January 18, 2019
Gastrointestinal motility disorders in children are common and sometimes considered benign. However, these diseases often have complex causes, and patients can benefit from specialized pediatric gastrointestinal management.
“Even common conditions like constipation aren’t as easy as some people think. Different types need to be managed differently,” says Pediatric Digestion at the Mayo Clinic in Rochester, Minn. says Dr. Louis Magnini, an internal medicine physician. Children with constipation may have congenital slow colons, anorectal malformations, or pelvic floor problems.
Referral to a pediatric gastroenterologist may be beneficial for children with constipation or other movement disorders, such as:
- dysphagia
- abdominal distension
- Low feeding resistance
- chronic nausea and vomiting
- acid reflux
“Although constipation is the most common problem, we also see children with movement disorders complicated by underlying conditions such as spina bifida, spinal cord lesions, tumors, and Hirschsprung disease. “It’s a rare congenital disease that involves nerve cells in the body and makes it difficult to move and defecate,” says Dr. Manini.
Available tests include:
- Study of gastric, small intestine and colonic transit
- Anorectal pressure measurement
- Colon pressure measurement
- Esophageal pressure measurement
- Gastroduodenal manometry
Esophageal manometry can detect rumination syndrome. Rumination syndrome is when a person repeatedly spits out food, chews it again, and then swallows it. “Rumination disorder is an underdiagnosed disease because tools for diagnosis and management are not common,” says Dr. Manini. Children with rumination syndrome may be referred to a behavioral psychologist at a children’s center. This professional can teach most people effective diaphragmatic breathing techniques.
Gastroduodenal manometry is used to assess the strength of the stomach contractions and their coordination with the small intestine. “This test can be difficult to perform in children,” Dr. Manini says. “However, our team has the expertise to care for children and ease their fears.”
Once testing is complete, your treatment plan may include medications, surgery, or behavioral therapy. Heller myotomy may be performed in children with achalasia. Children with Hirschsprung disease usually require initial anorectal surgery and continued monitoring for future complications such as strictures and incontinence.
For children with pelvic floor problems, a physical therapist can provide pelvic floor therapy. Biofeedback may be used to teach children to relax and tighten their pelvic floor muscles.
“Having these new tools to assess children is a huge advantage in guiding the management of children,” says Dr. Manini. “Testing and treating children is often not as simple as treating adults. However, we have the expertise and experience to provide complete management for pediatric patients.”