Gastrointestinal Conditions Learn more about the most common conditions we treat in Gastroenterology. Eosinophilic Esophagitis Eosinophilic esophagitis (EoE)Eosinophilic esophagitis (EoE) is a chronic disease is associated with inflammation in the esophagus, the tube that carries food from the mouth to the stomach. It is usually caused by a particular kind of allergy to specific foods or even airborne proteins. What are the signs and symptoms of eosinophilic esophagitis? Common symptoms in children may include: Difficulty swallowing Aversion to eating in infants Nausea and vomiting Poor weight gain Nausea and vomiting Heartburn Abdominal pain Food getting stuck in the esophagus (impaction) Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes eosinophilic esophagitis? Experts do not know what causes some children to have EoE. It often runs in families. It is more common in individuals who has asthma, eczema, and other allergies How is eosinophilc esophagitis diagnosed? The definitive diagnosis of eosinophilic esophagitis is through upper gastrointestinal endoscopy and biopsy. If there is a history of food getting stuck, it is common to do a special X-ray of the esophagus after drinking a contrast material to make sure the esophagus is not narrowed. How is eosinophilic esophagitis treated? Unfortunately standard allergy testing is usually not helpful in identifying which food(s) may be causing eosinophilic esophagitis. The most common offending foods are milk, soy, wheat, eggs, nuts and fish. Depending on the severity of symptoms and inflammation, your physician and dietician will work with you to make dietary changes. Medications, such as steroids and those that reduce stomach acid, may help relieve symptoms and are often used in conjunction with dietary changes. Neurogastroenterology and Motility Disorders Abdominal migraineAbdominal migraine is a common condition that causes repeated episodes of abdominal pain in otherwise healthy children who have no symptoms in between. The pain can be located in the middle or throughout the abdomen, can vary in severity, and lasts for at least 1 hour. Children generally have at least 2 other symptoms with the pain, such as lack or loss of appetite, nausea, vomiting, headache, eye discomfort with bright light, or turning pale. Abdominal migraine is most commonly diagnosed in children ages 2 to 10, but it can happen in people of all ages. As its name suggests, abdominal migraine is closely related to migraine headache. Most children with this condition have a family history of migraine headaches. And many children with outgrow abdominal migraines as they age and start having migraine headaches instead. What are the signs and symptoms of abdominal migraine? Abdominal pain is the main symptom of abdominal migraine. Your child may also have: Nausea Vomiting Pale skin Loss of appetite Headache Eye discomfort with bright lights Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes abdominal migraine? Experts are not sure what causes abdominal migraine. Like migraine headaches, abdominal migraines may be triggered by certain foods, lack of sleep, motion sickness, travel or missing meals. How is abdominal migraine treated Treatment for abdominal migraine usually involves taking medicine to prevent or stop episodes from happening. Non-steroidal anti-inflammatory drugs (NSAIDs), anti-migraine or anti-nausea medicines help stop the episode once it has started. Preventive medicines are drugs that your child takes every day to help prevent an episode. These may include a particular type of anti-histamine and other drugs. Some children may also benefit from therapy or relaxation techniques to reduce stress. Avoiding known triggers can also help reduce or prevent attacks. Recognition of the clinical pattern is important to help guide how much of a medical evaluation may be necessary to exclude other causes of abdominal pain. ConstipationConstipation is when a child has hard stool that is difficult to pass or has fewer bowel movements than normal. It is a common problem in children and most often improves with time. But it can get worse if it is not treated. What are the signs and symptoms of constipation? Symptoms of constipation may include: Having stools that are hard or painful to pass Not passing stool as frequent for more than a few days in a row Abdominal pain or cramping Stooling accidents such as wet brown spots on your child’s underwear Bleeding from the anus Diarrhea Abdominal distention or bloating Decreased appetite or food intake What causes constipation? There are many different causes of constipation. They can include: Anatomical issues, pelvic floor muscles not working appropriately, changes in pelvic floor sensations, behavioral, and psychosocial factors Stool not traveling through your child quickly enough, which can be due to their colon not pushing enough or not at all Taking certain medicines that can cause constipation Dietary issues, such as not eating enough fiber or drinking enough fluids How is constipation treated? Treatment options for constipation may depend on your child’s age and how severe the constipation is. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for constipation. Dietary and behavior changes are usually the first steps to treat constipation. This may include eating more fiber, drinking more fluids, and creating a toilet routine. Your child’s doctor may suggest laxatives, enemas or stool softeners to help relieve your child’s symptoms In very rare cases, some children may need surgery to clear the bowels of feces. Cyclic vomiting syndromeCyclic vomiting syndrome is a condition that includes repeated bouts of severe nausea and vomiting with periods of normal health in between. These episodes can last for several hours or days and often keep your child from participating in their daily normal activities. While symptoms can vary for each child, the episodes are often very similar for each individual child, as symptoms often start at the same time of day, are similar in severity, and last for roughly the same amount of time. The symptoms of cyclic vomiting syndrome start on average between the ages of 5 and 6 years old but can happen in people of all ages. It is slightly more common in girls than in boys and is predominantly in Caucasian children. What are the signs and symptoms of cyclic vomiting syndrome? Severe nausea and vomiting are the main symptoms. These symptoms often start in the morning or when your child wakes up. Vomiting can be so severe that the child cannot walk or talk. Other symptoms can include: Feeling tired Pale skin Abdominal pain No interest in food or decreased appetite Excess salivation Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes cyclic vomiting syndrome? Experts are not sure what causes cyclic vomiting syndrome, but there seems to be multiple contributing factors that ultimately cause a change in the interaction between the brain and the gut. The condition is known to be associated with migraine headaches and may be more common in children with a family history of migraines. It has also been linked to other medical conditions such as dysregulation of the autonomic nervous system, mitochondrial dysfunction, menses, food sensitivities and allergies, and anxiety. How is cyclic vomiting syndrome treated? Treatment for cyclic vomiting syndrome involves providing adequate hydration and if necessary, taking medicine to prevent or stop episodes from happening. There are two main types of therapy: Abortive therapy: Medicines that help stop the episode once it has started. These may include anti-migraine or anti-nausea medicines Preventive therapy: Medicines that your child takes every day to help prevent an episode. These are usually medicines that turn down signals from the GI tract and brain called neuromodulators. Some children may also benefit from cognitive behavioral therapy or relaxation techniques to reduce stress. Avoiding any known triggers can also help reduce or prevent attacks. Working with a specialist is important for more severe cases. Functional nauseaFunctional nausea is nausea that has lasted for at least 2 months, at least 2 times per week, is not related meals, and not caused by any other medical conditions. In some cases, children with functional nausea also have functional vomiting. Both of these diagnoses are more common in children with underlying anxiety and depression. The nausea can range from mild to severe, may come and go, and commonly starts early in the morning while improving throughout the day. Functional nausea is often associated with abdominal pain. Although functional nausea is not a life-threatening condition, it can disrupt your child’s ability to function on a daily basis as it can interfere with their schooling and social life. What are the signs and symptoms of functional nausea? The most common symptom is nausea that does not go away. Other symptoms may include: Vomiting Becoming pale Sweating Dizziness Feeling tired Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes functional nausea? While the diagnosis of functional nausea remains unclear, it is thought to be due to abnormal signaling between the nervous systems of the gut and the brain. There are numerous contributing factors, most notably stress and anxiety which can make the nausea worse. How is functional nausea treated? There is not a standard treatment for functional nausea. Your child’s health care team will create a treatment plan based on your child’s specific symptoms. Treatment options may include: Relaxation exercises or behavioral therapy to help reduce stress or anxiety Medicines, such as specific antihistamines and antidepressants, to help improve signaling between nervous systems Medicines to improve nausea Gastroesophageal reflux (GER)Gastroesophageal reflux (GER) occurs when the contents of the stomach come back up into the esophagus. GER is sometimes called reflux, acid reflux or heartburn. GER is very common in babies and also occurs in older children and adults. In most cases, GER only happens once in a while and does not cause any other health problems. However, some children can develop gastroesophageal reflux disease (GERD), a more serious condition that can cause other health complications. What are the signs and symptoms of GER? Common symptoms of GER in babies and children can include: Spitting up or vomiting Regurgitation of food into the mouth or throat Heartburn (a burning sensation in the back of the throat or chest) Nausea Irritability in infants Problems swallowing Metallic or acidic taste in mouth or throat Please note there are many conditions that have similar symptoms, including GERD. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes GER? GER is usually caused by a problem with the lower esophageal sphincter (LES). This is a muscle at the end of the esophagus. When the LES doesn’t close properly or relaxes at the wrong time, it allows food back into the esophagus and causes the symptoms of GER. How is GER treated? In most cases, GER is mild and making lifestyle or dietary changes can reduce the symptoms. In babies, GER often improves as the infant ages as the lower esophageal sphincter matures and works more appropriately. Your child’s doctor may suggest: Feeding your baby in an upright position Taking small breaks during each of your baby’s feeds Sleeping with their head elevated Not lying down right after eating Making changes to diet or eating habits If your child’s symptoms do not improve with lifestyle changes, talk with your doctor, as this may be a sign that they have GERD or another condition that presents with similar symptoms. GastroparesisGastroparesis is a condition when the stomach muscles aren’t working properly. This causes food and liquids to remain in the stomach for longer than normal. It can cause discomfort, nausea and a feeling of fullness in the stomach. There is no cure for gastroparesis, but treatment can help reduce symptoms. What are the signs and symptoms of gastroparesis? Your child’s symptoms can include: Nausea or vomiting Bloating Stomach pain or discomfort Feeling full after eating only a little bit of food Excessive burping Weight loss Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes gastroparesis? In most cases, the cause of gastroparesis is unknown, but there are some possible causes, which include: Infection Certain medicines A problem with the nerves in the stomach Previous stomach surgery How is gastroparesis treated? Your child’s team at Connecticut Children’s will work with you to identify the best options for care with you and your family. Your child’s doctor may recommend: Medicine to help empty the stomach or to reduce nausea and bloating Eating a special diet Eating smaller, more frequent meals A feeding tube to provide the nutrients your child needs if symptoms are so severe that your child can’t keep down any foods or liquids. If these options do not help, your child’s health care team may discuss surgical options. Rumination syndromeRumination syndrome is a disorder associated with regurgitation, or backward flow, of undigested food and drink back into the mouth shortly after eating without any effort. The child then re-chews the food and swallows it, or may spit it out. Children with rumination syndrome have regurgitation soon after a meal. The regurgitation of food is not a conscious behavior and it can affect children of all ages. What are the signs and symptoms of rumination syndrome? Some common symptoms in children may include: Repeated regurgitation of food, usually within 10 minutes after eating Effortless regurgitation not preceded by retching or nausea A feeling of abdominal discomfort such as pressure, pain, or burning before the regurgitation What causes rumination syndrome? Experts are unclear about what causes rumination syndrome but it may be due to increased activation of the nerves in the abdominal wall after meals. After the initial event resolves, this abnormal activation after meals persists and the regurgitation remains. How is rumination syndrome treated? Treatment of rumination syndrome is generally focused on changing this abnormal increased sensation. To accomplish this, your health care team may suggest the following approaches for treating your child’s rumination syndrome: Behavioral therapy Biofeedback Removing distractions during meals Creating a relaxed environment during meals Medications to help block the food from coming back up Pediatric Inflammatory Bowel Disease Crohn’s diseaseCrohn’s disease is a chronic condition that causes inflammation (ex. swelling, redness or sores) in the digestive tract. It is a type of inflammatory bowel disease (IBD). Crohn’s disease can affect any part of the digestive tract, from the mouth to the anus, but it most often affects the lower small intestine and colon. The peak age of diagnosis in children is in the early teen years, though Crohn’s disease can affect very young children as well. Having a a sibling or parent with IBD increases the lifetime risk of developing Crohn’s disease. Crohn’s