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The Physician
The Physician, Training in Pediatric Emergency medicine
Category: Paediatrics
Satisfied Customers: 956
Experience:  MD. with 20 years of experience including paediatrics
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Hi, My daughter is six years old. She has complained of

Resolved Question:

Hi,

My daughter is six years old. She has complained of frequent stomach pain around her belly button for about three years. She frequently has accidents when she has a bowel movement as she cannot get to the toilet in time. Occasionally she will go through a phase of wetting as well. She never has accidents at night.

At the end of last year she went six months without any accidents and we thought she had grown out of the problem as she had never been completely clean since she had been out of nappies. The problem then flared up again in February and we have some weeks when she will only have 1 accident, others when it is nearly every day, if not more than once a day. She just says she can't tell when she needs to go.

She had a blood test for coeliac disease last year and I've been told the result was 'very negative'. At the time she had the test she wasn't eating a lot as the stomach pains were putting her off eating. Then when she was clean for the six months she wasn't eating a lot of bread, she would have wraps or crackers, so I don't know if that was the difference. I have noticed the days she is worse, she has eaten bread in the preceding couple of days.

She has also suffered from quite bad eczema since she was a baby. In particular she always has sore cracked skin around her mouth that nothing seems to completely get rid of. Her skin has been getting worse and she generally has quite dry, skin all over which goes quite thick and scaly and very itchy.

She has been given a cream regime from the hospital which helped initially but seems to be less so now. That is also probably down to it being very hard to smother a stubborn child in cream several times a day!

Our GP has suggested she has encopresis and she has been on movicol sachets for about 2, 3 months now. She has one a day as any more seems to send her the other way.

Could her problems be diet related?

The doctor has advised it probably isn't lactose intolerance as she would be suffering with diarrhoea. She was formula fed as a baby and was sick every time she had a bottle but she stopped having milk at about 10 months as she refused to have it.She eats more fruit and vegetables than anyone else in the family.

She does have to be reminded to drink otherwise she will go all day with nothing. She probably drinks about 7-800ml a day at the moment. Occasionally I have managed to get the 1 litre the hospital wanted her to have.

I guess I just can't understand how she could go for six months with no problems and then it all started up again.
Submitted: 2 years ago.
Category: Paediatrics
Expert:  The Physician replied 2 years ago.

The Physician :

welcome to justanswer.com.

The Physician :

In her age group, abdominal pain, especially around the navel is common.

The Physician :

Sometimes thay are due to problems in the abdomen and gastrintestinal system, at other times they are NOT related to the abdomen at all.

The Physician :

The history of associated bed wetting should trigger the investigation of both her gastrointestinal tract and her urinary tract as well.

The Physician :

I believe at this point after physical examination, the Gp must have done not just her blood count but her other tests like her Liver function test. Also urinalysis and urine culture to rule out urinary tract abnormalities and infection.

The Physician :

She might benefit from an abdominal ultrasound as well, just to make sure thare are no hernias (pin hole umbilical, and epigastric). other things like mesenteric adenitis, and abnormalities of the colon.

The Physician :

If all these results are negative, it will be wise to seek some psychological evaluation, by a pediatric clinical psychologist.

The Physician :

A significant percentage of children in that age group with abdominal pain, without a determined cause, may be due to some issues which parents MOST times are NOT aware of

The Physician :

There is also something called abdominal migraine.

The Physician :

ultrasound will also evaluate for some MORE SERIOUS conditions like tumors and congenital abnormalities of the kidneys, liver or pancreas

Customer:

I specifically mentioned she doesn't have any accidents at night but you have taken this to mean she wets the bed???

Customer:

She had an ultrasound last year after three UTIs in one year. This came back as normal.

Customer:

You haven't actually mentioned anything about my questions over diet and why the doctors say it is because she is constipated causing the encopresis when she eats better than most kids. Or why she could go six months with no problems and then it all starts again.

The Physician :

No You said inter alia 'occasionally she will go through a phase of wetting as well'

The Physician :

Now there are specific dietary causes of abdominal pain, and they usually have associated symptoms, rather than abdominal pain and frequent or uncontrollable bowel movements.

The Physician :

So please understand the medical logic, based on understanding of normal physiology(function) of the gastrointestinal tract.

The Physician :

The fact that she never 'have accidents in the night' means that whatever it is, has to do with her consciousness.

The Physician :

If she had other associated symptoms, like nausea, vomitting, fever, and diarrhea, thenone would consider specific pathologies.

The Physician :

In fact, medically the fact that she went six months without the 'accidents' means it is not a pathologically progressive illness or disorder.

The Physician :

The solution would be to continue giving her a balanced diet of vegetables, fruits and complex carbohydrates. Avoid refined carbohydrates like flour/bread.

The Physician :

If she is does not take milk (lactose intolerance can easily be tested), then find an alternative source of protein. Soy for example.

The Physician :

Medically, if ultrasounds are normal, then an endoscopy may need to be done, BUT remember this has to be at the discretion of her pediatricians. Another alternative is to ask to be reffered to a Pediatric gastroenterologist.

The Physician :

My advise (which I think is why you came to Justanswer.com) An honest advise, from a physician of 23 years and a pediatric emergency provider, IS

The Physician :

Begin consultation with a pediatric clinical psychologist, even as the medical tests are on-going, THERE ARE PROVEN methods of

The Physician :

Getting her to consciously control her bowel. these are done on individualized basis and theefore need extensive consultation and interviews.

The Physician :

YOU should also start her on a balanced multivitamin, in consult with your pediatrician. T

The Physician :

The crack in the mouth may be angular cheilitis and could be due to Vitamin B and other nuitritional deficiencies. It is also found in immune disorders which can easily be tested by your pediatrician

The Physician :

In summary

The Physician :

  • Appendicitis

  • Gallstones

  • Stomach ulcers

  • Hernia or other bowel twisting, blockage or obstruction

  • Inflammatory bowel disease (Crohn's disease or ulcerative colitis)

  • Intussusception, caused by part of the intestine being pulled inward into itself

  • Tumors or cancers

  • Urinary tract infections

  • Sickle cell disease crisis

The Physician :

The above are the MAJOR, OR SERIOUS DISEASES that may affect children causing abdominal pain. Appendicitis is acute. So it s out, gall stones would have been picked by ultrasound, so would have tumors or cancer, intussusception (rare in her age). Hernias would have been obvious or picked up by ultrasound, Stomach ulcers, inflamatory bowel disorders have associated symptoms of vomitting, diarrhea, fever etc. urinary tract infections are covered already as you alluded. Sickle cell disease is familial and must have been checked (otherwise ask your doctor to do so)

The Physician :

So like i said, get additional consultation from a gastroenterologist, (may be endoscopy). then begin rehabilitating her. Diet must avoid milk and refined carbs. include multivitamins.

The Physician :

Thank you for choosing justanswer.com

The Physician, Training in Pediatric Emergency medicine
Category: Paediatrics
Satisfied Customers: 956
Experience: MD. with 20 years of experience including paediatrics
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