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Do Your Kids Suffer From Travel Bowel?

Many people suffer from bowel upset when they travel (constipation and/or diarrhea). When you travel, you eat different foods at different times. It can throw your GI system into a mess. We recently went on a family vacation. After a long day of travel, my two year-old acted like she needed to go poop. She found a corner to poop in (her M.O. these days) and after turning bright red (obviously straining), she started to scream hysterically. I took a look in her diaper and it was full of blood (no poop). I felt so bad for her. Even though I had anticipated such possible problems (packing some Miralax), I hadn’t given it to my child and ended up doing too little, too late.

How to prevent bowel problems when traveling

Every so often, a kid comes along that never has trouble pooping. If yours is that kid, skip this section. For the vast majority of everyone else, read on. The key to the travel bowel is anticipating and prepping. With a little effort, you’ll be leaps and bounds ahead of me.

  1. Make sure your child drinks plenty of fluid on the days of travel.
  2. Try to keep meal times and types of foods as “typical” as possible, and include lots of naturally rich fiber foods (e.g., fruits and veggies). If fiber-rich foods are hard to come by, you can always try a fiber gummy.
  3. Don’t be afraid to give a small dose of Miralax (maybe half a dose of a previously tried amount) if your child is particularly inclined to constipation.
  4. Don’t let your child go more than his/her usual interval between poops before intervening. For example, if your child stools 1-2 times a day and you get to the end of the day with no poop, give some Miralax. Don’t just wait it out (as a little problem will often compound into a big problem—see my above example).
  5. Be aware of your children’s stooling while on vacation. I know it sounds crazy (I don’t normally ask my 10 year old if he’s pooped every day), but prevention is a lot easier than treatment.

How to treat, once the damage is done

Hopefully, you don’t have to go down this road (as we did), but better to know what to do than have to run to the emergency room because of some bloody poop.

  1. Start with an enema to get things flowing from the bottom. Prep yourself. Giving your child an enema will rank right up there in the “gross things you have to do a as a parent.” I think that the Fleets enema is one of the easiest to use (and in most cases, it is the one most often stocked in stores). In our case, the only market open late at night had a regular (adult) Fleets enema. I just used half of the enema.
    1. To do it: Start on a tile floor (easier to clean up) and move the bathroom mat. Roll your child on his/her side in the fetal position next to the toilet. If the child is young enough to be diapered, lift the legs like you are changing the diaper. Then insert the flexible tip/end into the child’s anus and squeeze out the liquid. If you have someone there to help hold your child, that is ideal. Your child will naturally jump and try to arch away (and it helps to have someone holding the child steady). My child demonstrated super human strength despite my husband holding her and she moved enough to get the tip out two different times! I know, horrifying!
    2. Instruct the child to hold the liquid as long as he/she possibly can (ideally 5 mins). The second he/she can’t hold it any longer, hastily put the child on the toilet. Expect a fair amount of the liquid to come out. Hopefully enough will stay in to loosen the hard stool.
    3. The enema can be repeated another time if needs be. (I’d give it an hour first though.)
  2. Give Miralax to get things moving from the top. Once your child is fully backed up, don’t be afraid to give full doses (you may start with a half capfull in a small child younger than 3 or 4 years-old, and a full capfull in an older child).
  3. Treat anal fissures. If your poor child experiences an anal fissure (as mine did), treat the torn anus with an antibiotic ointment (or Vaseline in a pinch). See article ANAL FISSURES: A COMMON CAUSE OF BLOODY STOOLS.
  4. If your child happens to be suffering from diarrhea, take a look at what your child is eating. Typically diarrhea (that isn’t a food- or water-borne infection) is from a bad diet. Try reducing the juice, soda, and sugary foods/treats and see if that helps slow things down a bit. If you are traveling in a place where clean water is questionable, you may end up having to seek medical care to treat the diarrhea.

May all your travels be uneventful and regular. Happy travels!

