Latest / Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner / Constipation and Abdominal Pain: What To Do and When To Worry

Transcript

Constipation and Abdominal Pain: What To Do and When To Worry · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

0:00
I'm Holly Weymant, and this is Pediatrics Now, brought to you by the Department
0:04
of Pediatrics at UT Health San Antonio and University Health's new Women's and Children's Hospital.
0:11
Today, we're going to discuss how to distinguish functional constipation from
0:16
organic causes, when to worry, and how to manage it effectively.
0:20
Joining me today is Dr. Anandini Suri from our pediatric GI team.
0:25
She's the newest member of that team, and she has a special interest in liver disease.
0:31
And Anadini, we are so grateful to have you here on Pediatrics Now. Thank you.
0:37
Thank you, Holly. Regarding constipation, as we know, it's incredibly common in pediatrics.
0:44
Why is it one of the most frequent reasons children come to clinic?
0:50
Well, I guess, you know, not stooling causes a lot of issues overall.
0:58
And sometimes I see patients coming in with diarrhea instead of constipation
1:02
because they haven't stooled for so, so long that they cannot even maintain continence.
1:07
So you can have belly pain. They don't eat well. Things don't move well. You can be very gassy.
1:13
So all these kind of intertwined, I think that's, it is very stressful for the family.
1:19
And sometimes also has a lot of mental impact on the kids, specifically if they're
1:24
not spitted enough that they can't even maintain continence.
1:27
And that is really bad. Like you're in a diaper in a school or in the school
1:31
or you poop while in the middle of a class and that's not good, right?
1:36
So, yeah. So that's probably the most common kind of things that we would see.
1:42
I was talking with some pediatricians yesterday and they talked about,
1:46
It's just, I mean, they see so many kids with constipation and belly pain in general.
1:53
When a child presents with abdominal pain, how often is constipation the underlying
1:59
cause and what advice do you have there?
2:03
So I think when it comes to constipation that's bad enough to come to GI versus
2:08
belly pain, it's very important to differentiate between belly pain and constipation.
2:13
When it is functional constipation, it is just not pooping well enough or having
2:19
hard stools or not having significantly
2:22
good stools, which is not associated with a lot of belly pain.
2:26
Sometimes belly pain can be one of the main presenting symptoms and constipation
2:35
can be masking or increasing the belly pain.
2:38
So it's very important to differentiate what is the presenting symptom,
2:41
whether it is constipation predominantly or it is belly pain.
2:45
Because if it's pain predominant, a lot of the times you could have something
2:49
like an IBS underlying, which is causing constipation,
2:52
versus it is not being true functional constipation, which is where kids would
2:58
mostly be present with just not pooping well and not feeling well because they're
3:03
not pooping, rather than pain. Pain is probably second rate of constipation.
3:08
You did your training in pediatric GI and med school in India.
3:12
And then when you came to the United States, it was a Mount Sinai hospital system.
3:17
When a child presents with constipation, what would you say,
3:23
what would be the first few things to make sure to do in the general pediatric setting?
3:28
Yeah, I think looking for red flags is most important. So red flags, is the child thriving?
3:35
Fine. Is the child having any blood in stool? Is the child having vomiting?
3:40
Are there alternating episodes of diarrhea and vomiting?
3:45
Those are the things that I would look for mostly because if there are any red
3:51
flags for constipation, that means that it is probably not functional and that
3:57
that needs more investigations on the GI part.
4:00
So if, say for example, if the kid is alternating between constipation and diarrhea
4:06
and is having a lot of blood in stool, some of the IBD phenotypes can present with constipation too.
4:12
If the child is not growing well, then again, some GI diseases like IBD or celiac
4:19
disease, thyroid diseases, those could be possible.
4:23
You know how is the intellectual development how is
4:26
overall development is the kid having any
4:29
gross motor delays some of the most spina bifidus can
4:32
have like gross motor delays or you know lower limb like muscles like lower
4:38
limb plagias like diplagias and stuff that can have been maybe it's very mild
4:43
and it's missed and that is the cause of constipation so those kind of things
4:48
some of the red flags that we have to look for would be those.
4:52
What about red flags for abdominal pain? Are they similar to what you just said?
4:57
Almost similar. I think in a kid who is otherwise thriving well,
5:02
growing fine, doesn't have anemia, has a good amount of albumin in his body,
5:08
the likelihood of that being any primary GI disorder is low.
