When Should I Call and When Can It Wait??

Answers to Your Questions About Your Child’s Tummy Aches

littleboybellypain

It’s been a busy week for everyone.  My Facebook feed is flooded with back to school pics of their kids holding the cute back to school signs.  So of course I posted my pic also.  My oldest daughter went back last Thursday.  Here she is holding up her sign.  She started the 2nd Grade this year. She was looking forward to seeing all her friends again.  The summer was great but after multiple trips to the pool, swim lessons, music lessons, vacations and staycations I think we were all ready to start this school year.  It is a bittersweet time.  I loved spending those lazy summer days with my girls, but they DEFINITELY need to get back to school for everyone’s sake.  The amount of fights I have broken up between these 2 sweet little girls is now in the DOZENS!!  So the school grind will do them both some good.
Back to School

This is her second year in this school, she knows the principal, all her teachers from last year, this year should be a stroll in the park for her.  Yet not even one week in and I have already had 2 phone calls from the school nurse and 5 visits to the nurse’s office. Living in the Northeast, this has been a brutal week hitting temps of 90s every day, no AC in the school (except the nurses office…..hmmmm I maybe onto something here).  The classrooms are very hot, but when should I be worried??  It is way too early in the school year to start a precedent of running to pick her up with every phone call and visit to the nurse.  But my inner mommy doesn’t want to neglect her pain and leave my baby in school if she is sick.

In my practice the start of school year is a busy time, especially for kids complaining of “tummy aches.”   As a “Kids Tummy Doc” I am going to share with you when to be alarmed with your child’s complaint and when it’s ok to wait and watch before calling your doctor. 

When should I call and when can it wait??

A Guide to your Kids Tummy Aches

  • Is it only after she eats? If so I would keep a careful eye on frequency and try to keep a record of what foods cause her to have the belly ache (fatty foods, spicy foods, dairy, etc)
  • Is it when she wakes in the morning prior to school? Make note if it only occurs weekdays, if she is symptom free on weekends this may be school related and due to stress or anxiety. I recommend talking to your child about her classmates, reach out to the teacher if this occurs excessively and always ask your child about bullying.
  • Is it after physical activity? Make note of when last meal was prior to onset of pain.  Send your child to school with water daily to avoid dehydration.
  • Does the pain wake your child from a sound sleep?  If this occurs there may be some organic etiology occurring.  Call for an appointment immediately with your child’s Pediatrician or Pediatric GI
  • Is it occurring more than 2-3 times a week?  Call for an appointment with your child’s Pediatrician or Pediatric GI
  • Where is the location of your child’s pain?  Think of the stomach as having 4 sections with the belly button at the center.  Each area helps the doctor narrow down the source of your child’s pain.  An example is that most commonly pain in the Left Lower Quadrant indicates issues with stooling or bowel movements and this patient may be suffering from constipation. Make sure to ask your child where the pain is and report this to your doctor.Quadrants
  • Does the pain radiate or spread to any other areas?  Many times it may start right around or above the belly button or in the Left Upper Quadrant and can radiate up to their chest.  This indicates gastroesophageal reflux and occasionally occurs with gastritis, and YES even kids can get stomach ulcers.  This child needs medication and a strict reflux diet to be followed.  Call for an appointment with your child’s Pediatrician or Pediatric GI.
  • Does the pain improve with eating? This may indicate gastritis or possibly a gastric ulcer, contact your child’s Pediatrician or Pediatric GI.
  • Has your child lost weight since the onset of these symptoms?  Unintentional weight loss should always indicate an immediate appointment with your child’s Pediatrician or Pediatric GI. 

Children are commonly not able to completely explain their pain to us.  I usually feel like a detective trying to get info from my patients regardless if its a 4 yo or a 16 yo (but it’s way easier to get info out of the little ones than the teenagers, believe me…. the teenagers require me to go into interrogation mode).  However, if you keep a watchful eye on their symptoms and think about these questions you will definitely know when to call for that appointment.

Now that school is back and I am trying to schedule all my kids after school activities, I think to myself that I don’t want to overload their schedules. I want them to have time to focus on school work and still have playdates with friends.   As parents we all want to offer our kids the world, but what we forget sometimes is that too many activities for children can lead to stress about their school work, their inability to keep up academically and the first way they may exhibit this, before even telling mom and dad, is by having GI complaints.  Be mindful when putting together their schedules and even with your high school kids look over how many times the teams and groups they want to join meet for practices and games each week.

Please let me know your thoughts regarding today’s post.  Did I miss any questions that your kids always complain of?  Is there something you would like me to add to this list?  Leave it below. Stay Healthy & Be Well!

