Conditions We Treat

Acid reflux is the term used when the stomach contents come back up into the esophagus while eating or after a meal. Most people experience this at some time and it’s only a cause for concern if the reflux occurs frequently.

How is it diagnosed?

Signs of acid reflux are different at different ages. For babies, spitting up is common and usually not a sign of any real problems. But if the spitting up is frequent, that could be a sign of pathologic reflux. In older children or teens, symptoms can also include excessive burping, hoarseness, painful or difficulty swallowing, coughing, wheezing, frequent stomachaches or heartburn.
Tests can also be performed including barium studies, and upper endoscopy (to check the esophagus and stomach) or an esophageal pH probe.

How is it treated?

Infants, children and teens are treated differently, and in some cases, all that’s needed are some lifestyle or diet changes. Sometimes, acid blocking medications are prescribed.

Children of all ages can suffer from occasional stomachaches or abdominal pain, which is common. But if the pain is frequent or lasts for two or more months, there could be another reason such as constipation, lactose intolerance, inflammation (celiac disease or inflammatory bowel disease), or infections. Even stress can be a trigger.

How is it diagnosed?

Your pediatric gastroenterologist will take a detailed history to determine when and where the pain started and if it has changed over time. Tests on blood, urine and stool can be performed to look for other causes of the pain. If those tests don’t indicate a cause, an X-ray, imaging studies, or additional lab tests may be recommended. In some cases, an endoscopy may be performed so the physician can check for any issues in the digestive tract.

How is it treated?

Once the cause of the pain is diagnosed, treatment will focus on the root cause. If the pain is considered ‘functional’ – which means there may be pain despite normal digestive function – the treatment may include diet changes or medications.

Celiac disease is an autoimmune disorder in which consumption of gluten (a protein found in wheat, rye and barley) leads to intestinal damage. When a child has celiac disease, the immune system actually attacks the small intestine and this damage leads to malabsorption of important nutrients. If left undiagnosed or untreated, these patients can become malnourished or suffer from bone loss or neurologic symptoms.

With the incidence of food hypersensitivity and allergies on the rise in children and adolescents, diagnosing celiac disease can be difficult. Chronic abdominal pain, for example, is considered a classic symptom of celiac disease, but it can also be a sign of a specific food allergy – or an indicator of inflammatory bowel disease.

How is it diagnosed?

For children and adolescents in particular, there are some specific symptoms and risk factors that may lead to a diagnosis of celiac disease. Symptoms of celiac disease can appear at any age once foods containing gluten are introduced into the diet.

'Classic' symptoms include abdominal pain and bloating, vomiting, diarrhea as well as weight loss or ‘failure to thrive’. Less typical signs include joint inflammation, decreased bone density, dental enamel defects, delay in puberty, rashes, fatigue, short stature and iron deficiency anemia. Celiac disease is often seen in children who are considered high-risk, such as those with autoimmune thyroiditis and diabetes mellitus Type 1, Turner Syndrome, Down Syndrome, Williams Syndrome or those who have a first-degree relative who has been diagnosed with the disease.

There are three primary ways to test for celiac disease in children:

1. Perform a serologic test (such as antibody to tissue transglutaminase, anti-tTG IgA).
2. If blood testing is positive, perform an upper endoscopy to biopsy the small intestine and confirm the presence of celiac disease.
3. After diagnostic testing is done, place the patient on a gluten-free diet and monitor symptoms for remission.

How is it treated?

A life-long gluten-free diet is the only known treatment.

Colic is a common condition among newborns characterized by inconsolable crying and fussiness. These fits of crying generally happen at night, but may not follow a pattern in some babies. The good news is that if a baby is suffering from colic, it doesn’t necessarily mean anything medically is wrong and even colicky infants will gain weight and continue a normal growth pattern.

How is it diagnosed?

First, your physician will rule out any medical conditions and review the behavior and pattern of crying. If the physical exam reveals that the baby is otherwise healthy, then the ‘Rules of Three’ are considered:

1. At three weeks old, crying starts.
2. The crying lasts for three hours a day.
3. It happens at least three days a week.

How is it treated?

