Pediatric Gastrointestinal Conditions

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This is weekly dose of Wellness brought to you by MemorialCare health system. Here's Deborah Howell.

Deborah Howell

Welcome to the show. You are listening to. Weekly dose of Wellness brought to you by MemorialCare health system I'm Deborah Hall and today's guest is Doctor Barry Steinmetz, the associate medical director at the pediatric gastroenterology, Hepatology and Nutrition Center at Miller Children and women hospital in Long Beach. Our topic will be pediatric gastrointestinal conditions. What you need to know to keep your kids healthy, and that's a good thing. Welcome Doctor Steinmetz. Well, let's jump right in. What are some of the most common signs and symptoms of gastrointestinal conditions that parents should be aware of?

Barry Steinmetz, M.D.

Well, some of the things that parents should be concerned about is what is really constipation is very common in children. Constipation, though, however, should be defined as an alteration of regular bowel patterns that actually puts the stress on the child. Most people think that there's a defined limit and it's actually very important that every kid is a little bit different, but it's a change in the habits that's actually important, or an actual distress that the stooling actually causes the child. Other things would include weight failure or weight gain failure where children who may be always small and growing small is not something to be concerned, but if they start to plateau and change in the growth percentile, that would be something to be concerned.

Deborah Howell

OK, that's Constipation. What about Crohn's?

Barry Steinmetz, M.D.

Crohn's disease is somewhat becoming more common, and it's somewhat of a common disease. In Pediatrics and we do see a lot of at Millers Children Hospital. It is something that you should be aware of. Usually, it runs within the families. It doesn't always have to, but it usually presents with weight loss, diarrhea and blood in the stool

Deborah Howell

OK, all right. So how prevalent are these pediatric gastrointestinal conditions in children today?

Barry Steinmetz, M.D.

Well, it can be very, very common gas suffragio, reflux disease and infants. It's exceedingly common Constipation, actually. If you look across the board and pediatric general pediatric offices, 1/3 of them will be due to either Constipation or abdominal pain. So abdominal pain in children Constipation reflux is exceedingly common.

Deborah Howell

Wow, so are pediatric gastrointestinal conditions hereditary or environmental or?

Barry Steinmetz, M.D.

Well, it can be a mixture of both. The predisposition for many of the disorders can be genetic. For example like we mentioned Crohn's disease or also colitis can run within families. Other things such as celiac disease tends to run within families. Things like cystic fibrosis and the resultant problems with the pancreas that tends to be directly genetic, but things definitely have a genetic predisposition.

Deborah Howell

OK, So what are the most common ones that you see?

Barry Steinmetz, M.D.

Well, some of the things we mentioned. Inflammatory bowel disease which consists of Crohn's and also colitis. Things like gastroesophageal reflux disease, chronic abdominal pain and fatty liver disease which is occurring more because of the obesity epidemic that we're seeing in this country.

Deborah Howell

Maybe you can describe the conditions of fatty liver to us.

Barry Steinmetz, M.D.

Well, what it is. It's a child that develops what's called a hepatitis. Hepatitis to physician does not necessarily mean alcohol use, drug use, or a viral infection. It means irritated liver and it's when you have a irritated liver and a child who tends to be overweight and there's no other reason for it. The problem is that due to the excessive weight, fat settles in the liver and when it settles in the liver it irritates the liver. Now this may not be a problem in a year or two years of having the problem, but after 20 years of chronic irritation in the liver, you can end up with scarring of the liver. It's just the same as if you had hepatitis B or hepatitis C. It's irritation delivered day in day out that causes a problem.

Deborah Howell

My goodness and then what kind of symptoms would you have at that point?

Barry Steinmetz, M.D.

Problem is you don't have any symptoms. Usually, you have children who are obese and you have children that are functioning in their daily life. They're playing, they're doing everything like you would see, so it's usually something that's found on annual screenings done by pediatricians

Deborah Howell

OK, all right. You mentioned infantile GERD. Maybe you can explain a little bit more about those conditions.

Barry Steinmetz, M.D.

Sure, infantile GERD or gastroesophageal reflux disease UM is a process of where food comes backwards from the stomach up into the esophagus in a reflux fashion, and it becomes a disease when it causes a problem many parents out there know that their children can spit up and they can wet burp or they can vomit slightly after meals and they're happy child children. They grow and they thrive, and there's no real issues from it that's not infantile reflux disease. Infantile reflux disease is when they have a problem due to that spit up in that backflow. Either they're irritable, they don't want to eat well because it hurts them when it comes back up, they're not gaining weight, have problems with chronic cough or breathing issues that when it becomes in a disease and it definitely needs to be evaluated and treated.

Deborah Howell

So at what point, do you take your child in?

Barry Steinmetz, M.D.

Well, I would say the very first thing that you do is you speak with your pediatrician. You ask your pediatrician is this something I should be concerned with? If they say, well, you know it sounds like you might have a little bit of infantile reflux. We'll try this medication and an empiric trial fails. Those would be things to make it say, well, I think we need to take the next step.