5:13
But having said that, it's not 100%, but yes, the likelihood of that being the
5:19
primary GI disorder is low. So red flag, belly pain would certainly,
5:23
nighttime pain is another big red flag.
5:25
Vomiting is a red flag for belly pain.
5:28
Not growing well, having poor appetite, those kind of things are red flags for belly pain.
5:34
And Andini, can you review for us, why are those symptoms red flags for belly
5:39
pain? Because it could be what?
5:43
So IBS or non, like when you don't have a mucosal GI disease is what IBS is.
5:49
IBS is also like an issue with the GI tract, but it does, you don't have a mucosal disease.
5:56
And there are a lot of external factors affecting IBS. In sleep,
6:00
typically at night, those factors kind of get silenced and the gut is a little more relaxed.
6:08
So you don't have a lot of nighttime awakenings, specifically when there is
6:12
like a pain which is not coming from a mucosal disease.
6:16
While if you have a pain coming from IBD or something like that,
6:19
it's a pain coming from a different source, right?
6:24
It's an inflammatory pain. And we know from our knowledge of medicine overall
6:31
that inflammatory pain is typically very often worse in that night.
6:37
So nighttime pain is a big red flag. Having blood in stool is a red flag,
6:42
again, for a mucosal disease, whether it be IBD or celiac disease.
6:47
Then not being able to grow well or not having a good appetite certainly is
6:52
a red flag because that tells you that the function of the GI tract is not great.
6:57
Because the function of the geotrack is for you to eat and to absorb food so you could grow.
7:04
So those are a factor. So that tells us that the function is a factor.
7:08
So yeah, those are the major red flags.
7:12
And Anadini, that is so helpful. And are you saying,
7:16
so if a child does not have any of these red flags, what can be treated and
7:21
managed in the primary care general pediatric setting And what would you advise
7:28
if we start with constipation?
7:31
If there are no red flags for constipation, I think it's reasonable to start
7:35
them on stool softeners. I like to do Miralax.
7:38
It's approved for ages one and above.
7:42
So the downside of Miralax is that there is a lot of fluid that needs to go in with taking Miralax.
7:49
So if the kid is not good with drinking fluids overall, then we may need to
7:54
get a little more innovative with how we give Miralax to the kids.
7:58
But overall i think i love mirror likes
8:01
i don't do a lot of senna although we can
8:04
certainly do it in a certain set of population or kind of
8:07
to start off start off with with
8:10
so severe constipation at least in the beginning of
8:13
the regimen to let them start pooping because
8:16
senna does give cramps and that can be
8:19
often confused with some like gas cramps
8:22
that you could have from just being constipated so sometimes it
8:27
converts in that belly pain component that comes
8:30
with constipation so i
8:34
usually just like like soft nurse the
8:37
good part about meralax is that it can be titrated based on how
8:40
the child is stooling i like to do about
8:43
how i mean for younger kids age less than
8:45
like five seven years of age up to almost seven
8:48
ten years of age maybe just half a capful a day and
8:52
each cap goes in about eight ounces six
8:55
to eight ounces of liquid so maybe we so
8:58
half a cap would go in half of that amount but if that
9:01
is a big amount of liquid for the kid to consume then i would just go with a
9:06
smaller amount maybe around four ounces for a cap the key is to tell the patients
9:12
that it is a medicine so you have to take it like a medicine like you can't.
9:17
Keep drinking fluid with me, relax in it for the whole day.
9:21
You've got to chug it down in, say, 10 minutes, 15 minutes, 20 minutes.
9:25
20 minutes is the upper limit.
9:27
So that's the key. So having to take Miralax, take it in a good amount of fluid
9:32
and take it in the right way.
9:34
Okay, so you're saying that Miralax is much better than Senna,
9:38
which is a natural stimulant laxative used to treat constipation.
9:42
Yeah, I mean stimulants, so this is how softness and stimulants.
9:48
Softeners basically increase the increase the fluid content of the of the poop
9:54
so you can just so the poop is softer and can kind of moves better stimulants will make the intestine,
10:02
contract and kind of go you i think stimulants are sometimes more useful to
10:07
in the initial phases of constipation treatment when you really have to like
10:12
start the car and get it going you know so It's like a startup thing or when
10:17
you have from the patients,
10:19
I like to use Senna more on our patients who really have like some kind of outlet issues or, you know,
10:26
something a little more than functional constipation.
