Tummy troubles: SouthFlorida.com

From diarrhea to constipation -- what all parents should know about their child's tummy troubles.

When Jessica Gutierrez's 3-year-old son suffered through two days of vomiting, she couldn't help but feel helpless and frustrated. The stomach virus was another step back in Gutierrez's seemingly endless battle to put some pounds on her son, Jair.

"He eats but doesn't gain any weight," Gutierrez said.

For days, it seemed Jair rejected everything Gutierrez tried to feed him because he didn't feel well. Then just weeks later, Jair lost his appetite again when a different bug landed him at the emergency room at Holtz Children's Hospital at the University of Miami/Jackson Memorial Medical Center.

Wanting a sick child to eat and drink is a common desire by concerned parents, said Dr. Luis Concepcion, a Jackson Health System pediatrician, but he said, it's not something parents should obsess over -- just keep an eye on.
"We shouldn't push kids too hard to eat," he said. "Especially when kids are vomiting, more food will irritate the stomach. I recommend avoiding solid foods for at least six hours after the vomiting is over."

Concepcion said children are great at listening to their body's signals that their stomach is ready for food again.

Diarrhea and Vomiting

Contaminated food can cause diarrhea and vomiting, but doctors say the more common culprit are viruses and bacteria. Both diarrhea and vomiting can cause dehydration, so it's important to offer kids liquids, starting in small quantities and increasing slowly. Parents should avoid juice, soda and other sugary beverages because they make stomach problems worse. Another option for kids who won't drink water is mixing it with Gatorade or, for younger kids, Pedialyte. Physicians say parents shouldn't stop feedings just because a child has diarrhea.

For a queasy stomach, pediatricians recommend the BRAT diet -- bananas, rice, applesauce and toast -- with a small modification. Parents should add low-fat, high-protein foods such as chicken and beans to the diet. It's also important to avoid greasy, spicy or overly seasoned foods.

Constipation
Another stomach issue many children will struggle with is constipation. A common myth is that milk is the culprit. Dr. Amber Langshaw, a pediatric gastroenterologist at Holtz Children's Hospital, said milk is rarely the reason for constipation.
"Children don't get enough fiber, and they don't get enough fluids," she said. "People in South Florida don't realize how much fluid we lose because of the heat."
Langshaw said regularly adding water and fiber to a diet will greatly reduce constipation. Also, kids who drink too much fruit juice and don't eat enough fresh fruits aren't getting enough fiber; they should eat two to four servings of fruits and vegetables each day.
Langshaw also warns that many parents mistakenly think their newborns and infants are constipated when they are actually just straining to have a bowel movement. She said it takes time for newborns to develop that nerve coordination. Constipation becomes more of an issue in the toddler years.
"Next time your child is constipated, try prunes and increasing fluid intake," Langshaw said. "Or you can have your child consume a couple of ounces of prune juice mixed with a couple of ounces of water."
If that doesn't work, a doctor may order extra fiber. Langshaw also recommends parents avoid potty training when a child is constipated.
"Children can associate pain with potty training, and then they can become afraid of the potty," she said.

Tummy Aches

The most common gastrointestinal issue Concepcion hears about is the general complaint of a tummy ache. While there can be a variety of causes, one of the most common is gastritis.
"One doesn't think kids get gastritis, but their diets actually predispose them to this problem," Concepcion said. He said too many acidic foods are often to blame for gastritis. Many children only drink fruit juice, which he says is too acidic for some stomachs to handle.
"Fruit juice is good, but not when it replaces water. Children shouldn't consume more than a cup of fruit juice a day, and consuming too many tomato products can also add to the problem. "

The bottom line is when a child's stomach problems don't go away after a few days or if pain is severe, it's time to go to the doctor. However, both doctors agree the solution to most tummy troubles is a high-fiber, balanced diet with plenty of fruits and vegetables. And that advice is something the whole family needs to follow.

"The solution is treating the family. I can't tell you how many times I treat a child and the parent says, 'I have that problem, too,'" Langshaw said.

Jessica Gutierrez is learning she'll have to avoid the temptation of pressuring her son to eat when he doesn't want to and trusting that offering him healthy foods is her best strategy.
"If he's eaten a little bit, I don't keep bothering him," she said. "He's thin, but maybe he was meant to be that way."

Sandra Fiedler Esquivel is a media relations specialist with Jackson Health System and a freelance journalist. She lives in Pembroke Pines with her husband and two children.