Deborah Howell

Right. Yeah, and the same thing I'm thinking you know, OK, your kids constipated, but once you've taken them to the doctor in that case.

Barry Steinmetz, M.D.

Well, that's a good question. Well, once again as stating that the definition of Constipation really should be an alteration of a normal bowel habits for the patient before the child and then if it causes undue rest so Constipation can come and go based on diet based on water intake based on activity level and that if it's intermittent once in a while it may not be something that you need to be concerned about, but if it's a day in day out, over weeks and months, that's definitely something that should be evaluated and helped with in your pediatric, you know GI Community, or at your pediatrician.

Deborah Howell

It's kind of tricky because sometimes your kids don't want to tell you stuff.

Barry Steinmetz, M.D.

Absolutely, and once they're past the age of you helping them in the in the restroom and it makes it far more difficult. But it's something you should check with every once in a while, with your children and say is everything going well. Are you eating fine? Because sometimes in this busy life and our business you know running around schedule it's very difficult but should be asked.

Deborah Howell

So true, and I guess all a lot of this can be controlled by diet, so maybe you can give us a sort of a boilerplate of what would be a fantastic diet for your kid.

Barry Steinmetz, M.D.

Sure, especially for being on talking about Constipation. Things like good adequate water intake. Liquid intake is very key, especially with this past couple of months in California, Southern California, where we've had like heat, which has been unbelievable. You want to make sure that they take adequate water intake. That's the first thing.

Deborah Howell

And what is adequate water for a child?

Barry Steinmetz, M.D.

Well, it depends on the age, but I would say that you want to get at least 3, 8-ounce glasses of water or liquid in in the child on per day and maybe even more if it's extremely hot outside.

Deborah Howell

And that's tough because they're at school for a big part of the day.

Barry Steinmetz, M.D.

It is very tough and some kids really like water and some kids don't. So, you kind of got to see how your child is and just encourage them to take this.

Deborah Howell

Yeah, OK, and you know what? That doesn't count. You know you're not saying, OK, I had three Cokes. So, there's my three, you know, 8 ounces of liquid.

Barry Steinmetz, M.D.

No, no, that doesn't quite qualify actually, as sodas and non nutritive type liquids are really one of the problems of the childhood obesity epidemic that we're seeing and I recommend to my overweight patients that if you enjoy your food and you enjoy eating and I certainly do, you should not drink your calories away. You should not have those things like sodas and Arizona iced teas or any of those sugary drinks.

Deborah Howell

Right. Now, is mineral water significantly better for you than just regular tap water?

Barry Steinmetz, M.D.

Well, it depends what you're considering mineral water. A lot of people say mineral water and they talk about bottled water that that actually is created by reverse osmosis, which has very minimal electrolytes in it. In general, there's not much difference between tap water and bottled water. There are some different flavor profiles for some of the flavor fanatics out there, but other than that, California has some extremely good tap water and it's as good as most of the bottled water you're going to be getting.

Deborah Howell

That's interesting because you hear so much hype about you know how much you know the perrier's and the all the different you know, designer waters that have minerals in them are supposed to be so much better for you.

Barry Steinmetz, M.D.

It's marketing.

Deborah Howell

OK, good to know This is why we have you on the show. What else do we need to know about our kids and gastrointestinal conditions in general?

Barry Steinmetz, M.D.

Well, I would say just in general, uhm, ask your kids if they're having any problems. See if they have any problems when they're eating. Do they have any things like pain and every once in awhile, ask them are you stooling well or eliminating wells everything going fine. Uhm, do they have any concerns. The problem is, sometimes I don't think the children know that something may be abnormal and it's difficult as they get older, especially in the teenage years where they don't maybe not share so much, but every once in a while.

Deborah Howell

Yeah, of course not.

Barry Steinmetz, M.D.

Discussion, yeah. Every once in a while discussion is very important. I think that's the key thing is trying to have an open communication with their children.

Deborah Howell

OK, that's a tough one, but I'm sure there's a way to say it and ask it and get a correct answer.

Barry Steinmetz, M.D.

Easier said than done, absolutely, but still important.

Deborah Howell

And then. All right, thank you so much. Doctor Steinmetz, do you have any information as to where people can go to get further information on these conditions?

Barry Steinmetz, M.D.

Sure, if they have any, uh, any concerns, they can actually log on to the website Miller Children. So it's Millerchildren.org/GI and then that will allow him to look at. Common pediatric GI diagnosis and it allows them to know where our offices are and our satellite offices are and how to get an appointment.

Deborah Howell

It's a beautiful thing. Thank you so much. It's been wonderful to have you on the show today. Doctor Steinmetz.

Barry Steinmetz, M.D.

My pleasure, have a good morning.

Deborah Howell

And to listen to the podcasts or for more information, please visit MemorialCare.org. That's memorialcare.org I'm Deborah Howell. Join us again next time as we explore another weekly dose of Wellness brought to you by MemorialCare health system. Keep those lines open with your kids and have a fantastic day.