Paediatric GI Disorders
Diagnosis and management of common digestive problems affecting children
What is paediatric GI disorders?
This covers the bowel problems children are born with, and they present in one of two ways: immediately, in a newborn who cannot feed, or gradually, in a young child who is never quite right.
The newborn group includes bowel that is blocked, narrowed, twisted on its blood supply, or joined to nothing at all. These are surgical emergencies and are usually recognised in the first days of life.
The gradual group includes a segment of bowel born without its nerve supply, so it cannot relax and pass stool through. A newborn who does not pass stool in the first day or two, or a child with lifelong severe constipation and a distended abdomen, is investigated for this.
In all of it, the priority is the same: establish whether the bowel's blood supply is at risk, because that is what turns a problem into an emergency measured in hours.
What you might notice
- A child vomiting green or being unable to keep feeds down
- A newborn who has not passed stool
- A swollen, tight abdomen
How it is diagnosed
An abdominal X-ray shows the pattern of gas, and that pattern says a great deal about the level of a blockage.
A contrast study, given by mouth or into the back passage, shows where the bowel narrows and whether it is twisted.
Where a missing nerve supply is suspected, the diagnosis is made on a sample of the bowel lining, which is the only thing that proves it. In an unwell newborn none of this delays treatment: a baby vomiting green fluid is treated as a twisted bowel until proven otherwise, and goes to theatre on that basis.
Recovery
These are among the larger operations in childhood and the stay is measured in weeks rather than days for a newborn, with feeding built up slowly once the bowel starts working again.
A stoma is often formed to rest the bowel and closed at a later operation, and a specialist nurse works with the family from the start.
After a pull-through operation, bowel habit takes months to settle and frequent stools and soreness around the bottom are expected early on. Longer term most children do well, though some need help with constipation or soiling for years, and that support is part of the treatment rather than a sign it failed.
If it is left untreated
A bowel that is twisted loses its blood supply, and the length of bowel involved dies within hours. A child who survives that may be left dependent on feeding through a vein, which is why green vomiting in a baby is an emergency and not something to observe overnight.
A blockage left untreated leads to vomiting, dehydration and perforation.
A segment without nerve supply causes progressive distension and, at its worst, a severe infection of the bowel wall that is life-threatening in a young infant. Constipation from birth, with a swollen abdomen and poor growth, is not ordinary constipation and needs investigating.
Questions about paediatric GI disorders
My baby vomited green. How urgent is that?
Very. Green vomit in a baby means bile, and bile means the blockage is below where the bile duct enters, which raises the possibility of a bowel that has twisted on its blood supply. That can cost a length of bowel within hours. It needs an emergency department immediately, not a call in the morning, and it is assessed as a twist until something else is proven.
Will my child need a stoma, and is it permanent?
Often a stoma is formed, and in the great majority of these conditions it is temporary. It rests the bowel or protects a repair while it heals, and it is closed at a later operation once things have settled, typically within months. A specialist nurse works with you from before it is formed until you are managing it confidently. A permanent stoma is uncommon and would be discussed with you specifically.
Will bowel habit ever be normal?
For most children it becomes normal or near enough that it does not affect daily life, though it takes months rather than weeks. In the early period after a pull-through operation, frequent stools and a sore bottom are expected. A minority need ongoing help with constipation or soiling into school age, and that is managed in a dedicated clinic rather than left to families to work out.
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Day CareTalk to a care coordinator about paediatric GI disorders
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