10:28
But you can certainly use it at the initial phases kind of to get the clean out started.
10:34
But as a overall maintenance regime with all the cramps that it causes,
10:40
I don't typically prefer Senna, although I know a lot of people would prefer it.
10:45
I would prefer more softener so it is softer and doesn't cause a lot of cramps and you don't have any.
10:52
Anything muddying your picture, especially if the kid has belly pain.
10:55
If the kid doesn't have any belly pain, you could certainly try Senna and see.
11:00
Sometimes how I do is just tell parents, you know what you could do,
11:03
Senna, it can cause cramps. So just be mindful.
11:07
If you think Senna is causing the cramps, you could hold off and just do the
11:10
relax. That's the other way to go.
11:12
How long should maintenance therapy realistically continue for constipation?
11:17
I i i like to tell them that you
11:20
should poop every day or every other day and
11:23
your poop should be like soft serve it should not hurt and there
11:26
should be no blood whether it takes to get there
11:29
whether it takes you one year
11:32
or six months that changes with every patient so you could do relax as needed
11:37
until you get there i give i like to empower my patients and parents to kind
11:43
of get to know their body and and this is a very safe drug that they can titrate
11:48
on their own so that's how I like to,
11:51
approach it I initially when I give them a clean out I may give them a dose
11:55
but after that when they kind of start doing better I always tell them that
11:59
you titrate based on how you feel your body is doing.
12:05
And Anandini, this is also helpful. Thank you so much.
12:08
And what evidence is there about, or what would you say about the long-term safety of Miralax?
12:16
Miralax is a pretty safe drug. It doesn't get absorbed in our body.
12:20
It just stays in the colon pools and water.
12:23
So I have not seen any issues with Miralax.
12:27
Some parents would come and report behavioral issues with Miralax.
12:33
I don't think the data is strong to support anything.
12:37
At the same time, being the practitioner, I guess we have to be very cognizant about how parents feel.
12:45
And, you know, the compliance kind of will directly depend on that.
12:48
Other softeners, if mirrorless is not working, I typically like to do magnesium sulfate.
12:53
And that works well with both adults and young kids.
12:58
And Andini, what about diet? When should that be brought up regarding constipation?
13:04
You know, the funny part about diet in kids with constipation is that I don't
13:09
think we have a one-to-one relationship, data to show one-to-one relationship.
13:13
I think a good diet overall, a good healthy diet with good exercise is a key
13:20
thing to keep constipation away.
13:24
But I do have, especially in my GI clinic, I do see a lot of patients who have,
13:30
who at Please report to me that they have a great diet and they're still constipated.
13:34
So there is more to constipation than just diet in kids for sure.
13:38
But I think just having a healthy diet with good amount of fiber and fluid in
13:43
it is always helpful, whether it directly affects your constipation or not.
13:48
But it may not be the only thing.
13:51
And is there a couple of lines like specifically that you would love for our listeners,
13:57
our pediatric practitioner listeners to say in their busy day where they're
14:00
seeing 40 patients, but specifically like try to eat something green with lunch
14:06
and dinner and drink a glass of water with each meal or what would you say?
14:11
Yeah, I would say fruits and vegetables with each big meal.
14:16
You make sure that you have fruits and vegetables with each fruits,
14:20
fresh vegetables, fruits, all vegetables with breakfast, lunch and dinner,
14:23
one portion and at least 10 ounces of 10 to 12 ounces of fluid per day.
14:29
I would stay away from sodas and sugary drinks.
14:33
You never know which way they kind of switch your system.
14:38
So just water and fruits and vegetables with every meal.
14:44
One of my daughter's friends, he was having dinner with us.
14:48
We were at a place that offered his favorite drink, which was this natural prebiotic
14:54
drink. I know that's probably a different podcast, but do you recommend those
14:58
types of drinks for kids?
15:01
There's no data showing a lot of use about pre- or probiotics in constipation.
15:08
There is not great data around it.
15:10
I mean, as long as they're not contraindicated in kids.
15:15
I mean, in kids who are otherwise fine without any medical problems,
15:18
they're not contraindicated.