disease may slow growth and delay puberty. What are the signs and symptoms of Crohn’s disease? The symptoms of Crohn’s disease can vary from one child to another. The symptoms may develop over time or appear more suddenly. Some of the most common symptoms in children may include: Abdominal pain, often in the lower right side Diarrhea that is sometimes bloody Rectal bleeding Loss of appetite Weight loss Fatigue Fever Delayed growth Joint pain Skin tags around the anal opening, sometimes with fissures Erythema nodosum, a rash in which painful red nodules appear on the shins Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes Crohn’s disease? Experts don’t know for sure what causes Crohn’s disease though current thinking is that there is an abnormal response of the intestinal immune system to the intestinal microbiome. There is some evidence that Western diets, often high in fat and sugars, and low in fruit, vegetables and fiber may predispose to IBD. It may also have a genetic link, since the condition can run in families. How is Crohn’s disease treated? There is currently no cure for Crohn’s disease, but with proper treatment it can be well managed. Treatment options can be medical or surgical depending on the location, severity and extent of disease. Non-Surgical Medications, such as anti-inflammatories, antibiotics, immunomodulators and biologics, can help relieve symptoms, prevent flares and help the intestines heal. It is critically important that your doctor be up-to-date on the newest therapies and how to optimize them Surgical If medications and diet aren’t working or if the symptoms are severe, your child may need surgery. These procedures usually involve removing sections of the gastrointestinal tract that are diseased. Our experienced multidisciplinary medical and surgical team at Connecticut Children’s will work with your family to discuss your child’s treatment options. Ulcerative colitisUlcerative colitis is a type of chronic inflammatory bowel disease (IBD). It occurs when the inner lining of the large intestine (colon) and rectum gets red and swollen. This swelling usually starts in the rectum and lower part of the colon, then can extend through the whole colon. Ulcerative colitis is commonly diagnosed in children ages 13 to 20, but it can occur in people of all ages. What are the signs and symptoms of ulcerative colitis? Common symptoms may include: Bloody stool Frequent diarrhea Urgency to have a bowel movement Fatigue Weight loss Anemia Stomach pain Loss of fluids and nutrients Some children may also have: Skin sores Itchy or red eyes Joint pain or swelling Kidney stones Rashes Since ulcerative colitis is a chronic condition, children may have periods of time when the symptoms worsen (flares) and then go away (remission). Almost everyone with ulcerative colitis requires some type of therapy. The goal of therapy is to keep people in remission. Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes ulcerative colitis? Experts are not sure what causes ulcerative colitis, but it is thought to represent an abnormal response of the intestinal immune system to the trillions of bacteria found in the stool. In some cases, family history may also play a role. How is ulcerative colitis treated? Treatment may depend on your child’s age and the severity of their symptoms. Your child’s doctor may recommend medications, dietary modification, and in some cases even surgery. Non-Surgical Medications, such as anti-inflammatories, immunosuppressants and biologics can help relieve symptoms, prevent flares and help intestines heal. For some patients changing diet may be helpful. Surgical If medications aren’t working, or if your child’s symptoms are severe, surgery may be required. At Connecticut Children’s, our team of expert gastroenterologists and surgeons will walk your family through your child’s surgical options and help you find a treatment that works best for your child’s individual needs. Pediatric Liver Disease Alagille syndromeAlagille syndrome is a rare genetic disease that can affect many organs in the body, including the liver, heart, eyes, kidneys and spine. The symptoms of Alagille syndrome can vary greatly, even between people in the same family. Some children with the condition can have very mild symptoms, while others may have severe complications that can be life-threatening. Some of the main health issues children may have include: Too few bile ducts in their liver. This can reduce bile flow and make it hard for the body to properly absorb fat and vitamins, causing problems with growth. Heart problems that can range from mild conditions, such as heart murmur, to complex structural conditions, such as tetralogy of Fallot. Problems with the eyes, kidneys and blood vessels. What are the signs and symptoms of Alagille syndrome? The symptoms of Alagille syndrome can vary greatly from one child to another. Some of the most common symptoms in children may include: Persistent jaundice (yellowing of the skin and eyes) Severe itchiness