7 Additional Things to Know About Pediatric Gastroparesis
We probably don’t give much thought to the functioning of our stomachs. We may think about how hungry we are and then forget about it once we’re full. However, for kids with gastroparesis, it’s likely on their minds all of the time.
That’s because the condition can be quite uncomfortable. To truly understand what’s happening, families need to be aware of the different parts of the stomach and how they operate together. Gastroparesis is a condition in which the stomach takes too long to empty. Food and liquid remain there for an extended time. That can lead to nausea, vomiting, early satiety, fullness, abdominal pain and weight loss.
If your child has just received a gastroparesis diagnosis, you have probably started learning about it and have additional questions. Here some further things to know about the condition:
7 Additional Things to Know About Gastroparesis in Kids
1. How the stomach functions
The stomach has five main parts: cardiac, fundus, body, antrum and pylorus. When operating well, these parts work together to accommodate food, store food, compact food, digest it and push it out into the small intestine. When a child has gastroparesis, however, any combination of these five sections can be problematic and cause symptoms. And the symptoms can be related to liquids or solids.
While we can conduct a four-hour gastric emptying scan to determine if the stomach is slow to empty and can distinguish between liquid and solid emptying, we don’t currently have a good test that tells us which one or more of the five parts are not working properly. However, we do have medications that work on different parts of the stomach. So, through a bit of trial and error, we can determine which part is the problem based upon which medication helps relieve some of the symptoms. Sometimes we may need to use a combination of medications to address the symptoms.
2. The incidence
Gastroparesis is common in adults, but not very common in children. In kids, it most frequently happens following a viral infection. But often times we don’t know the cause, which is called idiopathic. While it does happen in the presence of diabetes or neurologic conditions, this is less often seen in kids. Additionally, some kids can have hypermobility of their joints, a condition that can affect multiple parts of their bodies including the gastrointestinal tract, and can develop gastroparesis.
3. It seems different in kids of varying ages
Gastroparesis in infants and toddlers presents differently because they can’t tell us what hurts. They will often be diagnosed with a feeding disorder because they will just stop eating and are vomiting and fussy. Older kids can tell us how they feel and report symptoms of nausea, bloating, feeling full, and thus, the diagnosis is easier.
4. The varying degrees of severity
Gastroparesis can be mild, moderate or severe. The severe form is referred to as gastric failure. Kids who have this stop eating and keep vomiting, which leads to weight loss and dehydration. They often need to be fed via a feeding tube that bypasses the stomach in order to get nutrition. Sometimes they cannot tolerate that either and may have to go on intravenous total parenteral nutrition (TPN). Fortunately, this is a rare form of the condition.
5. Quality of life
With the right treatment, many children can find relief from their symptoms. But getting the right diagnosis and subsequent treatment can be a long process, which can impact a child’s quality of life. Due to the symptoms of stomach pain, nausea and vomiting, these kids miss a lot of school and activities. Many are home schooled. Further, it can take a couple of years for them to slowly get better. A small number of them will not get better and will continue to have symptoms for the rest of the lives. Post-viral gastroparesis usually improves within three months to three years. Gastroparesis in patients with hypermobility usually improves after adolescence.
6. The best course of treatment
Treatment for gastroparesis is going to be different for every kid, but options include medications, diet modifications, and medical and surgical procedures. There are techniques that a GI-focused psychologist can teach kids to decrease the symptoms of abdominal pain and nausea and improve appetite. These pain and nausea coping skills can improve attendance to school, daily functioning, nutrition and weight gain. For kids with severe forms, multiple specialists are required to address all of their needs. We recommend that patients have a team that includes a neurogastroenterologist, nutritionist, psychologist and social services to help kids with school.
7. When to see a specialist
If your child has had an acute illness, such as the stomach flu, and if the symptoms haven’t gotten better, such as bloating, fullness and pain, I recommend having another conversation with your primary care doctor. If your child has been taking medications for these symptoms and isn’t getting better, your pediatrician may recommend a referral to a pediatric gastroenterologist.