15:21
I mean, it's like any other drink. But is there a medical indication that it
15:25
will make a constipation better? That, I don't think so.
15:29
And it looks like it was also a soda. So, of course, water would be much better.
15:34
Yes, yes. And it's basically a soda with lots of bacteria that we don't necessarily
15:40
know what it is. Yeah, absolutely.
15:43
So the other thing about constipation, I think it's interesting to see the age
15:48
at which it is most common.
15:50
And most of my pediatricians or colleagues would agree that it's around the
15:54
time of toilet training that constipation is very common. And that's usually
15:58
mostly always functional than not.
16:01
So the only advice I would I would I have for my parents during that time is don't don't rush it.
16:10
Kids are ready when they're ready. Every kid is different and they're ready at their own time.
16:17
Giving Miralax to prevent constipation during toilet training,
16:21
I don't know whether that really helps.
16:23
There is no great data about it. I would just let the kid decide when he's ready to poop on the toilet.
16:31
I saw that with my three kids. Each one is so different.
16:35
I couldn't believe it. So yeah, if the constipation has set in,
16:40
it's reasonable to do Miralax until we have finished toilet training,
16:45
totally finished toilet training.
16:47
If there is no constipation and the kid is otherwise pooping, fine.
16:52
And we don't feel like that he's constipated.
16:56
We, I don't think, should do Miralax to aid toilet training.
17:01
It would happen when it has to happen.
17:04
And Ndini, in our Grand Rounds episode, which is posted on our website,
17:09
pediatricsnowpodcast.com, the video and the slides for listeners who want to
17:15
see the slides for that, it was a great presentation.
17:18
The doctor radiologist who was leading that, she does not recommend x-rays for constipation.
17:26
Is that something you would agree with?
17:29
I was just about to talk about that.
17:32
No x-rays. So poop is a normal content of your colon.
17:36
You're just going to see poop in the colon if you do x-rays,
17:40
and that doesn't tell you anything about how constipated you are.
17:43
Constipation is a clinical diagnosis.
17:46
It depends upon how, I mean, there's a frequency and the consistency of stools that matter.
17:52
It is a consistency that matters more than frequency.
17:57
So we could go over the Bristol stool chart, And some of my patients,
18:03
I do use it to show them, but bristles three is where we would like them to be.
18:09
And like I said earlier, once every day or every other day, which is a soft
18:16
serve consistency, is fine.
18:18
So at least three to four times a week.
18:21
Is acceptable frequency with a softer consistency. I think consistency beats
18:26
frequency. Every person is different.
18:29
And I remember Dr. Cynthia Blanco, who is our division chief for neonatology,
18:36
and she's a national expert on feeding.
18:39
She was talking about how in babies, their GI system, it's developing.
18:43
So it's also normal for it to be different at times. That that's normal.
18:48
So it's the same. So babies, I think, like I said, again, the consistency trumps frequency always.
18:55
In babies, it could go as far behind as like a baby once a week or twice a week.
19:01
And that could be normal.
19:02
As long as, like I said, the red flags would include whether the kid is thriving well or not.
19:08
And whether they have like signs of possible obstruction or some kind of other disease like vomiting.
19:15
Alternating between diarrhea and vomiting. not not developmental
19:19
milestones being behind if there is for babies
19:22
specifically is there is there any spinal abnormality or a pit or something
19:27
we can see an exam on the on a back on a back exam specifically for babies i
19:33
think just that history of when the first stool was passed and how the stool
19:37
is now is there an explosive stool and you know those kind of things,
19:42
Hirschsprungs is the other thing when it comes to less than one year old infants
19:47
that we get concerned about.
19:51
So that's probably the only place where radiographs would sometimes be helpful
19:56
but that's also a lot of history like when was the first time he is pooping,
20:02
was the first poop normal in the first 48 hours have we been growing well how
20:07
does the poop come out doing a rectal exam and seeing if there is that classic
20:11
explosive poop that's coming out.
20:14
Those are the things that would kind of point us towards or away from horse flags.
20:18
Those would be the red flags. Yes.
20:22
So...
20:23
This is all extremely helpful. What about x-rays for abdominal pain?
20:29
Is there, what would you say there? It depends on where the patient is presenting.
20:34
So abdominal pain has a long list of differentials with age.
