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Common Paediatric GI complaints Dr J Henderson Paediatric ConsultantIntroduction • Topics to be discussed (in 20ish minutes) • Nutrition • Feeding difficulties • Poor weight gain • Abdominal pain • Constipation • DiarrhoeaNutrition • 1-5yrs: 1000kCal for first year then add 100kCal for each year • Formula milk meets these demands • Formula should only be changed if under the direction of a healthcare professional • Breast milk is best form of nutrition: support new mums, do not pressure! • Fed is best • Think about mental health as well • Social media sites/groups are not always as “supportive” as they are indented to be • Solids from 6mths (can be as early as 4 months eg GOR) • 1-2yrs of age • Higher Fat, lower fibre • Full fat milk • 2-5yrs of age • Gradual reduction in fat, increased fibre • Semi-skimmed milkNutritional Assessment • Dietary Intake (may need dietician) • Feeding difficulties • Chronic Disease • Clinical Exam • Growth charts (centile “spaces”) • BMI (guide only) • Behavioural changes (eg social, irritable) • Subcut fat • Thin hair, poor nails, pale conjunctiva • Stomatitis • Hepatomegaly - ?Fatty Liver infiltrates • Investigations • Focused • Anaemia (FBP + red cell indices) • B12 & folate • Albumin • Consider Fat soluble vitamins & ZincFeeding Difficulties • Can lead to Malnutrition • Reduced intake (eg Tongue tie, CP, poverty) • Malabsorption (Eg CF, Coeliac) • Increased Loss (eg vomiting, diarrhoea) • Increased requirements (Heart/thyroid disease)GOR(D) • GOR: non-forceful reflux of gastric contents into oesophagus • GORD: GOR causes complications: • Faltering growth • Oesophagitis • Aspiration • Vomit: Forceful contraction of the diaphragm • Posseting: Infant regurgitation due to functional immaturity of the lower oesophageal sphincter • Resolves by 12-18mths (no treatment needed)Abdominal Pain • Functional or Organic? • Do not label as “functional” if: • RU/LQ pain • Nocturnal • Pr bleeding • Unexplained pyrexia • Weight loss • Delayed Puberty • Joint involvement • FHx of organic diagnosisAbdominal Pain - Organic • History extremely important! • Age • Symptoms •Location • Duration • Systems questioning • Don’t forget, the primary problem may not be within the abdomen •Don’t forget the testis, hips, chest and ENT examAbdominal Pain - Functional • Only diagnose if organic pathology ruled out • Functional Diarrhoea •Aka Toddler Diarrhoea • Symptoms >4 weeks • Onset usually 6-36mths • No faltering growth (assuming normal calorie intake) • ≥3 large soft unformed stools/day when awake • ?Role of Faecal CalprotectinAbdominal Pain - Functional • Functional Constipation • ?timing of meconium after birth • Use Bristol stool chart • Reassurance (if no pathology suspected) • Not “bowel obstruction” • Provide advice on this • Education • Advise what will happen with laxatives • ?more pain • ?watery stools • Compliance with medication – not a “quick” fix • ERIC website • Poo goes to “pooland” storiesConstipation • NICE guidance • Red flags • Reported from birth • Ribbon stool • Meconium delayed (>48hrs) • Abdo distension with vomit • Leg weakness/abnormal reflexes • Treatment • Hydration • Good digestive health • Macrogol • Macrogol + Stimulant • Treatment tailored based on overall needs of the patient (eg, chronic pathologies needing suppositories – not because the parent asked for one)Diarrhoea • ?Dehydrated • Ketones in urinalysis does not diagnose dehydration • Clinical assessment (AVPU, HR, eyes, Skin, U/O) • Can be present with other pathologies • Focused history important (eg sepsis? Colitis?) • Don’t forget travel history • GE usually 5-7days. • Challenge you diagnosis if >2 weeks • Can have transient lactose intolerance around D10. • NICE guidance • ORS • Hand hygiene • No school until after 48hrs of last episode • No swimming for 2 weeksThank you for listening Any Questions?