Fatty deposits in the skin (xanthomas) Dark urine or gray or white stool Delayed growth or poor weight gain Heart murmur Unique facial characteristics (pointy chin, broad forehead and widely spaced eyes that are deeply set) Spinal growth changes Enlarged spleen Over time, children with Alagille syndrome may develop one or more of the following problems: Malabsorption issues Poor growth or delayed puberty Liver failure Portal hypertension Heart and blood vessel problems Kidney disease What causes Alagille syndrome? Alagille syndrome is caused by a gene mutation that passes from parent to child. About 30 to 50 percent of children with Alagille syndrome inherit it from their parents. In other children, the mutation occurs through a new gene change. Alagille syndrome is a condition that a child is born with, but it may not be diagnosed until later in life. If one parent has the gene mutation for Alagille syndrome, each of their children has a 50 percent chance of inheriting the mutation. Children born with the gene mutation are considered to have Alagille syndrome, and even if they don’t have symptoms, they have a 50 percent chance of passing the mutation onto their children. How is Alagille syndrome treated? There is currently no cure for Alagille syndrome. The goal of treatment is to reduce your child’s symptoms and prevent complications. Your child’s treatment may involve surgical or non-surgical options. Non-Surgical Medicines may be prescribed to: improve bile flow relieve itching lower cholesterol Vitamin supplementation may be needed for fat-soluble vitamin deficiency: Vitamins A, D, E and K Calcium Zinc Nutritional supplements and a high-calorie diet Specialized baby formula rich in a type of fat that is easily digestible may be needed A high-calorie diet may be recommended to prevent malnutrition and growth failure Surgical If medicine or dietary changes do not work, some children may need a surgery called partial biliary diversion. This surgery diverts bile acids between the liver and gastrointestinal tract and may help improve symptoms such as itching. In severe cases, children with liver disease may need a liver transplant. Alpha-1 antitrypsin deficiency (AATD)Alpha-1 antitrypsin deficiency (AATD) is a hereditary condition (passed down in families) that can cause liver and lung disease. Alpha-1 antitrypsin is a type of protein made in the liver. It protects the lungs and allows them to work normally. In children with AATD, their liver does not make the correct form of this protein. Over time, not having enough of this protein can cause lung disease. And a build-up of this abnormal protein in the liver can lead to liver disease. AATD can affect people differently. The liver and lung disease caused by AATD can range from mild to severe. Some people with the condition may have few or no problems with their liver. What are the signs and symptoms of AATD Some common symptoms in children may include: Jaundice (yellowing of the skin and eyes) Severe itchiness Dark urine or pale-colored stool Delayed growth or poor weight gain Enlarged liver Bleeding A buildup of fluid in the stomach Feeling tired Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes AATD? AATD is caused by a gene mutation that passes from parent to child. In most cases, both parents need the gene mutation to pass the condition to their child. Children who inherit only one gene mutation are less likely to develop AATD, but could pass it along to their children. How is AATD diagnosed? A simple blood test (AAT level) can be done to measure how much alpha-1 antitrypsin is circulating in the blood. Another blood test (AAT mutation analysis) can tell whether a person has AATD or is a carrier. How is AATD treated? The goal of treatment is to reduce your child’s symptoms and prevent complications. Your child’s treatment may involve surgical or non-surgical options. Non-Surgical Medicines can be given for: Severe itching Fluid buildup in the belly Vitamins or nutritional supplements can help your child get enough nutrients Surgical In some cases, children with severe liver disease may need a liver transplant. Liver transplantation is a cure for AATD. Your healthcare team will help determine if this is the best treatment option. It is very important that a child with AATD avoids smoking and is not exposed to second-hand smoke. Autoimmune hepatitisAutoimmune hepatitis is a serious liver condition that occurs when a child’s immune system attacks their own liver. Over time, this can damage the liver and cause it to not work properly. This can lead to long-term liver disease. Autoimmune hepatitis is not very common, but children as young as age 2 can have it. It is more common in girls than in boys. There are two types of autoimmune hepatitis: Type 1 is the more common kind and can occur in people of any age Type 2 is more common in children What causes autoimmune hepatitis? Like other autoimmune diseases, experts don’t really know what causes autoimmune hepatitis. Possible causes may include