20:38
And if the patient is presenting the ED acutely with 10 on 10 pain,
20:43
I can see why the ED will get an x-ray because we want to make sure that there
20:47
is no perforation or volvulus, you know, those kinds of surgical interventions that are going on.
20:52
So, I mean, it depends on a case-to-case basis.
20:56
But if it is a kid who's coming into your clinic complaining of,
20:59
like, chronic abdominal pain, which is going on for some time,
21:03
I don't think there is a lot of use for x-rays.
21:05
Again, I think they get done to prove slash disprove constipation,
21:10
which is what there isn't a lot of,
21:12
I mean, treatment of that belly pain associated with constipation should be
21:16
driven by x-rays for sure. I think we should just treat clinically.
21:21
But I think getting x-rays is more to make sure there is nothing else going
21:25
on or nothing surgical going on.
21:28
And for, so Anandini, for constipation and or abdominal pain,
21:35
what tests would you recommend and when?
21:39
Like I said, for functional constipation with no red flags, I probably would
21:44
not do any kind of testing.
21:46
The only thing in younger kids would be to make sure that the kid doesn't have
21:51
a thyroid disease. That's all.
21:53
Okay, so no tests run. No testing. No testing for something that has functional constipation.
22:00
Thyroid is the only thing I sometimes tend to test. I mean, I've never seen
22:05
something come back positive.
22:07
For me, the yield is very low. The only reason I test this is because it's probably an easy thing to fix.
22:13
And it's an easy thing to fix differently. so that's why I do it but yeah no,
22:18
mostly not but kids who walk into the GI clinic often can have other red flags
22:22
and if you have a red flag then you want to go look in,
22:25
diseases for sure. And one pediatrician I was talking to in passing yesterday,
22:30
she mentioned I could always run the, like, I can't remember what it was.
22:34
She said it very quickly, K something test. Is there some other test that pediatricians
22:38
might be running for constipation?
22:40
I just wanted to make sure, I'll probably edit this part out,
22:43
but that we're not missing something that you would recommend.
22:46
Do test, don't test. But I guess bottom line, you don't need to run any tests
22:51
No, for functional constipation with no red flags, I typically don't run any tests. Okay.
23:00
So what does an evidence-based clean-out look like today?
23:06
So there is not a lot of evidence around clean-outs.
23:10
I think every program does it differently. it's about using a softener with
23:16
a stimulant often just to kind of make sure all the poop in there is out.
23:23
So a large dose of, and also giving a low residue diet so you don't make more
23:30
poop. So the clean out is kind of useful.
23:33
I mean, kind of successful, you know. A low what diet, Anadini?
23:37
A low residue diet. So we typically, to achieve a good, very,
23:41
very good clean out, we typically tell them to be on like a liquid diet or a
23:47
clear liquid diet and those kind of diets.
23:50
That's what we would do before a colonoscopy too. Just because that basically,
23:55
because you don't have any residue, so you don't make poop and you're able to
23:58
clear out all the poop that's in there.
24:00
So that is always helpful. So low residue diet.
24:05
And then we would give them a big dose of Miralax, around four to six grams
24:12
per kilogram is the dose I like to use in kids.
24:16
And you could do some Senna.
24:21
Some people like to do it in the beginning and the end. So I just like to do
24:24
it once in the beginning and then just do the Miralax.
24:27
And for a clean out, which is mostly for constipation, it comes up to almost
24:32
like depending on the size of the child, it comes up to around five to five
24:36
to ten packets of Miralax, which each packet goes in eight ounces.
24:39
So about, you know, like 40 to 80 ounces of fluid or something,
24:44
which is a lot of fluid. So that can take some time to be done.
24:47
Right. So I like to give them, depending upon how sick they are,
24:51
either 24, sometimes 36 to even 48 hours, depending upon how bagged up they
24:56
are, to kind of finish it.
24:58
And you can actually do it two or three days in a row, like two or three clean
25:03
outs in a row to kind of actually clean you out totally.
25:08
And the way you know you're cleaned out is, or the patient is cleaned out,
25:13
is that you have liquid stool, which is like water, and you can almost see through it.
25:21
And Andini, what is the one thing you wish pediatric practitioners understood
25:26
better about managing constipation?
25:29
I think Miralax is very safe, and starting Miralax in patients with constipation
25:36
early on, in patients when it is approved, of course, early on is very important.
25:43
And encouraging the patients to take it properly is the other key.
