Sarah is a bright, happy one-year-old who loves exploring things, playing with other kids, and watching insects on the playground. But one day, her caregiver notices that Sarah is not her usual, active self. Instead she is fussy, cries easily, and is generally cranky. The caregiver knows from experience that sudden changes in personality could mean a child is uncomfortable or in pain. Since Sarah is too young to talk, how can the caregiver know what is bothering Sarah, and how to make her feel better?
It can be difficult to recognize stomach distress in small children. Often, they make known their general unhappiness, but how can you tell if they are bothered by a stomachache, a toothache, or something else entirely? The easiest way to identify a stomachache or bowel problem is through the child's vomiting or stools. If a child's bathroom habits change, take note. The following behavioral cues may also help:
- The child lies flat on her back and brings her knees all the way up to her chest (typically children younger than one).
- The child is obviously straining to have a bowel movement.
- A mobile child goes to his or her "usual spot" for bowel movements and cries.
- The child is not interested in food or refuses to eat, even a favorite food
- The child vomits food, or liquid (more than a "spit up").
- Bowel movements have blood or pus.
- Bowel movement are watery.
- Bowel movements are more frequent than usual for the child.
Children with the last two symptoms have diarrhea. Children with diarrhea have frequent bowel movements, and their bowel movements, or stool, are so watery that they conform to the shape of the diapers. Diarrhea should always be taken seriously because it takes away fluid from the body and, if not treated, can cause dehydration. Diarrhea can result in hospitalization or even death in only a few days if it is not treated.
Whether the child has constipation or diarrhea, take the following steps to fight the problem:
Give fluids. Fluids help lubricate the digestive system and are essential to almost all bodily functions. Fluids may help eliminate constipation and will replenish the liquid lost in children with diarrhea or vomiting. Water, clear liquids such as caffeine-free flavored waters or fruit-flavored drinks, gelatins, or frozen pops can also help replace fluids. Due to the sodium and mineral content, ask your pediatrician, childcare or health consultant before offering sports drinks.
Observe the child's behavior. If a child has a fever, is lethargic (listless, unresponsive), or has blood or pus present in the stool, call the parents and encourage them to seek immediate medical attention. The child may have a truly dangerous illness and should be examined by the family doctor.
Isolate the child from other children. Stomachaches can be caused by contagious illnesses that can spread to other children or adults. Unless the tummy trouble is caused by diet change or antibiotic, the child may need to stay home or away from other children until a doctor says she is no longer contagious. Take the child to a quiet place away from other children and try to provide comfort until the parent arrives.
Caregivers should pay close attention to a child's stomachache because it may or may not indicate a serious condition. Stomachache or other digestive problems can be caused by food intolerance or colds and viruses. It can, however, be an indication of a more serious medical condition. Watch for changes in the color, texture and frequency of the child's bowel movement; changes in the child's complexion, or fever. The parent should be encouraged to call a doctor immediately if:
- There is blood or pus in the stool or it appears black.
- Diarrhea lasts more than one day.
- Constipation lasts more than a week.
- The condition does not respond to simple treatments (more fluids, more exercise, more fiber in diet).
- The child develops tears or hemorrhoids around the rectum.
If there are signs that the child is dehydrated, contact the parents immediately. Signs to watch for include:
- Failure to wet diapers in more than six hours.
- Skin does not flatten when pinched and released.
- Dry mouth and tongue.
- No tears when crying.
The child's doctor probably will advise giving the child rehydrating fluid, water, juice, or other clear liquids, but may also prescribe a specific formula or have fluids given in the hospital.
by Judith Wellen, MS, Health writer, eMD.com