genetics (passed down in families), viruses, certain medicines, viruses or other germs, or a problem with the immune system. What are the signs and symptoms of autoimmune hepatitis? The symptoms of autoimmune hepatitis can vary. Some children have no symptoms or only mild symptoms. If your child does have symptoms, they can include: Feeling tired (most common) Nausea or vomiting Pale or gray-colored stool Dark-colored urine Lack of appetite Jaundice (yellowing of the skin and eyes) Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. How is autoimmune hepatitis diagnosed? A healthcare team will make a diagnosis based on a child’s symptoms, blood tests, and a liver biopsy. How is autoimmune hepatitis treated? Autoimmune hepatitis can be a lifelong condition, but it can be controlled with the right treatment. One out of four children with autoimmune hepatitis may go into remission and eventually be able to stop treatment. However, this should only be done under the advisement of a healthcare team. Non-Surgical In many cases, autoimmune hepatitis can be managed with medications called immunosuppressants that help calm down an overactive immune system. Examples of these medications include: Steroids, such as prednisone or budesonide Azathioprine Surgical If the liver is damaged so much that it stops working, your child may eventually need a liver transplant. CholestasisBile is a liquid that helps with digestion and the absorption of fats. Bile is made in the liver and moves through bile ducts into the intestine. Cholestasis is a problem with the flow of bile from the liver to the intestine. It can occur if the liver can’t produce enough bile or if the bile ducts are blocked. Cholestasis is a rare condition in children. Pregnant women can also get cholestasis, but it usually goes away on its own after birth. Having cholestasis during pregnancy does not increase your baby’s risk for the condition, though it can increase the risk for preterm birth and some other problems. What causes cholestasis? Cholestasis can have two causes: Hepatocellular: a problem with the production of bile in the liver Obstructive: blockage of the bile ducts The following conditions increase the risk of cholestasis: Biliary atresia Alagille syndrome Cystic fibrosis Hepatitis A, B or C In some cases, children who are taking certain medicines or getting parenteral nutrition may also develop cholestasis. What are the signs and symptoms of cholestasis? Common symptoms in children may include: Jaundice (yellowing of the skin and eyes) Dark yellow or brown urine Gray or white-colored stool Delayed growth or poor weight gain Itchy skin Nausea or vomiting How is cholestasis treated? Treatment for cholestasis will depend on the cause. Treatments may include both non-surgical and surgical options. Non-Surgical Your child’s doctor may suggest a special diet to help your child gain weight. Medicine can help relieve itching. If your child has chronic liver disease, your health care team will help manage the condition to keep your child’s liver as healthy as possible. Surgical If your child has biliary atresia, they may need surgery called Kasai portoenterostomy to help drain the bile ducts. In some cases, children with severe liver disease may need a liver transplant. GallstonesThe gallbladder is a small organ that sits below the liver. It stores bile (a liquid made of cholesterol, bile salts and water) that helps with digestion. When you eat, bile is secreted from the gallbladder into the intestines to help digest food. Gallstones occur when bile hardens in the gallbladder. These gallstones can block bile from getting released into the intestine. What causes gallstones? Gallstones are not as common in children as they are in adults. But children may be more likely to develop gallstones if they: Are obese or eat a diet high in fat Have a blood disease such as sickle cell anemia, beta-thalassemia or hereditary spherocytosis Have another condition such as cerebral palsy or Crohn’s disease Take certain medicines, such as birth control pills Have a family history of gallstones What are the signs and symptoms of gallstones? In some cases, gallstones don’t cause any symptoms. If your child does have symptoms, they may include: Pain in the right upper or upper middle part of the abdomen Pain that more noticeably appears after eating fatty or greasy foods Nausea or vomiting Fever Jaundice (yellowing of the skin and eyes) Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. How are gallstones treated? If your child has no symptoms, they may not need treatment. For children with symptoms, treatments may include both non-surgical and surgical options. Non-Surgical Lifestyle changes: Increasing physical activity Avoiding unhealthy fats like fried foods or desserts Eating foods high in fiber including more whole grains, fruits and vegetables Medication may be considered in some cases to help dissolve gallstones. Surgical If your child’s symptoms do not get better with dietary changes, they may need to have their