25:50
Referring to GI would be important in the presence of red flags for sure,
25:54
but also sometimes in the absence of red flags, Like some of these kids can
25:57
be compliant with MiraLax and still have a lot of constipation.
26:02
And that may mean that we may have to do more workup on the GI side.
26:05
And that's when they should probably come to us.
26:08
But I would appreciate if we have started a good MiraLax regimen and made sure
26:15
that they're compliant with it before they come to see us.
26:19
And as we know, it can be hard for some kids to even eat a strawberry or to
26:23
get the... So do you have any advice regarding Miralax and actual child taking it?
26:32
Yeah, like I said, I sometimes also tell my patients to, it's ideally should,
26:39
one cap should go in eight ounces.
26:42
Sometimes I just tell them to take it in four ounces and drink the rest of the
26:46
four ounces afterwards or something like that.
26:50
But the key is to ask them what is the short what is the maximum amount of fluid
26:56
they will be willing to finish in 20 minutes for some kids it's around six ounces
27:02
for some kids it's around eight ounces they're sitting at a breakfast table
27:05
they can chug down in eight ounce whatever.
27:08
And so yes so that's where i kind of change with patients,
27:14
And Anandini, to review, when is it time when it comes to constipation and abdominal
27:22
pain or abdominal pain to refer to a GI specialist?
27:26
Like I said, constipation specifically, we've done Meralax. It's not working.
27:32
The kid's still constipated. Yes.
27:35
Any reflex, the kid is not growing well. The kid's having blood and stool despite
27:39
the stool being soft or, you know, has anemia with constipation.
27:43
Or he's not eating well, has vomiting.
27:45
Vomiting is a big risk for me, even with just belly pain or vomiting or nausea and things like that.
27:53
Yeah, those would be my, or has some kind of spinal anomalies or has diplegias and stuff like that.
27:59
So that may need more workup. So that's where a referral would be indicated.
28:06
And of course, the pediatric practitioners are seeing a lot of kids with stomach
28:11
bugs and who are vomiting.
28:12
So how do you distinguish yeah so
28:15
by vomiting i don't mean it's like it's not an acute
28:18
vomiting for sure if we have that history of you
28:21
know an infection and it's an acute vomiting we'll
28:24
let it settle out but i'm more talking about like chronic vomiting there are
28:28
kids who would have like like forward movement is problematic or you know they
28:34
have constipation that this chronic nausea vomiting that's sometimes it's more
28:38
nausea than vomiting that's not letting them eat well and stuff like that.
28:42
So it's more, this is more like chronic symptoms, of course, not acute symptoms.
28:48
Okay. And Dr. Suri, I know you're a mom of two and you have so, so much knowledge.
28:55
Is there anything else you want to mention for the pediatric practitioner where
29:00
they're seeing so many different things with so many patients?
29:04
Anything else you want to mention regarding constipation or abdominal pain?
29:08
No, I would just say just look for red flags. The kids, somebody,
29:13
one of my GI mentors sometimes told me that there's only one job kids need to do is to eat and grow.
29:19
If they don't eat and they are, they eat and they don't grow, that's not normal.
29:24
So I guess we all know that. So as long as there is good growth and he's eating,
29:30
okay, I guess we're fine with calling this functional.
29:34
Child or baby is in the exam room. When is it time for that child or baby to
29:39
go to the emergency room?
29:41
With constipation you mean or abdominal pain
29:45
i think abdominal pain kids would just go to
29:47
the emergency room anyways because if you have a 10
29:50
on 10 belly pain even if it is like a like a
29:53
you can have functional pain which is 10 on 10 but if
29:56
it is a 10 on 10 belly pain and you are writhing in pain you're not going to
30:00
be in my exam room you're going to be in the er for constipation i i mean not
30:05
a lot of people with constipation actually need a ed referral the most of the
30:10
them who come through ED are those who don't have a lot of, have issues with medical access,
30:15
they know healthcare access of any sort.
30:17
But again, pain may be the only thing that can, that would probably take them to the ED.
30:24
You see patients at our Wurzbach-Fredericksburg UT Health Pediatrics Clinic,
30:30
also called Gateway, and then also at University Health's GI Clinic and the Liver Clinic, correct?
30:37
Yeah, yeah. The University Health Clinic, Yes, that's a liver-only clinic,
30:41
but I see most of my GI constipation, abdominal pain kids at the gateway location.
