first, with pneumonia.  Then, a few years ago he presented as fever, nausea and sore throat.  The poor kid vomiting for over 8 hours, he was pitiful.  If I hadn’t seen the positive strep test myself, I would have really thought it was a stomach virus.  It’s always safest to check if you have any doubt.  Strep throat cannot be confirmed without a throat culture, and MUST be treated with an antibiotic.

Again, I want to stress the importance of HYDRATION! Slow but steady hydration is the key to avoiding dehydration. If your child does not urinate at least once in 12 hours, please have him evaluated for dehydration.  Fever, along with vomiting and diarrhea can increase the risk for dehydration.  For more advice on fevers or hydration, please see my related posts.

Remember, sick kids need a little more patience, understanding, and TLC.

At some time or another, a vomiting child is something we all deal with….kind of like a rite of passage. Every Mom or Dad has a gross vomiting story to tell. Good luck with the vomiting thing when you experience it along your parenting journey.