Although there is no defined ‘treatment’ for colic, there are a few things that may help parents and caregivers get through this often frustrating time. Occasionally, mothers who breastfeed can make changes in their diet. Removing dairy products or foods that cause gas is a good start. If the mother isn’t breastfeeding, a change in the baby’s formula could help. In addition, the baby may benefit from massage or soft music and swaddling can also help.

Constipation is generally defined as having fewer bowel movements than usual or having painful bowel movements. Constipation isn’t unusual in children, but it could be an indicator of an underlying condition that needs special treatment. “Functional” constipation (which means the condition is not related to another cause like colon disease) is often diet-related.
Another common cause is a child’s avoidance in using the toilet. In infants, straining or having trouble with bowel movements could just be a sign of their body system being immature. Toddlers often are too busy playing to stop and use the bathroom, while some school-age children may be uncomfortable asking for a break or going in a less private environment.

Other general causes include changes in diet or schedule, traveling, toilet training, or taking over-the-counter cold medications, some pain medications and more serious drugs, like antidepressants and chemotherapy medications.

How is it diagnosed?

What is normal for one child may not be normal for another. As children grow from infancy, their bowel movements become fewer as a rule. An infant can have several bowel movements a day, while a child of 3 or 4 may not even go every day.

Physicians look at each child’s history and routine to check for underlying causes, but generally ask if the child has difficulty passing stools, what the stools look like, if several days pass without a bowel movement or if the child has large stools.

How is it treated?

In some cases, increasing fluids or fiber in the diet can help or giving the child a mild laxative may be recommended. If the constipation becomes chronic, patients may require long-term treatment.

Diarrhea is generally defined as an increase in the frequency of bowel movements or stools that are loose or liquid. The condition is considered ‘chronic’ if it lasts for four weeks. Causes of diarrhea can vary with age. For younger children, it could be the result of lactose intolerance or too much fructose from juice. Other causes include food allergies, food poisoning, bacterial infections, irritable bowel syndrome, Crohn’s disease, ulcerative colitis or celiac disease.

How is it diagnosed?

Diagnosing chronic diarrhea starts with providing the physician with information describing the stools, what other symptoms your child might have, a review of the child’s diet and whether your child is taking any medications, including antibiotics. Stool and/or blood tests may be required, and possibly an upper endocopy and colonoscopy.

How is it treated?

Since every child is different, the treatment will be directly tied to the cause. Often, only a change in diet is recommended, but some children may require medication – especially if there has been significant weight loss.

Encopresis, or fecal incontinence, is a condition that occurs when a child (usually 4 years or older) holds a bowel movement to the point that some stool may pass through, resulting in soiling. There can be a number of causes including diet, a decrease in fluids, illness – even fear of the toilet or the inability to use a facility that’s not private. Because every child’s ‘normal’ bowel activity can be different, the first clue to this condition is determining if your child is constipated. Then monitoring if your child is soiling his or her underwear unknowingly.

Once a child starts holding bowel movements, fecal matter can actually get stuck, making it harder and more painful to go. If fecal matter starts to build up and a child has large stools, this can stretch out the colon and weaken the muscles and nerves that give a child that urge to go to the bathroom. This can cause a child to ‘go’ without even knowing it.

How is it diagnosed?

Your physician will need to know if your child has any symptoms like soiling their underwear, having small, hard stools or experiencing pain while trying to pass a stool, have large bowel movements, experiencing abdominal pain or losing their appetite.

How is it treated?

Treatment depends on a child’s age and their symptoms. Laxatives or stool softeners may be recommended to essentially empty the child’s colon and rectum. (The bowels and colon need time to shrink back to normal size.) You may be asked to schedule times for your child to go the bathroom after each meal. Even if they don’t have a bowel movement, this could help your child pay attention to those urges to go.

Eosinophilic Esophagitis (EoE) is an isolated inflammation of the esophagus caused by an abnormal production and accumulation of a specific white blood cell called the eosinophil. A variety of stimuli may trigger this adverse reaction, including a combination of immediate and delayed hypersensitivity to certain foods. Children with EoE range in age, gender, and ethnicity and usually have other allergic diseases – like asthma or eczema. Some common indications of the disease in children include abdominal or chest pain, difficulty feeding and swallowing food, failure to thrive (poor growth, malnutrition and weight loss), poor appetite, and vomiting and not respond to reflux medication.

