The runs, the toots and the troubles

Diarrhea, gas and constipation can make your child miserable. The experts tell us signs, symptoms and cures

In the preschool set, few things elicit belly laughs as effectively as resounding belches or punchlines featuring the word “poop” — but the discomfort that gas, diarrhea, and constipation can cause your little one is no joke. So we’ve put together some pointers on getting to the bottom of digestive distress — and what you can do to ease it.

Gas
Before your baby starts speaking, it can be tough to tell if crying and grimacing is due to air trapped in the tummy and intestines, unless, of course, impolite noises dispel her suffering. (While many parents assume gas is the culprit behind colic, some experts believe the characteristic crying pattern may actually be a part of normal brain development, notes Richard Haber, director of the paediatric consultation centre at Montreal Children’s Hospital, and a spokesperson for the Canadian Paediatric Society.) If she’s drawing her knees to her chest, that’s one clue gas could be to blame.

Clearing the Air. In this case, brushing up on your burping technique could pay dividends. If your baby is bottle-fed (breastfeeders typically gulp less air), you may want to enlarge the nipple opening so the formula drips through steadily. “That might reduce the amount of air that’s taken into the intestine,” Haber says. Gently bicycling your baby’s legs during an attack may also relieve the pressure by propelling bubbles through the bowel. For the occasional episode, you can also try gripe water or Ovol drops. According to Haber, though there’s scant evidence these remedies work, they seem safe when used as directed.
Dietary Factors. If gas problems persist after you’ve tried these strategies, talk to your doctor. If you’re bottle-feeding, she may suggest switching to a different type of formula. Otherwise, you may need to do some detective work to figure out whether a particular food (in your diet, if you’re breastfeeding, or your baby’s, if he’s eating solids) could be the cause.

Eating Habits. While a toddler can tell you his tummy hurts, nailing down exactly what’s causing the trouble can still take some work. (Gas that doesn’t cause discomfort isn’t worth worrying about — it’s perfectly normal to pass gas dozens of times a day, and some kids are more, er, effervescent than others.) For starters, busy little people are notorious for bolting their food, which interferes with digestion. Drinking pop can also sneak air into tiny tummies. Encouraging a relaxed atmosphere at mealtime, reminding your little dynamo to eat slowly, and avoiding soda (which really doesn’t belong in a toddler’s diet anyway) may help take the wind out of her sails, so to speak.

Food Sensitivities. If none of the above factors are to blame, a diet diary may help pinpoint the guilty party. Some children seem to be sensitive to certain sweeteners, like sorbitol. Others may have difficulty digesting beans or certain starchy veggies: In this event, an over-the-counter product called Beano, which helps break down complex carbohydrates, may provide relief. (Food intolerance and excess sugar can also cause gas: See the section on diarrhea.)

Gentle Digestive Aid. When bouts of burbling aren’t linked with a certain food, you might want to consider giving cooled chamomile tea a try (unless ragweed allergies run in your family, since the two plants are closely related). “Chamomile tea is a carminative, which is a term used to describe herbal products that can help dispel gas,” explains Jasmine Carino, an associate professor at the Canadian College of Naturopathic Medicine in Toronto.
First, let’s talk about how to tell whether your child has diarrhea, since the definition is, um, loose. It’s not a question of colour: The palette for normal poop ranges from greenish to yellow through to brown, says David Israel, clinical professor and head of gastroenterology at BC Children’s Hospital in Vancouver. Nor does consistency tell the whole story: Some people normally produce very soft stools. The secret to diagnosing diarrhea is looking for changes in your child’s typical pattern: Significant increases in the urgency and frequency of bowel movements, plus a much more liquid than usual consistency, add up to diarrhea.

When it comes to determining what’s causing diarrhea, three key factors to consider are how rapidly it comes on, its duration and whether it’s accompanied by other symptoms.

Acute
Diarrhea Gastroenteritis.
Sudden onset of diarrhea and vomiting point to gastroenteritis — inflammation in the stomach and intestine brought about by viruses or bacteria. Diarrhea is Mother Nature’s way of evicting these organisms, so don’t give medicines to stop it.

While the body can fight off most such infections on its own, vomiting and diarrhea can dangerously deplete the body’s water and electrolyte stores very quickly, so warding off dehydration is the key to a safe, speedy recovery.

Haber recommends offering an oral rehydration solution, like Pedialyte or Gastrolyte, which contains just the right balance of sugar and salts to maximize fluid absorption. (Juice can worsen diarrhea, but you can continue breastfeeding.) Alternate with water for the first six to 12 hours — until vomiting subsides. (Diarrhea may linger for a week or so.) “Sometimes you have to spoon the fluid in every five minutes,” acknowledges Haber — small, frequent sips are easier to keep down than big gulps. If your toddler turns up her nose at the taste, don’t substitute pop or juice. Over the next 12 to 24 hours, you can add other fluids, including milk or formula if they’re on your little one’s regular menu. Afterward, feed her whatever tempts her appetite.