gallbladder removed by surgery. The surgical team at Connecticut Children’s uses minimally invasive procedures whenever possible. Liver failureThe liver is a large organ that filters toxins from the body and helps to digest food. It also makes proteins that support the immune system and serves other important functions. Liver failure happens when the liver becomes so damaged that it cannot work properly. It can happen in children and adults of any age. There are two kinds of liver failure: Acute liver failure happens quickly in a child who has no previous liver disease. Chronic liver failure happens over a period of time in a child who has liver disease, such as biliary atresia or hepatitis. What are the signs and symptoms of liver failure? Symptoms of liver failure may include: Pain in the upper right part of the abdomen Jaundice (yellowing of the skin and eyes) Nausea or vomiting Feeling tired Confusion Dark urine Bleeding or bruising easily Itchiness all over the body Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes liver failure? The causes of acute and chronic liver failure are different. Acute liver failure has many causes and can differ by age. Causes may include: Infections or viruses: Epstein-Barr virus, cytomegalovirus, hepatitis A, B or D Drugs or toxins: acetaminophen (Tylenol), poisonous mushrooms, insect or rodent poison Often, the cause of acute liver failure cannot be found. Chronic liver failure is caused by an illness that has damaged the liver. Some liver conditions that can lead to liver failure include: Biliary atresia Autoimmune hepatitis Metabolic diseases: Wilson disease, alpha-1 antitrypsin deficiency, galactosemia, tyrosinemia or mitochondrial disease How is liver failure treated? Treatment will depend on how severe the liver failure is and the cause of liver failure. Children with both acute and chronic liver failure need to be treated in the hospital. Your health care team may discuss both non-surgical and surgical treatment options. Non-Surgical Your child’s doctor may wait to see if the liver heals on its own. Supportive care to treat a patient’s symptoms Medicines can sometimes help treat liver failure if it is caused by a medication or toxin, the immune system, or cardiovascular condition Surgical In many cases of liver failure, your child may need a liver transplant. The need for liver transplant depends on: If the cause of failure is known If more than one organ or part of the body is affected If there is any brain damage and the chances of it being reversed with transplant If the transplant will be successful Your child’s health care team will explain the transplant process Non-alcoholic fatty liver diseaseNon-alcoholic fatty liver disease (NAFLD) occurs when too much fat builds up in the liver. It is not caused by drinking alcohol. There are two main types of NAFLD: Nonalcoholic fatty liver (NAFL). This is a milder form with simple buildup of fat. Nonalcoholic steatohepatitis (NASH). This is a more serious type where fat buildup causes liver injury (inflammation). It can lead to scarring of the liver (fibrosis) and even cirrhosis. NAFLD is a progressive, yet reversible disease. It’s the number one cause of liver disease in children in the U.S. What are the signs and symptoms of non-alcoholic fatty liver disease? Non-alcoholic fatty liver disease usually has no signs or symptoms, especially early in the disease. What causes non-alcoholic fatty liver disease? Experts are not sure what causes non-alcoholic fatty liver disease, but it may be linked to genes or certain health problems. Children are at higher risk for NAFLD if they: Are overweight or obese Have type 2 diabetes Have high blood pressure Have metabolic syndrome, a group of conditions related to obesity Have high triglycerides (certain fats in the blood) How is non-alcoholic fatty liver disease treated? In most cases, your child’s care team will recommend weight loss through lifestyle changes (dietary changes and exercise) to help reduce fat buildup in the liver. Your child’s care team will discuss the best treatment approach with you and your family. Nutrition Allergic enteritisAllergic enteritis is a type of food allergy that causes inflammation in the small intestine or colon of infants. It is most often caused by the proteins in cow’s milk, although it can sometimes occur with proteins in foods such as chicken, eggs, fish, soybeans and rice. Symptoms usually occur in the first few months after birth but may also develop in older babies. For babies who are solely breast fed, changes in the mother’s diet can be helpful. Some babies can be quite ill and require special hypoallergenic formulas. What are the signs and symptoms of allergic enteritis? Common symptoms include: Vomiting after feeding Diarrhea Abdominal discomfort Slow weight gain Facial puffiness from low proteins in the blood Blood in the stool Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes allergic enteritis? While clear that an allergy to dietary proteins causes allergic