What You See: Clumps of spit-up hitting the fan... and the dresser... and the wall
The Diagnosis: Gastroesophageal reflux
Picture your baby's tummy as a small balloon with a snug ring at the top keeping food and other stomach contents in their place. Unfortunately, this muscle isn't always as strong or in control as we'd like, especially in young kids. This means that pressure put on a baby's belly, even from a gas bubble, can trigger an unwelcome uprising.
Treat It: While spit-up stains are gross and unfortunate, most babies continue to drink, eat, and be merry without treatment -- and stop spitting up within (an admittedly long) six to nine months. In the meantime, give baby smaller and more frequent meals, and keep her sitting upright after eating. Feeding her thicker foods also may help, but discuss this with your doctor first. And try burping her -- it might cut down on the air bubbles and gas that sometimes aggravate reflux. When to worry: if your baby seems to be in pain or has had a tough time gaining weight. In this case, talk to your pediatrician about GERD, a more serious form of reflux.
What You See: A "red flag" (poop with a streak of blood)
The Diagnosis: Constipation
You're changing baby's diaper and you see...blood. A streak or speck on the surface of formed poop almost always means the skin around the anus is slightly torn, causing it to bleed. This tear also means baby is constipated. Once he's no longer stopped up, the skin will heal and the bleeding will end. However, if you see poop that contains blood or mucus, see a doctor. And if you're wondering how often your baby should be pooping, here's a rule of thumb: Start worrying if the time between his bowel movements is spread out longer than usual. For instance, if he usually goes once a day and starts going every third or fourth, that's a potential problem.
Treat It: After each diaper change, apply petroleum jelly around the anus. When baby is constipated, the "fix it with food" mantra really sticks. If your child isn't yet on baby food, give him two to four ounces daily of apple or pear juice -- they contain sorbitol, which helps keep things moving (talk to your doctor if your baby is younger than 4 months). If he's already eating baby food, feed him jarred fruits; if he's on table food, give him plenty of fiber-rich veggies and beans and cut back on dairy. Not improving within a day or two? Talk with your doctor about a stool softener.
What You See (and Smell): Lots of fussing, grimacing, and gas
The Diagnosis: A gassy baby
Gas is gas. And as smelly and annoying as it is, there's not a whole lot you can -- or need -- to do about it, so long as your baby is eating and growing well.
Treat It: Some healthy foods can make baby gassy. So if you're nursing, avoid broccoli, cabbage, garlic, and onions, all thought to cause gas. A bottlefed baby might benefit from simply swallowing less air -- hold her bottle more upright to let bubbles of newly mixed formula settle before feeding. In times of distress, try rubbing her tummy to get the air moving.
What You See: Vomiting after eating
The Diagnosis: Food poisoning
Of course, kids can throw up for reasons unrelated to illness, like carsickness or overeating. But when food poisoning is the culprit, toxins produced by bacteria cause the sudden onset of nausea, vomiting, and/or diarrhea (usually within six hours of eating a contaminated food). Common foods to blame include dairy, produce, meats, eggs, and rice. Here's comforting news for the family: The vomit-inducing toxins aren't contagious.
Treat It: If your child ate a suspect food at home, toss the rest. Fortunately, vomiting usually stops on its own within 48 hours. If your child stays hydrated, it typically isn't dangerous in the absence of other symptoms. It just makes him miserable. Give him frequent but small amounts of fluid until he feels better. If you're worried about dehydration or if the vomiting or diarrhea is unrelenting or bloody, call your doctor.
What You See (and Smell): Green, rank diarrhea
The Diagnosis: Rotavirus
This seasonal virus is most common November to April. If baby's poop suddenly becomes greener, more frequent, and more foul-smelling than usual, chances are she has rotavirus -- especially if she also has a fever, is vomiting, and shows signs of belly pain, like fussiness and drawing her legs to her chest. The virus is the most common childhood cause of potentially severe diarrhea, and its symptoms are usually very treatable.
Treat It: Ever run a 5K on a hot, humid day -- without drinking much throughout? If you remember how you felt (very parched), that may be how baby feels if she becomes too dehydrated from rotavirus. So keep up her normal fluid intake -- breastmilk or formula for babies and milk or Pedialyte for children 1 year and older. Symptoms should subside within eight days, but call the doctor right away if baby seems lethargic or cries without tears. Also call if your child has less than two wet diapers daily for more than the first couple of days.
What You See: Your child's refusal to eat, accompanied by a sandpaper-like rash
The Diagnosis: Strep throat (probably)
While strep is by no means the only possible cause of these symptoms, it's definitely worth considering once kids reach age 2 or 3 (younger children can get it but seem to be less susceptible). This pesky infection is known to cause stomachaches ranging from mild to downright severe. In fact, even a stand-alone tummy ailment without a sore throat or fever can mean strep, especially if your preschooler has been in contact with someone who's had it.
Treat It: Your doc will do a throat culture to determine if your child has strep. If the verdict is yes, he'll need antibiotics; they'll help him feel better and prevent long-term side effects. Kids aren't considered contagious 24 hours after starting antibiotics and generally feel much better within a couple of days.
What If It's Appendicitis?
Don't take a chance. If your child has extreme or unexplained belly pain, see your doctor immediately. Appendicitis is difficult to diagnose since kids don't develop the same telltale symptoms as adults do (fever, loss of appetite, right-sided belly pain). It's very uncommon in children: only one or two out of every 10,000 children younger than 4 gets it. All the same, your doctor may order blood and urine tests and maybe even a CT scan. If your child has appendicitis, you'll be happy you took these precautions -- when the appendix bursts, a deadly infection can develop.
Tummy Tool Kit
Have these on hand for typical stomach ailments.
- Sensitive baby wipes maintain good diaper hygiene without further upsetting the skin.
- Diaper cream provides a protective layer between baby's skin and irritating bowel movements.
- Burp cloths keep your clothes, carpet, and furniture somewhat spit-free.
- Pedialyte gives baby valuable electrolytes that help prevent dehydration during periods of vomiting or episodes of diarrhea.
- Petroleum jelly moisturizes skin during times of frequent diaper changing. It's also good for soothing bottoms irritated by constipation.
Laura Jana, MD, is a new member of American Baby's advisory board.
Originally published in the March 2009 issue of American Baby magazine.