Adenovirus: This Virus Is Super Tricky

Adenovirus is going around. It’s a sneaky little virus (it can infect just about anywhere and happen anytime of the year). However, the sore throat, fever, pink-eye combo that happens most commonly in the summer is in full swing in our community now. The key to this little bug is prevention. Don’t get it in the first place. Wash your hands like crazy and make your kids do the same.

Adenovirus causes all sorts of problems

It can infect multiple organ systems, which makes it unique. There aren’t many viruses out there that can cause respiratory illness, GI illness (the vomit/diarrhea bug), conjunctivitis (pink eye), urinary tract infections, you name it. Stupid, but interesting random fact: the virus causes cancer in rodents, but not in humans. Go figure. Here’s the low down.

Kids hit the hardest

While anyone can get this nasty little bug, kids get the short end of the stick. Young children are affected the most. Interestingly, there is also a peak seen in military recruits (accounted for by their close quarters).

What are adenovirus symptoms?

This is the trick. Because adenovirus can infect all different parts of the body (and sometimes at the same time), it can present in all different ways.

  1. Respiratory symptoms: Cough, runny nose, sore throat, fever. The symptoms can be pretty severe and will even look like RSV. The key is what symptoms go together. If you have a case of bronchitis and conjunctivitis (pink eye), that is almost always adenovirus. Other viruses don’t usually give you pink eye with lower respiratory tract infections.
  2. GI symptoms (Gastroenteritis): Vomiting and diarrhea. It is quite common in the daycare setting.
  3. Urine/kidney symptoms: Painful urination, frequent urination, and blood in the urine.

How do you catch adenovirus?

The site of entry usually determines the site of infection. If the virus goes in the respiratory tract via inhaling infected droplets, you get a respiratory bug. If you ingest fecal material, you’ll get a GI (gastrointestinal) bug. I know the concept is gross, but this is how it works. Infected person A doesn’t wash his/her hands after going to the bathroom (or changing their infected child’s diaper) and touches the door handle. You come along and touch the infected door handle. Your hands now have infected material. When you later wipe your mouth, voila, you’re infected. It’s a hardy little virus and can survive a long time outside of a host (which means surfaces stay infectious for a long time). FYI, water can get infected also. Once again, here’s another reason to make sure pools are chlorinated properly.

How is adenovirus diagnosed?

There are fancy lab tests to diagnose adenovirus. Most of the time we don’t do them as there isn’t a cure and the tests are expensive. However, sometimes there are circumstances where testing is done (e.g., severe symptoms, young infants, prolonged fever, immunocompromised patients). The patients that we have specifically tested in our office over the last few weeks have all been positive for adenovirus. The location tested reflects the presenting symptoms. If the symptoms are respiratory, we usually use a swab that goes up the nose. If the problem is diarrhea or bloody urine, a stool sample or urine sample is tested. Blood tests are hit-and-miss whether they are helpful (as most people will have positive titers anyhow by the time they are school-aged). Most of the time, the diagnosis is made clinically. I feel like such a detective when I piece together some of the adenovirus unique infectious qualities, and make the diagnosis.

Is there a treatment?

Unfortunately, there is no cure to adenovirus. Since it is a virus, antibiotics don’t help. In fact, antibiotics will just make matters worse. Antibiotics screw with your child’s normal flora and contribute to antibiotic resistance. So don’t buy into the “just in case” mentality with antibiotics.

The treatment is completely supportive. In essence, you treat the symptoms to make the infected person feel better. If there is fever, treat the fever (with Tylenol or Motrin). If there is vomiting and diarrhea, push fluids to keep the person hydrated.

Should you take your child to the doctor?

I end up seeing a ton of cases of adenovirus in the office because what to do often isn’t clear cut. The problem is that the symptoms of adenovirus often cross over with more concerning illnesses that should be seen. For example, if your child has a sore throat, it is reasonable to ensure the infection isn’t strep (which has to see a doctor for antibiotic treatment). If your child has pink eye, you probable should get that checked out to make sure it isn’t bacterial and needs a drop. So you can see how it’s a difficult call for a parent to make. If the symptoms are severe, prolonged, or questionable you probably should take your child in (or if your child is under 2 months old). If you’re certain it’s adenovirus (e.g., another child of yours has already seen the doctor and been diagnosed), then you don’t need to see the doctor.