How is it diagnosed?

In order to accurately diagnosis EoE, a procedure called an upper endoscopy with biopsy is required to identify and examine the eosinophilic inflammation in the esophagus.

How is it treated?

Treatment is based on eliminating the child’s ‘trigger’ food – the food that is causing the hypersensitivity or allergy. When trigger foods are removed from a child’s diet, symptoms of EoE can resolve and inflammation in the esophagus can heal over time. Treatment options include swallowed corticosteroids or diet elimination. This involves removing common foods that have been seen in allergic diseases: milk, egg, wheat, soy, peanuts/tree nuts, and seafood (fish/shellfish). By reintroducing each food slowly and monitoring esophageal reactions, the child’s trigger food or foods can be identified and eliminated from the diet.

This is a commonly used term to describe children who are not growing or gaining weight based on standard medical charts. FTT can happen when a child isn’t getting enough calories, isn’t absorbing their food or can’t eat properly. There are a number of reasons for FTT and some include the possibility that the child has a gastrointestinal issue like GERD or problems with their upper GI tract.

How is it diagnosed?

Physicians pay special attention to the weight and height of children to see if they are growing and gaining weight appropriately. Then they look for any GI issues that may be causing loss of calories, such as persistent vomiting or chronic diarrhea, which could be the result of celiac disease, inflammatory bowel disease or some other condition. They may also ask you if your child has any pain related to eating or refuses to eat. They may also ask you to keep a food diary to see if the child is getting the proper nutrition.

How is it treated?

If an underlying GI condition is found, the treatment for that particular disorder (like celiac disease or difficulty swallowing) will be recommended.

Sometimes a nutrition consult is necessary to adjust the diet based on the diagnosis and to make sure the child is getting and absorbing sufficient calories for growth.

Feeding and swallowing difficulties are referred to as dysphagia, which is generally considered a symptom brought on by other conditions. Dysphagia can occur at any age. Feeding disorders in general are quite common in children, but differentiating between a child who is a picky eater and a child who may have an underlying medical problem requires evaluation. Most children who are picky eaters outgrow their aversion to certain foods as they age. But some eating behaviors can impact normal growth and development and should be addressed as early as possible. If left untreated, feeding difficulties and disorders can lead to serious developmental delays and other issues, like malnutrition or anemia.

Some of the more common medical issues associated with feeding and swallowing difficulties include colic, eosinophilic esophagitis (EoE), gastroesophageal reflux disease (GERD), or any esophageal conditions that impact the muscles that regulate swallowing.

How is it diagnosed?

The symptoms of dysphagia are varied and will differ in each child. They could include experiencing pain while swallowing, actually being unable to swallow, regurgitation, coughing or gagging while swallowing, the sense of food getting stuck in the throat, acid reflux and unexplained weight loss. Feeding and swallowing difficulties are also often seen in children with other medical issues like cerebral palsy, cancer, head or spinal cord injuries and is sometimes seen in children who were born prematurely or with a cleft palate.

Diagnosing dysphagia can include a barium swallow study, an endoscopic evaluation of the upper digestive tract, or a test called manometry, which measures the muscle contractions in the esophagus.

How is it treated?

Depending on the diagnosis, treatment may include medication or a change in diet. In some cases, surgery can help. Certain children with swallowing difficulties may benefit from therapy with a speech pathologist.

The gallbladder is a small sac on the right side of the body, under the liver. The sac stores bile and aids in the digestion of fat after eating. Gallbladder disease is not as common in children as it is in adults, but they can suffer from inflammation, infection or gallstones, which can actually block the bile ducts. In children, the most common types of gallbladder disease are gallstones, inflammation of the gallbladder (cholecystitis), or a congenital defect.

The most common symptom in children is a pain in the upper right abdomen after eating that lasts for 30 minutes or longer. Other symptoms include nausea, vomiting, indigestion or burping after a meal. The symptoms can also include a high fever and chills.

Children can even develop gallstones and often the symptoms can look like digestive problems. Gallstones can block the bile ducts and can result in jaundice, a condition that causes the skin and the whites of the eyes to turn a yellowish color. Some children can be at an increased risk of developing gallstones if they are obese, have a family history or have inherited blood problems, like sickle cell disease.

