From the Guidelines
For a 7-year-old with gastrointestinal symptoms, the workup should begin with a thorough history and physical examination to identify potential causes, and initial testing may include a complete blood count, comprehensive metabolic panel, inflammatory markers, and a urinalysis, as recommended by 1 and 1. The evaluation process for a child with gastrointestinal symptoms involves several steps to determine the underlying cause.
- Common issues to consider include gastroenteritis, constipation, food intolerances, or functional abdominal pain.
- Initial testing may include:
- Complete blood count
- Comprehensive metabolic panel
- Inflammatory markers like C-reactive protein or erythrocyte sedimentation rate
- Urinalysis
- Stool studies for blood, parasites, and culture may be appropriate depending on symptoms.
- If the child has persistent symptoms like chronic diarrhea, weight loss, or growth concerns, additional testing might include:
- Celiac disease screening
- Abdominal ultrasound
- Referral to a pediatric gastroenterologist While waiting for results, symptomatic treatment may include:
- Ensuring adequate hydration
- A bland diet during acute episodes
- Possibly probiotics like Lactobacillus GG (5-10 billion CFU daily)
- Avoiding unnecessary antibiotics unless bacterial infection is confirmed
- For pain management, acetaminophen (10-15 mg/kg every 4-6 hours) is preferred over NSAIDs which may irritate the stomach, as noted in 1. It is essential to keep a food diary to help identify potential triggers, as suggested by 1. These steps allow for appropriate diagnosis while providing symptomatic relief during the evaluation process. In cases where gastroesophageal reflux disease (GERD) is suspected, lifestyle changes and medications like proton pump inhibitors may be considered, as discussed in 1 and 1. However, it is crucial to carefully follow patients empirically treated for GERD to ensure they are improving, as many clinical conditions can mimic its symptoms, as emphasized in 1.
From the Research
Diagnostic Approach
To determine the appropriate workup for a 7-year-old patient with gastrointestinal (GI) symptoms, a thorough history and physical examination are essential. The diagnosis of GI disorders in children can be challenging due to the breadth of potential dysfunction and the difficulty of pediatric patients to provide a detailed articulation of their symptoms 2.
Classification of GI Disorders
GI disorders in children can be classified into three categories: infectious, inflammatory, and immunologic pathology; motility disorders; and functional gastrointestinal disorders 2.
Functional Gastrointestinal Disorders
Functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), are common in children and can be diagnosed based on symptomology using the Rome criteria 3, 4, 5. The pathophysiology of IBS is complex and involves disordered communication between the gut and the brain, leading to motility disturbances, visceral hypersensitivity, and altered CNS processing 4.
Diagnostic Criteria
The diagnosis of IBS relies on symptom-based criteria, exclusion of concerning features, and the performance of selected tests to exclude organic diseases that can mimic IBS 5. Determining the predominant symptom (IBS with diarrhea, IBS with constipation, or mixed IBS) plays an important role in selection of diagnostic tests and treatments 5.
Key Considerations
- A thorough history and physical examination are essential to determine the underlying cause of GI symptoms in children.
- Functional gastrointestinal disorders, such as IBS, are common in children and can be diagnosed based on symptomology using the Rome criteria.
- The diagnosis of IBS relies on symptom-based criteria, exclusion of concerning features, and the performance of selected tests to exclude organic diseases that can mimic IBS.
- Determining the predominant symptom plays an important role in selection of diagnostic tests and treatments.
Possible Diagnostic Tests
Possible diagnostic tests for GI disorders in children include:
- Complete blood cell count
- C-reactive protein or fecal calprotectin
- Serologic testing for celiac disease
- Age-appropriate colorectal cancer screening 5