When are you out of the clear?

Now that you have a child infected with adenovirus at your house, when are you done with it? When can you stop worrying about the other kids in your house getting it? Here’s more bad news. Once exposed, it can take 2 days to 2 weeks to develop symptoms. To make matters worse, as already mentioned, the virus is really hardy and lives on surfaces a long time (toys, towels, light switches, etc). Unfortunately, that means more cleaning (add it to the never ending list, right?). It’s not uncommon for me to see families who have been dealing with this virus in one way or another for weeks and weeks in their houses. I’m sorry to be the bearer of the bad news.

One special subtype: the “super cold”

It’s worth mentioning, since it’s gotten a fair amount of press coverage over the years, there is one serotype (which is essentially a certain strain) of adenovirus called serotype 14 that is sometimes referred to as the “super cold.” When people get this strain, the symptoms tend to be very severe (with roughly 40% requiring hospitalization and half of those in the intensive care unit). This is diagnosed when specific testing is done (once again, getting to the severe cases).

Norovirus: Another Vomit/diarrhea Bug Going Around

A nasty little stomach bug called Norovirus has been going around our community for the last few weeks. While we (the medical field in general), don’t usually do specific testing (it’s expensive and time consuming for something we don’t have a cure for), the kids that have gotten testing for one reason or another have all come back positive for Norovirus. And for every kid I’m seeing in the office with it, we are fielding twice as many calls about it, so I know it’s out there.

Overall, Norovirus is the number one reason for diarrhea visits to the doctor (it causes vomiting too). Symptoms of the virus typically start 12-48 hours after being exposed. Once symptoms are apparent, the virus typically lasts 24 to 72 hours (although the strain I’m seeing has seemed to last a bit longer, unfortunately). A person who has had Norovirus can shed the virus for up to 2 WEEKS after recovering from the bug. Whoa, that means that once a person feels better and goes back to work, school, daycare, they can continue to infect everyone that they come in contact with for the next 2 weeks. No wonder it spreads like wildfire!

Norovirus Symptoms

  • Sudden onset vomiting
  • Watery (not bloody) diarrhea (often seen after the vomiting as the virus moves down the GI tract)
  • Abdominal cramps
  • Nausea
  • Low grade fever
  • +/- Headaches
  • +/- Body aches

How do I get Norovirus?

  • Touch contaminated surfaces (then touch your mouth, nose, or eyes)
  • Handle clothes/laundry with infected poop or vomit
  • Contaminated food
  • Contaminated water
  • Direct contact with an infected/sick person
  • Because of the spread from contaminated food and water, norovirus has been linked to many outbreaks, some of which have received a lot of press (think restaurants, cruise ships, etc.)

Now for the all important question…

Should I take my kid to the doctor if I suspect Norovirus?

The short answer is: probably not. There is very little to do for it (essentially just prevent/treat dehydration). There is no cure for Norovirus. Since it is a virus, an antibiotic will not help. There is no vaccine. The only way to prevent it is to stay away from sick people, diligent hand-washing, and cleaning infected surfaces/laundry. The reason a child needs to be seen is if he or she is vomiting so much or has so much diarrhea that the child is dehydrated. At that point, the child may need IV fluids or IV medication to stop the vomiting. Generally speaking, though the virus is absolutely miserable, is usually short-lived, and usually doesn’t cause long-term complications. With that said, if your child is particularly young (younger than 6 months) or experiencing unusually severe symptoms, you should probably take your child in. Examples of severe symptoms include signs of dehydration (unable to keep any fluids down, decreased urination, dry mouth, no tears when crying) or uncontrollable vomiting (i.e., it has been essentially continuous for hours).

As a parent, I think the vomit bug is one of the worst. May you escape this bug unscathed!