How is it diagnosed?

If gallbladder problems are suspected, several tests can be run to confirm the diagnosis including ultrasounds, CT scans and blood tests.

How is it treated?

In children with recurring gallbladder issues, the most common treatment is surgery to remove the gallbladder.

This type of bleeding can occur if a child strains when having a bowel movement, passes an abnormally hard or large stool, has hemorrhoids or has an irritation from a fissure. The cause can also be polyps in the colon or inflammation resulting from colitis or Crohn’s disease.

How is it diagnosed?

The physician will examine the child to determine what is causing the bleeding and discuss any symptoms that may indicate if the bleeding is an indication of an internal issue. Procedures including upper endoscopy or colonoscopy are frequently required to evaluate the source of the bleeding.

How is it treated?

For issues related to bowel movements or hemorrhoids, the treatment may include a stool softener or a change in diet. Depending on the cause of the bleeding and the location, a colonoscopy may need to be performed to see if there are polyps or other reasons for the bleeding. This procedure also allows the physician to remove any polyps found or take a biopsy to help diagnose the cause of the bleeding so the proper treatment can be recommended.

There are several types of hepatitis. Hepatitis A is caused by a virus children can catch from close contact with an infected person or from eating contaminated food. Hepatitis B is also caused by a virus that is spread through contact with an infected person’s blood or bodily fluids. Vaccinations for both of these types of hepatitis are recommended for all children.

Hepatitis C

Hepatitis C is a contagious liver disease caused by a viral infection. Since it is contagious, there are a number of ways it can be transmitted: infants born to mothers who already have been diagnosed with hepatitis C, contact with infected needles or the blood of a carrier, tattoos or body piercings with unsterilized equipment and in teens, unprotected sex with an infected person. Most people who have been infected have no symptoms, but if a child exhibits any of the following symptoms, they may have one or more symptoms including, fever, nausea, vomiting, diarrhea, dark urine, pale stools, abdominal pain jaundice or an enlarged liver or spleen.

How is it diagnosed?

During a physician examination, the physician can check for jaundice or perform an ultrasound to see if the spleen or liver are enlarged. The diagnosis can be confirmed with a blood test.

How is it treated?

There are several medications to treat hepatitis C and new drugs are being developed now. Depending on the type of hepatitis C diagnosed, your physician can determine the best treatment. Children diagnosed with the virus should get vaccinated for hepatitis A and B.

Hirschsprung’s disease is a disease of the large intestine and is considered a birth defect. A person with HD is born without the nerve cells that control the muscles that push stool through the large intestine. When the special cells (called ganglion cells) are missing, stool can build up in the colon and can lead to infections, pain and swelling or bowel blockages. Symptoms usually show up right away. Newborns who don’t pass stool in the first two days are checked for this disease. Other symptoms in babies include constipation or difficulty passing stools or they may vomit or have an enlarged belly. Some have diarrhea. Constipation is generally the main symptom in children or teens.

How is it diagnosed?

If Hirschsprung’s disease is suspected, the physician can perform a number of tests to confirm the diagnosis: a rectal biopsy, an abdominal X-ray, a barium enema or a test called anorectal manometry. This is a test that uses a small balloon to test the muscles in the anus and rectum.

How is it treated?

Children diagnosed with HD require surgery to remove the part of the large intestine that is missing the crucial ganglion cells. Then the healthy part of the colon is connected to the anus.

H. pylori is a bacteria that causes an infection of the stomach. Generally, it occurs when a person swallows the bacteria on food or fluid and it can come from using contaminated utensils or mouth-to-mouth contact through saliva. Children who get this infection may not experience any symptoms, but some of them may develop a stomach inflammation or ulcers.

How is it diagnosed?

If H. pylori is suspected, a stool test can be performed to look for the bacteria. Also, an endoscopic procedure may be performed to look at the lining of the esophagus, stomach and small intestine. Biopsies of the stomach can be taken and checked for the bacteria.

How is it treated?

Generally, a combination of antibiotics are used to treat H. pylori.

