Rumana Inushahmad Shaikh

MA 433

Pediatrics FGID work

1) B- Infant colic

2) The most important assessment is about dehydration. The degree of dehydration is assessed based
on fluid loss. If less than 50 ml/kg then no dehydration, 50-100 ml/kg loss then some dehydration and if
more than 100ml/kg loss it means severe dehydration.

One should look at the child's general condition, whether he/she is alert, restless or irritable or lethargic
or unconscious.

Other important assessments are for the appearance of eyes (normal or sunken) and the ability to drink
water or ORS solution, whether taken normally or refused, taken eagerly, or an inability to drink due to
lethargy or coma.

Dehydration is also assessed by skin turgor; following pinching, the abdominal skin may flatten
immediately, go back slowly or return very slowly (more than 2 seconds).

In addition, one should examine the features of malnutrition ( anthropometry for weight and height;
examination of wasting, edema and signs of vitamin deficiency), systemic infection ( presence of cough,
high grade fever, fast breathing and/or chest indrawing suggests pneumonia; high grade fever with
splenomegaly suggests malaria) and fungal infections ( oral thrush or personal satellite lesions).

For functional constipation- physical examination includes bimanual palpation of the abdomen, inspect
of the perineum and rectal examination. Usually, a rectal examination is performed after establishing
rapport with the patient and the family. A digital rectal examination may be delayed to facilitate the
therapeutic alliance between the child and the clinician until after a treatment trial fails. But if the
clinician plans a consultation but no follow-up, a rectal examination is necessary to evaluate the child for
the rare obstructing mass.

3) The diagnosis of childhood functional abdominal pain hinges on confidently ruling out organic etiology
using a careful history and examination; extensive investigations a unnecessary. The history should
include not only details of pain but also family details, child's emotional environment in home and
school, personality, coping skills, school performance and stress factors. The presence are of alarming
symptoms increases the probability of organic disorder and justifies further Igastro- diagnostic testing. In
the absence of red flags, the pain are diagnostic yield of investigations is poor.

Hemogram, ESR stool routine and occult blood, and urine microscopy should be carried out in all cases
to rule out organic disease. Abdominal ultrasonography is not helpful; the presence of lymph nodes of
<10 mm is not a significant finding. Further investigation is required only in those with alarm symptoms
and based on the likely diagnosis.
The aim of management of children with functional abdominal pain is to make a positive diagnosis,
normalize the lifestyle to not allow pain to curtail daily activities or school performance, and to rectify
psychological factors.

The crux of management is counseling the parents and the child, both jointly and separately. Parents
need to be tense, reassured about the benign nature of the ailment and emphasis is laid upon avoiding
too much attention to the child. The concept of visceral hyperalgesia should be explained to parents.
Provision of a nutritious diet with adequate fiber and avoiding intake of carbonated beverages and
refined food helps in reducing bloating.

Therefore, plan of investigation for infants with FGID includes routine tests, stool tests, and endoscopic
evaluation but no specific tests unless alarming symptoms are present or for reassuring the children and
their parents.