Pediatric GI Issues (OTC Treatments)

PEDIATRIC GI ISSUES

  • Gripe = sharp spasmodic pain in the bowel
    • Gripe is a symptom of colic
  • Colic = a syndrome where a healthy baby cries or screams frequently for extended periods of time for no apparent reason
    • Usually occurs between 4 weeks to 8 months of age
    • May repeat on a schedule (same time of day) that will vary with the infant
      • Colicky: crying more than 3 hours a day for more than 3 days a week for more than 3 weeks a month (colicky baby = rule of 3s)
    • Symptoms:  red face, clenched fists, passing gas, arching the back
    • No known explanation or proven therapies for colic
      • Consult a doctor before a giving a baby anything for colic
  • Infants cry to communicate
  • Simethicone (mylicon drops)–used for colic
    • Reduces surface tension of bubbles causing coalescence and expulsion of gas
    • Very safe, can be used with infants
  • “gas hold”– holding a baby gently but firmly in a face down position over your arm
  • Gripe water– comes in several different formulations (either nutraceutical or homeopathic mixtures)
  • Hyland’s Colic tablets are a homeopathic remedy indicated for the temporary relief of colic symptoms
    • Child 2 & under: dissolve 2 under tongue q 15 min for up to 8 doses, then q 2 h as needed
      • Usually we DON’T RECOMMEND LAXATIVES IN KIDS UNDER 2
    • 2 & over: 3 tabs instead of 2 & follow same above sig
    • Hyland’s Colic tabs may be dissolved in water first
  • Some anticholinergics (slow GI motility–can’t shit) are used to relieve colic
    • Donnalix –has been associated with several dosing errors in Australia, atropine, hyoscyamine, hyoscine
  • The only difference between constipation in adults vs. kids is that with kids there may be more behavioral differences
    • Some kids may hold stools when constipated in order to avoid the pain of evacuation
      • However constipation coupled with N/V, abdominal pain/tenderness should be referred to a doctor
    • Same constipation products are used with kids as adults but dosage is smaller  (another product used for kids is malt soup extract)
  • Glycerin suppositories are smaller for pediatrics than adults.  You need to hold their butt together to make sure it is retained.
  • You can use fleet enemas/suppositories (hyperosmotic products) in kids 2-6
  • When to contact a doctor about diarrhea in kids/infants:
    • If it’s severe or lasts longer than 2-3 days
    • Contains blood, mucous
    • Kid is losing weight, dehydrated
    • Diarrhea is accompanied by vomiting, fever, abdominal pain
  • Causes of diarrhea in kids/infants– viral (30-40%), parasites, dietary, medication related (antibiotics)
    • Treatment of diarrhea in kids– allow bowel to rest (let diarrhea run its course), loperamide, probiotics
      • Loperamide (ages 2 & up)
        • Ages 2-6: start hydration, refer to doctor before suggesting loperamide
        • Ages 6-8: 1 caplet after 1st loose stool, 1/2 caplet after each subsequent loose stool  (no more than 2 caplets q 24 h)
        • Ages 12 & up: 2 caplets after 1st stool, 1 caplet after each subsequent loose stool (not more than 4 q 24 h)
  • In most kids children drinking more fluids is sufficient for treatment of diarrhea (dehydration is often the cause)
    • Fluids should be provided in small quantities of continuous sipping
    • Popsicles and jello can be used to rehydrate
      • Rehydration solutions usually contain: K, Na, Cl, citrate, sugar
  • Management of acute diarrhea in kids: oral rehydration, maintenance, & nutritional therapy
  • Nutritional management of acute diarrhea:  We want to continue feeding in order to avoid side effects of malnutrition & thus stimulate intestinal cell (enterocytes)
  • N/V in kids: refer to doctor if the kid vomits more than 2x an hour, or if they continue to feel nauseated for ~2 hours or more, of they stop eating
    • Self-care options for N/V if indicated:
      • Antihistamines: may cause paradoxical stimulation/excitement in kids
      • Phosphorate carbohydrate solution (emetrol): kids 2-12:: 1-2 tea q 15 min until distress subsides
      • Rehydration solutions: continue dosing (in small volumes) even if the kid is still vomiting
  • Acid control in kids
    • Can use calcium carb & milk of magnesia: 2 years & up
    • H2RAs: 12 years & up
    • Omeprazole: 18 years & up

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