There are two main types of inflammatory bowel disease (IBD): Crohn’s disease and ulcerative colitis (UC). Both cause a child’s immune system to become overactive resulting in pain, swelling and inflammation of the intestines. While UC affects just the lining of the colon, Crohn’s disease can affect any part of the gastrointestinal tract.

IBD can affect children at any age and is most often seen in school-age children and teens. Some common symptoms include fever, nausea or vomiting, weight loss, frequent diarrhea, blood in the stool, and stomach pain. It can also affect the skin, eyes and joints.

How is it diagnosed?

After a thorough review of a child’s medical history and a physical exam, the physician can order blood tests, stool samples, X-rays or CT scans to diagnose IBD. Endoscopic procedures are required to confirm the diagnosis.
 
How is it treated?

Since both ulcerative colitis and Crohn’s disease are chronic conditions, the goal of treatment plans is to control and relieve the symptoms. Treatments for both conditions can include anti-inflammatory drugs, antibiotics, anti-diarrheal medications, corticosteroids or immune system suppressors. Nutrition supplements are also used to help the child maintain normal growth and development. For children with Crohn’s disease and ulcerative colitis, there are also a number of ‘biologics’ in use today. This is a type of medication that helps keep the immune system from causing inflammation.

Surgery to remove the colon is sometimes required for children with UC who have uncontrollable symptoms. For those with Crohn’s disease who don’t respond to other therapies, surgery may also be recommended to remove the diseased part of the intestine.

Irritable bowel syndrome is a condition that results in hypersensitive gut nerves. In children, these symptoms include recurring abdominal pain with diarrhea, constipation – or both – and a change in bowel habits. This could mean that a child has more or fewer bowel movements than usual or has watery or harder stools than usual. Other symptoms include the child feeling an urgency to have a bowel movement or feeling that the bowel movement was incomplete. There may also be abdominal bloating or a mucus-like liquid in the stool.

How is it diagnosed?

After taking a complete medical history, the physician will perform a thorough physical exam and discuss other issues that may cause symptoms, like stress. The goal is to rule out any other issues that may be causing the symptoms associated with IBS, so other tests may be performed like blood or stool tests, or an ultrasound. If the child has shown the main symptoms once a week for two or more months and is growing normally, and there is no indication of any other cause for the symptoms, then the diagnosis will be confirmed.
How is it treated?

There is no cure for IBS, but there are several ways to treat the symptoms including medications or probiotics and changes in diet. Some foods can trigger the symptoms associated with IBS, so determining which foods to avoid is important. Some of the more common triggers are sugary or caffeinated drinks, milk products, high fat foods or foods that cause gas. Consulting with a nutritionist can help identify trigger foods for individual children and ease symptoms.

Jaundice is typically seen in newborns and occurs when red blood cells aren’t functioning properly. This produces a brownish yellowish substance called bilirubin, which a baby can’t get rid of until their liver is fully developed. The result is a yellowish color on the baby’s skin and the whites of their eyes. Symptoms can include poor feeding or lethargy.

There are several types of jaundice and the type is directly linked to whether it occurs in the first hours, weeks or months of life. In older children, jaundice can be a sign of an infection or a problem with the liver, gallbladder or pancreas or a sign of a blood disorder. Symptoms can include fever, chills, stomach pain, itching and weight loss.

How is it diagnosed?

In infants, certain blood tests can be done to check for red blood cell counts or the levels of bilirubin in a baby’s system. There is also a test that can identify proteins that attack red blood cells. In children and teens, the yellowish skin tone can be accompanied by light-colored stools, dark urine and itchy skin. There can also be signs of swelling in the legs, ankles and feet. Blood tests are used to determine underlying conditions and may include a liver function test. Physicians may also order ultrasounds, MRIs or CT scans or a liver biopsy to check for any problems with the liver or bile ducts.

How is it treated?

Depending on the type of jaundice an infant has, they may be treated using special lights or with a special fiber optic blanket. Some infants require blood transfusions and if the mother is breastfeeding, the baby may need to stop and have formula for a day or two.

Treatment in older children can include IV fluids, antibiotics or other medications or blood transfusions. In some cases, there is no treatment and the jaundice will resolve on its own.

