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Intussusception is an uncommon disorder of the bowel which usually occurs in children under 1 year old. Boys are more commonly affected than girls.
Cause
One section of bowel slides inside another adjoining section and becomes stuck, causing a blockage. Occasionally this follows some inflammation of the bowel, such as gastroenteritis, which leaves the lymph glands enlarged, but in the majority of cases, no cause can be identified.
Clinical features
The baby suffers from severe spasms of abdominal pain; he draws his legs to his chest and screams. He may vomit initially. After an hour or so, the baby becomes exhausted, looks pale and is drowsy between spasms. He may pass a stool which has blood in it (called a redcurrant jelly stool).
Investigations
An X-ray of the abdomen, together with a barium enema, will confirm the diagnosis.
Treatment
Early diagnosis is critical and admission to hospital essential as intussusception is a medical emergency. Dehydration must be treated with an intravenous infusion. A barium enema itself may be sufficient to reduce the pressure in the affected portion of the bowel and return it to its normal position. Failing this, surgery will be necessary to relieve the blockage.
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Cause
When a piece of bowel protrudes through a weakness in the muscle wall it produces a lump or hernia which is often visible. In normal development of the foetus, the channel between the abdomen and the groin closes off after the testes or female ligaments migrate downward. If this channel remains open, the bowel can protrude through causing a lump to appear in the groin.
Clinical features
A lump becomes apparent in the groin, usually on one side, and may be tender to touch. This hernia can become trapped (obstructed) and its blood supply impaired. If this happens, your child will complain of abdominal pain, in addition to crying and being very irritable. He may also vomit.
Surgery is generally the treatment of choice for inguinal hernias, due to the risk of them becoming obstructed. Children recover completely after this operation.
When to see your doctor
See your doctor immediately if you notice a swelling in your child’s groin.
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INFLAMMATORY BOWEL DISEASE
HAEMORRHOIDS (PILES)
Haemorrhoids are enlarged veins inside the anus, thought to be caused by long-term straining to pass stools, such as occurs with constipation. The presence of haemorrhoids is rare in children.
Hiccups are common at all ages and are usually short-lived and no cause for concern. They are caused by a sudden spasm of the diaphragm (the muscle separating the chest from the abdomen) which may have been irritated. This is especially common after a meal, when the stomach has been stretched. Many ‘remedies’ for hiccups have been invented through the ages, such as holding the breath, giving the person a fright, or drinking a glass of water. We recommend you just let them pass of their own accord!
INFLAMMATORY BOWEL DISEASE
There are two types of chronic inflammatory bowel disease: Crohn’s disease and ulcerative colitis. Both are relatively uncommon in children. Characteristic signs include bleeding from the bowel and diarrhoea. The causes are uncertain. Both disorders require long-term care under a specialist.
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Giardia is a parasitic infection which can cause chronic diarrhea in children, as well as problems with the absorption of food.
Cause
The small intestine is infested with a tiny parasite called Giardia lamblia. It is picked up mainly from contaminated food or water.
Clinical features
Giardia infections tend to occur more commonly in toddlers and older children. The onset of symptoms may be sudden or gradual, and usually begin with flatulence, diarrhoea and a bloated belly. The child may complain of stomach aches and may even vomit. A poor appetite due to nausea is soon followed by significant weight loss and general listlessness. Sometimes the only symptom will be chronic diarrhoea and some children may have no symptoms at all.
Giardia infections can sometimes be confirmed on examination of the stools. If the parasites are not seen in a specimen, it does not necessarily indicate that Giardia is not present. The sample needs to be fresh and even a delay of a few hours can of the bowel and is no longer visible under rhe microscope once it has stopped moving. Several specimens may need to be examined before the diagnosis can be made. In children with diarrhoea or weight loss a duodenal biopsy may be performed to make the diagnosis.
Treatment
There are effective medications which can be used to treat Giardia infection. Strict attention should be paid to hygiene in all members of the family to prevent cross-infection.
When to see your doctor
See your doctor if your child has any of the symptoms above or if in addition to any of these symptoms he has a fever or is generally unwell.
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