30:46
And in part two of this, we will have an episode where we're talking about fatty
30:51
liver and how that's becoming more common and kids are getting it at younger ages.
30:58
And Andini, on pediatrics now, I love to talk about having a life outside of
31:03
medicine in this high-stress, high-burnout career.
31:07
I understand that you love yoga. Yeah, I do.
31:11
I think I did some in school growing up, like elementary school,
31:16
middle school growing up, and then couldn't continue it.
31:20
I think there is a lot of relaxation element that goes with yoga,
31:24
and it helps me kind of de-stress myself.
31:27
And as we are getting older and also getting into this very high-stress environment,
31:34
I think all the breathing techniques and the stretching exercises help,
31:39
relieve the pain that comes from a long day of work and all the stress that comes from it.
31:45
So that's where my interest in yoga lies.
31:48
And I was reading Olympic athletes are using, this was in the New York Times,
31:52
where there's some exercises, just what we can do throughout the day as non-Olympic athletes.
32:00
But even just like breathing in for the count of four or eight and then holding
32:07
the breath for a count of four and then breathing out and counting or covering
32:11
one nostril and breathing in how we do in yoga and breathing out.
32:15
Is that, for our listeners, like just something they could even do in a few
32:19
minutes a day, is that something that can be helpful, do you think?
32:23
Very, specifically for patients with abdominal pain and only abdominal,
32:28
like, you know, the ones who have what we call as a functional abdominal pain.
32:33
There are a lot of stressors, like I mentioned earlier, Most commonly,
32:37
it's anxiety, which are, I mean, and we see them, we see that all the time.
32:43
The profile is either it's a middle schooler or a high schooler with,
32:48
you know, high stress environment, type A student, maybe a recent move,
32:53
family issues, blah, blah, blah.
32:54
They may not even have a history of like a diagnosis of anxiety is what I mean.
33:00
But you can get all those histories out of them when you talk to them about
33:07
what's going on in their life.
33:08
And for those kids, I think just getting more oxygen with that breathing and
33:13
kind of letting go is what those breathing studies actually teach you. Yeah.
33:20
Rejuvenate your body with that oxygen and let go. And that can help all of us,
33:24
right? That's probably very helpful.
33:26
Yes, that's probably very helpful. And it is, yeah.
33:29
And a lot of my patients for a certain set, functional abdominal pain is a whole
33:34
topic. And there are a lot of symptoms that are comorbidities patients can often present with.
33:41
But in a certain set of patients, And there is good data to show that diaphragmatic
33:48
breathing is something that really helps.
33:50
So there are all these institutes across the country who would teach you how
33:54
to do diaphragmatic breathing and special breathing techniques,
33:58
which some kinds of breathing in yoga, which they teach, are actually diaphragmatic.
34:05
Not every. I mean, they have different breathing techniques.
34:07
But I have seen patients actually do really well just with breathing techniques.
34:14
And you'd like to start a yoga program, I hear, for children that could help
34:19
with constipation and abdominal pain or just help in general?
34:23
Let's see. It's just an idea that kind of came into my mind more recently just
34:30
as I've been exploring yoga and seeing how I can do more with it.
34:35
But yeah, let's see how it goes. Yeah, there is a lot of data around like just
34:40
exercise or just breathing that kind of can help with all these things, which we all know about.
34:45
It's about kind of making the next generation realize that that's something that's important.
34:52
And I feel like those who do realize it do fine, but those who don't kind of struggle with it.
34:57
And would you recommend how much, I mean, at least 30 minutes a day or anything
35:02
you want to say there of some sort of exercise?
35:05
Oh, some sort of exercise, yes. At least 20 minutes a day.
35:09
The breathing exercises are easy. And I think you could do like five minutes
35:13
or 10 minutes of deep breathing every day, wherever you are multiple times a day.
35:18
That's not hard, but it's about being motivated to do it.
35:22
We will have an episode on Pediatrics Now for parents.
35:27
Thank you so much for being here on Pediatrics Now. Thank you,
35:31
Holly. Thank you for having me.
35:33
Don't forget to click on the link in this podcast for free credit that may include
35:38
CME, MOC, or ethics credit, depending on our topic or podcast.
35:43
I'm Holly Wayment, and I'll see you next week.