Lactose intolerance is an inability or difficulty digesting lactose, the sugar in milk and dairy products. It occurs in children when they don’t make enough of an enzyme called lactase, an enzyme in the small intestine that aids in digesting lactose. Because the lactose isn’t digested, it can produce gas and acid resulting in pain, bloating, nausea and diarrhea. Symptoms usually occur right after a meal or a few hours later. Lactose intolerance is rarely seen in children under 5 and becomes more common during the teen years.

How is it diagnosed?

A good first step is removing all milk products from a child’s diet for about two weeks, then slowly adding them back, checking for symptoms as lactose is added back into the diet. Other ways your physician can diagnose lactose intolerance is to perform a lactose tolerance test to check for blood sugars or a hydrogen breath test, which measure the level of hydrogen gas being produced. An endoscopic procedure may also be performed, so a biopsy of the small intestine can be examined for the lactase enzyme.

How is it treated?

Treatments are determined based on the individual child’s symptoms. Some children may only need a low-lactose diet while other may require a completely lactose-free diet. Your physician and a nutritionist can work with you and your child to determine the correct diet and still get the calcium needed for healthy growth and development.

Malabsorption means that a child’s body is unable to completely absorb nutrients from the food they eat. During normal digestion, the nutrients from food pass through the intestinal wall and into the bloodstream, where they travel to other cells in the body. If this doesn’t occur, even a child eating a well-balanced diet can suffer from malnutrition.

Reasons for malabsorption can indicate damage to the intestinal wall caused by a virus, a bacterial infection or parasites, or a problem with enzymes that aid in digestion. Existing conditions or diseases may also play a role including lactose intolerance, celiac disease, Crohn’s disease, pancreatitis or cystic fibrosis.

Sometimes, malabsorption occurs for a day or two if the child has a severe case of stomach or intestinal flu. But if symptoms persist, chronic malabsorption can develop. Symptoms include abdominal pain and vomiting, frequent diarrhea with bulky, smelly stools, bone fractures, an increase in bruises, dry, scaly skin rashes and weight loss (failure to thrive).

How is it diagnosed?

To diagnose malabsorption disorders, your physician needs to rule out any other causes such as other digestive issues or malnutrition due to poor diet. Tests can be performed to check a child’s ability to digest food properly, including a lactose hydrogen breath test and analyzing a stool sample. An endoscopic procedure can also be performed to check the small intestine for signs of inflammation or infection.

How is it treated?

Once the issue has been identified as malabsorption, the cause dictates the treatment. For infections, antibiotics may be recommended. Other medications may be prescribed to help treat an overactive intestine. In some cases, changes in diet and nutritional supplements may be recommended.

The word ‘motility’ refers to the movement of food through the digestive tract. There are nerves and muscles in everyone’s digestive tract that work together to push food through the system, keeping the nutrients needed for good health and getting rid of the waste the body doesn’t need. Motility disorders are often suspected when a child suffers from chronic abdominal or chest pain, a distended abdomen, bloating, fullness after eating, constipation, diarrhea, heartburn, difficulty swallowing, nausea, and vomiting.

How is it diagnosed?

There are a number of tests that can be performed to see if the digestive tract is working properly – or if the symptoms are being caused by an underlying condition. Procedures or tests used to confirm the diagnosis may include endoscopy, barium contrast X-rays, motility tests called manometry, and/or tests for acid reflux.

How is it treated?

The results of testing can indicate a wide range of conditions, including swallowing difficulties, achalasia (when the nerves in the esophagus don’t work properly), encopresis (stool holding or soiling), Hirchsprung’s disease and IBS. Subsequently, treatments are recommended based on an individual child’s diagnosis and can include medications, dietary changes and in some cases surgery. Counseling may also be recommended to help children with any social challenges that occur as a result of their condition.

Nausea is the feeling of stomach discomfort that results in the involuntary urge to vomit. The feeling of being nauseas does not always lead to vomiting and can be caused by any number of conditions, including viral or bacterial infections, inflammation of the pancreas or liver, acid reflux, ulcers, reactions to medications, overeating, food poisoning, - even reactions to certain odors.

How is it diagnosed?

