Paediatric medicine - GI problems in infants

Dr Asoka Thenabadu provides the answers to some of the common questions that may be asked by worried parents.

Q: My three-year-old is eating well, putting on weight and growing in height. However, he is passing undigested pieces of food like peas and carrots in his stools. Why is this?

The child has a common condition called 'toddler diarrhoea'. This is the most common cause of chronic diarrhoea in children and it can persist for a long time.

Presenting between the ages of one and five, the child passes three to five watery stools per day often with undigested pieces of vegetable from a recent meal. Occasionally the child may have mild abdominal pain but this is unusual.

The child remains active, healthy and happy, and continues to gain in weight and height.

Examination of the child is unremarkable, with height and weight following the centiles on a growth chart. If the child meets these criteria, no further investigations are necessary.

The management is reassurance that there is no cause for concern and that the appearance of undigested food is due to the immaturity of the bowel. Toddler diarrhoea is not due to malabsorption or a serious bowel problem. It seems to be due to an increased speed of transit of food through the gut. Reducing the amount of fruit juice drinks or increasing the amount of fibre in the diet may improve the situation.

Thankfully, the symptoms usually disappear by the age of five years.

Q: My three-month-old baby takes milk adequately. He is gaining weight well but vomits out a lot of milk. Why is this and what can I do?

The baby has a common condition in infancy called gastro-oesophageal reflux. This is due to a lax gastro-oesophageal sphincter at the junction of the oesophagus and the stomach.

As the baby grows, the muscle will strengthen and develop and the vomiting becomes less frequent and disappears. A baby needs two and a half ounces of milk per pound body weight per day (156g per kg).

If the baby is gaining weight, he is obviously eating as much as he needs.

Q: My one-month-old baby cries excessively in the evenings for several hours and stops after some time. I am told he has infantile colic. The colic drives the baby and the rest of the family crazy. What can be done?

Infant colic can be distressing (photograph: MAURO FERMARIELLO / SCIENCE PHOTO LIBRARY)

Infantile colic (also known as baby colic or three-month colic) is a condition in which an otherwise healthy baby cries or screams frequently and for extended periods without any discernible reason.

It almost invariably disappears, often very suddenly, before the baby is three to four months old. It is more common in bottle-fed babies, but also occurs in breast-fed infants.

The crying frequently occurs during a specific period of the day, often in the early evening.

Traditionally, colic was ascribed to abdominal pain resulting from trapped gas in the digestive tract. Another theory is that it is due to milk products ingested by the mother.

Gripe water, soothing measures such as pacifiers, listening to soft music and rocking, are often effective in calming the baby during crying periods.

Some parents like to hold the baby upright, which may reduce the pain and crying by letting the trapped air in the bowel escape.

Colic can place an enormous strain on parents and other family members. However, it is a self-limiting condition and the baby will settle down soon.

  • Dr Thenabadu is a semi-retired locum consultant in paediatrics in Surrey.

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