#KidsTummyTroubles #bellyaches #whenshouldicall #abdominalpain

Helpful Tips for Dry, Itchy Skin

Tips for Dry Skin

Although I am a pediatric gastroenterologist, which means a “Kids Tummy Doctor”,  many of my patients with chronic diseases suffer from dry, itchy skin.  This, if left untreated, can be painful, make children cranky and frustrated and can lead to excessive scratching.  The excessive scratching worsens the problem and can lead to cuts and possible skin infections.  Patients that suffer from Inflammatory Bowel Disease, Crohn’s Disease, ulcerative colitis, Short Gut Syndrome or Small Bowel syndrome, Celiac disease, Cow’s Milk Protein Allergy or other allergic colitis conditions can experience this.  It is a multifactorial problem that can stem from poor nutrition and the bodies immune system reacting to the food allergen or is an additional manifestation of their chronic condition.

It is heartbreaking when I see one of my patients, especially the little babies,  so itchy and scratching their legs together to try to get a bit of relief.  Over the years I have compiled a list of helpful hints that I give to my patients and I have found that used together they work.

  • Avoid soap.  Use a non-soap cleanser such as Cetaphil, Cerave or similar products
  • Try Rubbing, vibration or applying pressure instead of scratching.  A good thing to “scratch” with is an ice cube
  • Drink plenty of water or other clear fluids to keep hydrated.  Remember although milk is nutritious it does not count as a hydrating fluid.
  • Apply moisturizer immediately after a shower or bath and do not rub dry with a towel.  Only use the towel to pat dry and take excess water off.
  • Creams are more effective than lotions
  • Apply moisturizer twice a day.  Good options are Aveeno, Eucerin, Lubriderm, or Aquaphor
  • Use only non-perfumed and unscented bath and personal care products
  • Avoid extremely hot showers and baths
  • Take an oatmeal bath to relieve itching and help with relaxation
  • Try baking soda or unscented bath oils for bathing
  • Apply cold packs, wrapped in a cloth to the skin
  • Whenever possible wear loose fitting clothing made from natural products.  This allows the skin to breathe
  • Protect your skin from the sun – wear sunscreen
  • Don’t forget your lips – wear lipbalm with SPF
  • Get plenty of rest
  • Keep room temperature at 60-70 degrees and keep air circulating and ventilated

Hope these are useful and provide some relief for those who need it.  Let me know your thoughts and comments below.

#KidsTummyTroubles #DrySkin #Healthtips #ItchySkin

A Mommy’s Day Off?!?

scooterSo I have a day off.  I was able to sleep in until my youngest daughter, who is now 4 years old woke up.  She slept in til 7:30 am…WooHoo!!  My 6 yo joined us downstairs a half hour later.  Summer camp is over and they have nothing structured planned for August.  My oldest is looking forward to a library event at 1 pm where she could win a Kindle reader because she completed 10 hours of reading thru the library’s reading program in July.  So what to do from now til 1……hmmm???

Brush teeth, get dressed, brush hair, eat breakfast, make beds (which is the only chore my 6 yo has right now)  It is now 10am. That killed some time.   Wait I didn’t even eat or have my coffee yet :(So lets try to solve that problem, put my Kcup in to be brewed and set the girls up to do their summer workbooks.  After only 10 minutes of negototiating they agree with going to park after completing 4 pages each in respective books.  I feel a huge sense of accomplishment for getting this done so early in the day.

Lily (the 4 yo) wants to ride her new birthday scooter that she got last week. and we’re off to the park. After we get cleaned up, eat lunch, do the library thing (which of course we don’t win the Kindle ), we go get ice cream at the local ice cream shoppe. Then I hear my phone beep in my purse on the drive home.  I check it at home and realize a friend just facebook IM’d me with a “quick question”.

An old college friend contacted me.  She suffers from inflammatory bowel disease.  This is a disease that I treat in my pediatric patients also, although we do not have as many medication options as the adults have.  She was started on a new medication and is having a twitching in her face and numbness after 2 weeks of this new med.  She called her doctor and can’t reach him. He is on vacation and although he has 4 partners that are IN THE OFFICE, the front desk won’t let her speak to any of them. So she is asking me for my advice.  I am used to this type of question.  Day off or not I will always get phone calls at all hours of the day or night.  The worst was when our friends had new babies.

I answered her questions and began to become more and more furious as speaking to her with the way this adverse reaction was handled.  This is the difference between adult and pediatric medicine. The bedside manner and level of concern.  In pediatrics we deal with our patients and the caregivers, which is similar to geriatrics.  I gave my friend the exact script of what to say to the front desk that would get her through to the doctor.  Most of the time its the annoying patients that get what they need from the medical system. The sweet people will get nowhere and I needed her to be seen by her doctor or by the on call physician.   She finally got an appointment for tomorrow and spoke to one of her doctors.

During this dialogue I received a phone call from the chief of the pediatric division at the hospital with a question regarding the Peds GI clinic statistics, I had to be referee between my girls at least 3 times, let my dogs out to pee in the yard 4 times and then gave the girls a snack.

And then guess what I found……my coffee still in the keurig!

#KidsTummyTroubles