In general, the physician will complete a thorough physical exam and medical history to determine the cause of the nausea or vomiting. Then, if necessary, other tests may be recommended to confirm a diagnosis.

How is it treated?

Based on the diagnosis and discovery of underlying causes, treatment can include medications or antacids to relieve symptoms. If certain trigger foods are the cause of the nausea or vomiting, dietary modifications may be recommended to ease symptoms.

This term refers to several disorders that are diagnosed when there is too much fat in the liver. One of the milder forms of the disease is steatosis. In some children, there may be no symptoms of this, but in more serious cases, the liver can become severely inflamed which can lead to progressive liver disease including hepatitis, scarring and cirrhosis. Risk factors for developing NAFLD include obesity, diabetes and insulin resistance.

How is it diagnosed?

During a physical exam, the physician may find the liver has increased in size. Lab tests may be performed to check for an increase in liver enzymes or an abdominal ultrasound may be ordered to check for steatosis. In some cases, a liver biopsy may be performed.

How is it treated?

For most children, dietary modifications and exercise will be recommend for weight loss. Medications may also be prescribed.

Pancreatitis occurs when the pancreas becomes inflamed. The pancreas is an organ located near the small intestine that produces enzymes which aid in digesting proteins, fats and sugars. It also produces hormones and sugars that help children maintain normal blood sugar levels. The cause of the inflammation in most children is viral infection, some medications or a congenital or inherited condition. Symptoms include pain in the upper abdomen or back, nausea, vomiting and possibly, fever and jaundice.

How is it diagnosed?

If pancreatitis is suspected by the physician, there are several methods used to confirm the diagnosis. Lab tests will be ordered as well as imaging tests such as abdominal ultrasounds or CT scans that may reveal any swelling of the liver.

How is it treated?

Treatment generally consists of withholding food and liquids until the pain subsides. During this period, children are given fluids or medications through an intravenous tube. Typically, within a few days, the child can either be fed by mouth or a feeding tube and most recover in about a week.

Short bowel syndrome is also referred to as short gut or intestinal failure. It is diagnosed when part of the small intestine is not present at birth (atresia), functions abnormally, or has been surgically removed due to conditions such as necrotizing enterocolitis. Symptoms include diarrhea, vomiting, excessive gas, bloating, poor appetite, and failure to thrive. As a result, children can suffer from malnutrition and dehydration as well as kidney stones, gallstones and liver disease. Babies may suffer from severe diaper rash as a result of chronic diarrhea.

How is it diagnosed?

Short bowel syndrome is assumed when a baby is born without part of their intestine or with damaged intestines, or has undergone surgery to remove part of their intestines. Comprehensive blood and stool tests will be ordered as well as abdominal imaging tests.

How is it treated?

To make sure babies and older children are getting proper nutrition, the first step is to modify the diet. Special formulas can be provided through a feeding tube and in some cases, the small intestine will adjust on its own, a process called adaptation. Many children can continue eating normally and may outgrow the need for the feeding tube. In cases where this is not successful, a long IV (or ‘central’ line) is inserted into a large vein and nutrition is provided through the IV. This is referred to as TPN. Sometimes, additional surgery may be recommended. Other treatments can include antibiotics or medications that help control diarrhea.

Weight loss or weight gain can be triggered by a number of factors. When a child loses weight, it is an indication that they are not getting enough calories, not absorbing nutrients properly, or are burning up an unusual number of calories. The most common reason for sudden weight loss is illness – like a stomach virus. Children can also lose weight due to food sensitivities or allergies, and in older children and teens, eating disorders are not uncommon. If a child is complaining of stomachaches, has a change in stool patterns or blood in the stool, or suffers from chronic diarrhea, it could be an indication of a more serious gastrointestinal issue.

For children who suddenly gain weight, the cause could be associated with medications, a change in dietary habits or hormone deficiencies such as an underactive thyroid. In both cases, family history and genetics play a role.

How is it diagnosed?

The physician will discuss the child’s medical history and complete a physical exam first. Lab tests may be ordered to determine if there are underlying medical conditions for either weight loss or weight gain.

How is it treated?

Once a diagnosis has been determined, the physician can provide appropriate methods of treatment. In addition to any medications that may be required, consultations with a nutritionist are generally recommended.