enterocolitis, the exact mechanism is unclear. How is chronic allergic enteritis treated? In most cases, allergic enteritis is treated by eliminating milk from the mother’s diet (if she is breastfeeding) or changing the baby’s formula to one that is hypoallergenic. Symptoms usually improve a few weeks after this change is made. Sometimes the mother is put on an elimination diet to cut out all foods that may be causing the allergy. For babies who are more ill, close monitoring by a pediatric gastroenterologist and pediatric dietician is important to guide therapy. Celiac diseaseCeliac disease is an immune condition in which the small intestine becomes inflamed in the presence of gluten in the diet. Gluten is a protein found in wheat, rye, and barley. When people with celiac disease eat gluten, it damages the small finger-like projections, called villi, in the small intestine. When the villi are damaged, they cannot absorb nutrients from food. This can cause problems with growth and development. Celiac disease can also cause a wide range of other symptoms. Although celiac disease is caused from eating gluten, it is not a classic food allergy. It is a lifelong condition. Your child with not outgrow celiac disease. It is important not to confuse it with gluten intolerance. Gluten intolerance is where people may not feel well after eating gluten (cramps, bloating), but there is no injury to the intestine and the immune system is not involved. Celiac disease is a common condition and often runs in families, but it can be hard to diagnose. What are the signs and symptoms of celiac disease? Symptoms of celiac disease can vary widely. In fact many people may have no symptoms and only be diagnosed indirectly when lab work is abnormal. Some babies can develop symptoms as early as 6 months of age, while other children may have few or no symptoms for many years. Common symptoms in children may include: Diarrhea Vomiting (more common in babies and toddlers) Abdominal distention (bloating) Decreased appetite Abdominal pain or cramping Poor growth Weight loss Anemia Delayed puberty Please note there are many conditions that have similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes celiac disease? Experts do not know what causes the intestinal immune system to react to gluten and cause celiac disease. They do know that it runs in families and is more common in families with Type 1 diabetes and some types of thyroid disease. How is celiac disease diagnosed? The traditional final diagnosis of celiac disease has been through intestinal biopsy done at the time of upper gastrointestinal endoscopy. This is a very quick and benign procedure. Most often, however, the initial suspicion for celiac disease is when certain screening blood tests have been done and are abnormal. It is important to not stop gluten before seeing the pediatric gastroenterologist as that may make final diagnosis more difficult. A prompt appointment is required so further testing can be done. How is celiac disease treated? The only treatment for celiac disease is to avoid eating foods with gluten. A gluten-free diet should relieve the symptoms of celiac disease and allow the intestines to heal. Your child’s doctor or nutritionist can help you learn more about what foods and other products contain gluten, and some tips on how to avoid them. Because celiac disease is a lifelong illness, your child will need to stay on this diet forever. They will not be able to go back to eating gluten once the symptoms go away. Failure to thriveChildren are diagnosed with failure to thrive when they don’t gain weight at the same rate as other children their age and sex. While failure to thrive is not a disease itself, it is a sign that a child is not getting enough nutrition or that another condition may be affecting the way the body processes calories. What are the signs and symptoms of failure to thrive? By definition, children with failure to thrive have poor weight gain. Depending on other possible factors, there may also be: Poor appetite Refusal to eat Diarrhea Constipation Difficulty swallowing Fatigue Delays in motor skills Please remember that failure to thrive is a description, not a diagnosis. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes failure to thrive? Failure to thrive can have many causes. Some common causes can include: Not eating enough food, sometimes from poor appetite or actual aversion to eating Digestive problems, such as gastroesophageal reflux (GER), celiac disease, or other disorders associated with poor absorption Food allergies Problems with metabolism Kidney or heart issues How is failure to thrive treated? Treatment for failure to thrive will depend on what is causing the condition. If your child has an underlying medical condition, getting treatment should help improve symptoms. Whatever the cause, your care team at Connecticut Children’s will work with you and your family to help your child get the nutrients they need to grow. Our skilled dieticians will work closely with you.