Gastrointestinal in children

Assessment
 Presenting problem
A. Vomiting
B. Abnormal bowel habits:
o Diarrhea
o Constipation
o Bleeding
C. Weight loss, failure to thrive
D. Pain
o Nutritional history
o Physical examination:
 General appearance:
a. Height and weight
b. Measure mid arm circumference
c. Observe color: jaundice (yellow discoloration)
o Mouth: dentition
o Abdomen
- Skin integrity
- Abdominal distension; visible peristalsic waves
- Inspect for hernias
- Auscultate bowel sounds (every 10-30 seconds)
- Palpate for tenderness
- Liver span (inferior edge palpated 1-2 cm below rcm)
- Spleen (felt on inspiration 1-2 cm below left costal margin)
 Disorder of the teeth

 Dental caries
 Erosion of the enamel and dentine of teeth
 Results from combination of fermenting sugars and starched and
acid forming organisms

Prevention

 Dental hygiene
 Regular dental hygiene
 Good nutrition
 Fluoridation

 Cleft lip and palate

 1 in 1000 births
 Multifactorial
 Common among children with chromosomal abnormalities
 Results from failiure of the embryonic structures of the face to
unite
 May occur separately or may combine to produce a single
unilateral or bilateral cleft from the lip through the soft palate
 Interfere with the child’s capacity to meet oxygenation and
nutritional needs
  May seriously hamper normal bonding process of children with
parents

Assessment

 Facial abnormally visible at birth

 Cleft lip or palate or both, unilateral or bilateral
 Difficulty sucking
 Inability to form airtight seal around nipple
 Formula/milk escapes through nose in infants with cleft palate
 Predispose to infection – communication between mouth and nose
 Difficulty swallowing
 Abdominal distension – air swallowing
  Post op: cleft lip repair
 Maintain patent airway
 Monitor amount of swallowing to detect hemorrhage
 Do not place in prone position or with pressure on cheeks
 Avoid any tension on suture line
 Avoiding straining on suture line
o Prevent crying
o Keep child comfortable and contented
o Use elbow restraint
o Keep suture line clean – clean after each feeding with saline,
peroxide, or water to remove crusts
o Pain relief

 Cheiloplasty
 Correction of cleft lip
 Unite edges to allow lips to be both functional; aesthetic reasons
 Performed usually at age 2 months

 Cleft palate repair

- Not done until age 18 months – anticipation for speech development
- Child should be weaned and able to take liquids from a cup before
palate repair

Nursing intervention

 Cleft lip (preop)

 Feed in upright poisition
 Burp frequently
 Press cleft lip together with fingers – to encourafe sucking and to
strengthen muscles
 If unable to suck, use a rubber tipped syringe; drip onto side of
mouth
 Finish feeding with water to wash away formula in palate area
 Prepare parents to care for child after surgery
 Instruct concerning feeding methods and positioning

 Post op cleft palate repair

 Position on side for drainage of blood
 Have suction available
 Prevent injury or trauma on suture line
o Use cups only for liquids; no bottles
o Avoid straws, utensils, popsicle sticks, chewing gum
o Provide soft toys
o Use elbow and wrist restraints
o Provide liquid diet initially -> soft -> normal diet
 o Give water after each feeding to clean suture line
o Hold and cuddle

Esophageal atresia and tracheoesophageal fistula

 Esophageal atresia
 Congenital defect; upper segment of the esophagus ends in a
blind pouch
 Tracheaesophageal fistula
 Defect in which embryonic structures fail to divide into a separate
esophagus and trachea
 Opening between the two structures
 Usually occur together
Assessment

 Copius oral and nasal secretions – first sign of a defect

 Choke or cough
 When suctioning or gavage is attempted – catheter cannot pass into
stomach

Medical and surgical intervention

 Prevention of aspiration
 Drainage tube may be placed in the blind pouch – to suction
secretions
 Esophageal atresia – medical emergency – end to end anastomoses
 Feeding tube maybe inserted into the stomach

Nurving interventions

 Provide nutrition
o Provide gastrotomy tube feeding until anastomosis site has healed
 o Start oral feedings when infant can swallow well
 Promote respiratory function: position properly

 Pyloric stenosis
 Is an uncommon condition in infants that blocks food entering the
small intestine

Assessment

 Olive size bulge under right rib cage

 Vomiting – projectile; non bilous
 Peristaltic waves duringa nd after feeding
 Failure to thrive
 Dehydration
 Diagnostic tests:
o Ugis – narrowing of diameter of pylorus
o Decreased serum na, k, cl
o Increased hct
o Metabolic alkalosis

Nursing intervention (pre-op)

 Replace fluids and electrolytes

 Prevent vomiting
 Give thickened feedings
 High-fowler’s
 Place on right side after feeding
  Minimize handling
 Strict i and o, daily weights, urine sp gravity

Nursing intervention (post op)

 Advance diet as tolerated

 Place on right side after feeding
 Observe incision for signs of infection
 Provide client teaching and discharge planning

 Intussusception
 Telescoping of bowl into itself
 Ileocecal region
 Edema, necrosis of bowl, obstruction
 Most common at age 6 months
 More in boys than in girls
 Associated with cystic fibrosis

Assessment

 Piercing cry
  Severe abdominal pain (pulls leg up)
 Vomiting of bile stained fluid
 Bloody mucus in stool
 Currant jelly stool

Management

1. Barium edema
2. Surgery

Nursing intervention

1. Provide routine pre and post op care

2. Monitor for peritonitis