Other Infections. An infection in the middle ear or even the urinary tract can also trigger diarrhea. Diarrhea in conjunction with fever, but little or no vomiting, could hint at one of these conditions.

Antibiotic After-effects. Diarrhea often occurs in the wake of antibiotic treatment, notes Carino, because it can upset the normal balance of bacteria that live in the intestine. Repopulating the gut with beneficial bacteria using a probiotic supplement (available in health food stores) or live-culture yogurt may help restore equilibrium.
Chronic
Sugar Overload. “Something else that can cause diarrhea is drinking too much juice,” Carino observes. If your toddler takes in too much sugar in any form, including fruit juice, bacteria in the intestine can cause the contents of the intestine to ferment. The result is less dramatic than the time Grandpa’s home-brewed beer blew the caps off the bottles, but the same principle applies: The bacteria gobble up sugar and produce gas. The excess sugar also acts like a sponge, sucking extra fluid out of the intestine — hence loose, watery stools. (Neither babies nor toddlers need juice; if you do offer it, many experts recommend limiting intake to four ounces per day.)

Food Intolerance. A similar chain reaction occurs with food intolerances. If your child always develops gas and diarrhea within an hour or two of eating, say, corn, you can try cutting the offending item out of her diet. If milk triggers similar symptoms, lactose intolerance may be responsible. (This condition is caused by deficiency in lactase, the enzyme that breaks down milk sugar, and is relatively uncommon before age six or seven.) If so, substituting lactose-free milk should reduce discomfort. (Don’t eliminate dairy products without the guidance of a doctor or dietitian to ensure your toddler doesn’t miss out on important nutrients.) A brief bout of lactose intolerance can also occur following gastroenteritis, which can injure the digestive tract lining and temporarily impair lactase production. This situation usually rights itself within a few weeks.

Anxiety. Did exam week once turn your bowels to water? Brain chemicals involved in emotions also influence nerves in the gut. If your child doesn’t have any other symptoms, ask yourself whether he might be feeling anxious about something, like starting nursery school or changing caregivers.
As unpleasant as diarrhea may be, hard, difficult-to-pass stools can cause greater misery. “A bowel motion should be a non-event — if it’s an effort, if it’s painful, if it’s infrequent, that’s not right,” Israel emphasizes.

Formula Issues. While constipation is relatively uncommon early in life, some bottle-fed babies may react this way to certain types of formula. If you suspect yours is one of them, ask your doctor to recommend an alternative.

Low-Fibre Diet. Toddlers often become fixated on a few foods, and a menu of fibre-meagre chicken nuggets and white macaroni doesn’t foster bowel health. Dietary fibre, along with adequate fluid, makes stool soft and bulky, and thereby easier to pass. Slowly switching to whole-grain breads and cereals, and even sneaking wheat bran or ground flax-seed into muffins and meat loaf, along with adequate fluid intake, may be all that’s needed to get things moving.

Lifestyle Factors. Eating prompts the gut to contract, so scheduled meals and snacks actually help promote bowel regularity. Changes in your child’s routine (say, starting daycare) can also contribute to constipation by making it easy to overlook early signs of toilet troubles. Why would that exacerbate the situation? A toddler who starts withholding bowel movements because the last one made his bottom hurt, or he’s reluctant to sit on the potty solo, can end up severely constipated. The longer the stool stays in the body, the more water is extracted from it; the harder the poop, the more it hurts to expel.

When you start toilet teaching, take advantage of your little one’s natural reflexes by putting her on the potty after meals. Gently massaging her abdomen in a clockwise direction beforehand may also encourage the process, says Carino. Promote relaxation by keeping your attitude low-key and saving special books to read together during bathroom visits. And talk to your doctor as soon as any difficulties develop — a short course of treatment with a stool softener or lubricant-type laxative could prevent constipation from becoming an ongoing problem.

“If a child is uncomfortable with bowel motions once or twice, then everything is OK, that’s not a concern,” says Israel, “but if it becomes a pattern, that definitely requires attention. Once the problem is there, it’s more difficult to deal with.”
Seek medical attention urgently if your child:
• develops diarrhea or a fever before six months of age
• passes bloody or black stools
• is still vomiting after four to six hours
• develops a temperature greater than 38.5ºC (101.5ºF)
• develops a fever plus a rash, or any other worrisome symptoms
• displays signs of dehydration (fewer than four wet diapers per day; no tears; dry skin, mouth and tongue; sunken “soft spot”)
• becomes excessively irritable
• becomes very lethargic or unresponsive.

If your baby or toddler experiences any of the following symptoms, alert your doctor promptly:
• diarrhea or cramping that lingers longer than five days
• very pale, or greasy and foul-smelling stools
• frequent straining or distress during bowel movements
• weight loss or abrupt levelling off of growth.

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