Gastrointestinal Issues

Problems with the gastrointestinal tract can either be caused by abnormal structure or may be because part of the tract is not functioning properly. Children with Down syndrome are more likely to have problems in both of these areas than the general population. Some of these problems are serious and life threatening and are likely to cause immediate problems in a newborn. Other issues may not be as serious, but nevertheless can cause considerable problems. Sometimes, gastrointestinal problems may not be noticeable by parents or doctors because some issues develop more slowly. Gastrointestinal problems are a common cause of illness in all children. The more common problems include gastroenteritis (an infection affecting the stomach and intestines) and appendicitis. Regarding typical stomach and digestive problems, children with Down syndrome are no different than typically developing children. However, if a child with Down syndrome seems to have more gastrointestinal problems it is important to have a medical assessment which should consider both the common conditions as well as those that tend to more often affect children with Down syndrome. Symptoms of Gastrointestinal Disorders Found in Children with Down Syndrome As with any health issue, there are numerous symptoms that occur with gastrointestinal tract problems. The following sections discusses some of these symptoms. Vomiting All children vomit from time to time. In babies this may just be a small amount of undigested milk that is brought back after eating and is not usually a sign of an underlying disease or problem. It can often be helped by careful attention to feeding technique, avoiding taking in too much air and keeping the baby upright they eating for about half an hour. Children may also vomit when they are ill (e.g., flu, chicken-pox or other viruses). In these situations the vomiting is usually short lived and goes away when the underlying problem is resolved. If vomiting is severe, frequent (i.e. more than a few times a day) or prolonged (lasting more than a few days) a visit to the doctor’s is warranted. Other signs that the problem is more serious include bile stained vomit, or blood in the vomit. This may look dark brown or like coffee grounds mixed in the vomit. Diarrhea Diarrhea is defined as frequent passing of loose, watery stools. It is impossible to specify how loose, or how often is “normal,” since every person is different. Many infants and toddlers (and some adults) will have several loose stools a day as their normal pattern. There will also be normal, healthy variations depending on what we eat and drink. The important thing is to notice if there is a significant change from the child's normal pattern that lasts more than a few days. Sometimes stools may be particularly bulky, foul smelling or look frothy or greasy. This may be a sign that something is not being absorbed properly in the diet. Constipation Most people get constipated from time to time. Very hard stools can be a problem in themselves as they can be painful to pass and cause a small amount of bleeding on the way out. Sometimes constipation is not identified because the child is continuing to pass small amounts of liquid stools. This happens when hard, dry stool is retained in the rectum, while small amounts of liquid stool seep around the sides, often resulting in soiling. Constipation is a common problem in children with Down syndrome, and in most cases it is not because of an underlying disease. It is likely a result of a combination of low muscle tone, poor motility, diet, and inadequate intake of fluids. Giving extra fluids, fruit and increasing fiber may solve the problem, or it may be necessary for a doctor to prescribe a stool softener. If constipation is severe or persists despite these measures, then other causes should be considered. Hypothyroidism, a common problem for children with Down syndrome, can cause constipation. Another cause of constipation is Hirschprung's Disease. Stomach Pain Children often complain of stomach aches. In many cases it is nothing to do with the gastrointestinal tract but is a general symptom of being unwell, or it may be the child's way of explaining a pain somewhere else in the body. It may also be a symptom of anxiety. Stomach pain is often caused by constipation. Advice should be sought from a doctor if it persists or if it is associated with other symptoms such as vomiting or the pain seems to be severe. Stomach pain may also be related to the esophagus (heartburn or indigestion). Reflux tends to cause these problems. Reflux (discussed below) is more common in babies with Down syndrome and should be checked if the baby seems to be in pain; especially after eating. Poor Weight Gain This can be a symptom of many childhood disorders. It is often associated with gastrointestinal problems. Although the above mentioned gastrointestinal problems may not generally be serious, if they are associated with poor weight gain or weight loss, the help of a doctor is recommended. It should be noted that children with Down syndrome do grow more slowly when compared with other children. They tend to be of shorter stature than their typical peers. Along with height differences, there are also different weight “standards” for children with Down syndrome. Like all children, there is considerable variation in size and weight so a child's actual weight is not as important as the rate of weight gain or the comparison with previous weight or height measurements for that child.