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2016-10-19 15:50:30 | 育児

draw her legs up to her belly. Sometimes the vomiting is more
prominent; sometimes the pain is. The vomiting is more copious
and repetitious than the usual spitting-up of a baby. The cramps
are sudden and usually severe. They come only a few minutes
apart; between them the baby may be fairly comfortable or
sleepy. After several hours (during which there maybe normal or
loose bowel movements) the baby may pass a movement con-
taining mucus and blood, the classic currant jelly or prune juice
stool; more often than not, this does not occur. The problem,
which is common, is due to an obstruction of the intestines,
which occurs when a small section of the intestine slides inside
the one next to it, like a telescope folding up. Children as young as
four months through about six years can develop this problem. If
it's caught early, it can often be easily fixed; if the bowel has been
injured, however, surgery may be necessary.

Also rare but serious are other types of intestinal obstruc-
tions. A part of the intestine becomes kinked and stuck in a
pocket in the abdomen, most frequently in an inguinal hernia.
There usually is vomiting and sharp cramps.

Persistent diarrhea. The most common type of persistent or
chronic diarrhea occurs in a young child who is obviously thriv-
ing and does not complain of feeling sick. The diarrhea may
come out of the blue or with a stomach flu. The child may have
three to five soft or runny and smelly bowel movements a day,
though he may begin the day with a normal one. There may be
mucus or undigested food in the bowel movements. His ap-
petite remains good, and he is playful and active.

The child continues to gain weight normally and laboratory
tests of the bowel movement reveal nothing abnormal. The con-
dition usually gets better by itself, over several weeks. Often the
diarrhea can be much reduced by cutting down on juice in the
child's diet. The most likely culprit is apple juice. That's why this
condition is sometimes called apple juice diarrhea. Juice should
generally be limited to eight to ten ounces a day.


There are several uncommon, more serious digestive diseases
that cause chronic diarrhea in infants and young children. For
this reason, it's a good idea to have the problem evaluated by the

Cystic fibrosis. The two most common symptoms of this
disease are foul-smelling diarrhea and a cough. Many other
symptoms also occur. The baby's rectum may protrude. The in-
testines may be obstructed right after birth by dry meconium
and from time to time in later years by hard, dry bowel move-
ments. After the baby starts eating solid foods, there may be fre-
quent bowel movements that look normal but are mushy,
greasy, and foul-smelling. Most infants have a good, even raven-
ous appetite while they have this disease. Nevertheless, because
of the inability to digest food properly, malnutrition and poor
growth sets in. Persistent bronchitis develops, though in a mild
case this may not happen until later in childhood.

Cystic fibrosis is a progressive, hereditary disease of specific
glands. The pancreas, which normally supplies digestive juices
to the intestines, doesn't function well. The glands that normally
make the mucus that coat the bronchial tubes secrete only ab-
normally dry, sticky mucus. As a result, serious lung infections
are .common.

The diagnosis is made by measuring the amount of salt in a
child's sweat; there are also genetic tests. Antibiotics and other
medications can reduce the lung infections. Use of digestive en-
zymes can help combat malnutrition and promote normal
growth. A child with cystic fibrosis should be evaluated and have
his treatment supervised at a center that specializes in the dis-
ease. For more information, see the Resource Guide (page 917).

Malabsorption. In this condition, the intestines are unable to
absorb all the nutrients that are presented to them; the nutrients
come out as diarrhea, and the child is apt to become deficient in
The most common cause of malabsorption is the inability to




digest certain types of sugar, fat, or protein. With this condition
there is always diarrhea, sometimes foul-smelling, sometimes
burning, often with cramps. Usually the child gains weight
poorly and seems unwell. The condition resolves when the of-
fending food is removed from the diet. It is important for par-
ents and doctors to work together to make sure the child's diet is
still nutritionally adequate.

Following prolonged diarrhea, a child may have difficulty di-
gesting lactose, the sugar in milk. In the past these children were
said to be allergic to milk, but this is not really an allergic reac-
tion. Rather, the irritated lining of the intestines simply needs
time to heal before normal digestion returns. Difficulty in di-
gesting the lactose in cow's milk may be inherited. Cramps or di-
arrhea usually start in school-age children. Elimination of dairy
products is the treatment.

Worms. It horrifies parents to find worms in their child's bowel
movements, but there is no reason to be distressed or to decide
that the child has not been properly cared for.

Pinworms, or threadworms, are the commonest variety. They
look like white threads a third of an inch long. They live in the
lower intestine, coming out from between the buttocks at night
to lay their eggs. They can be found there at night or in the bowel
movement. They cause itching around the anus, which may dis-
turb the child's sleep. (In earlier times worms were thought to be
the chief cause of children's grinding their teeth at night, but this
is not so.) A clear description of the worm will help your doctor
make the diagnosis.

Roundworms look very much like earthworms. The first sus-
picion comes when one is discovered in the bowel movement.
They usually don't cause symptoms unless the child has a great
number of them.

Hookworms are common in some parts of the southern
United States. They may cause malnutrition and anemia. The
disease is contracted by going barefoot in infested soil.


Children born in less-developed countries and children who
have lived for a time in a group home or shelter for the homeless
may carry intestinal parasites (that is, worms) without having
symptoms. Discovering the problem is a matter of sending sam-
ples of bowel movement to a laboratory for microscopic exami-
nation. Intestinal worms are fairly easy to treat with prescription


Constipation refers to hard, dry stools, which are difficult to
pass. It's not the number of bowel movements each day that de-
termines whether a baby or child (or adult) has constipation.

Infants often go through periods of constipation that are re-
lated to changes in their diets or changes in their intestines that
come with age. Adding four ounces a day of water or prune juice
often loosens things up. This amount of nonmilk fluid is safe for
babies. If this doesn't work or if constipation is severe, ask the
doctor about it, since it can be a sign of more serious illness.
(Some parents feel that the iron in infant formula causes consti-
pation. Studies have not found this to be the case, however, and
iron is very important for other reasons; see page 332.)

At any age, constipation is common in a mild illness. Any dis-
ease that can make a person feel sick all over is likely to affect the
stomach and the intestines, slowing down the bowels, taking
away the appetite, perhaps causing vomiting. With fever, the
body loses more water through the skin and in the breath, so the
intestines may absorb more water from the bowel movement,
making it hard and dry.

Chronic constipation is uncommon in the older baby or
child, especially those who eat a varied diet that includes whole-
grain cereals, vegetables, and fruits. A diet rich in meats and
processed grains may provide too little fiber for regular, soft
bowel movements. The solution may be as simple as substitut-
ing whole wheat for white bread, and fresh orange or peach
slices for cookies or cake after meals. Remember the "P fruits



that make you poop": prunes, plums, peaches, and pears. Apri-
cots, too. You can also add unprocessed millers bran (available in
most supermarkets) or bran cereal to muffins, applesauce, or a
peanut-butter sandwich. If you add bran or other dried fiber, be
sure to give your child two or three extra glasses of water or fruit
juice a day. A slurry of applesauce, bran, and prune juice is sweet
and crunchy, and it often works well.

In some children, milk and other dairy products slow the in-
testines down, resulting in constipation. Cutting down on dairy
products or cutting them out altogether is often an effective
treatment for constipation. If you do this, be sure to add other
sources of calcium and vitamin D (see page 331). It's also impor-
tant to see that your child has plenty of exercise and time set
aside to sit quietly on the toilet each day.

It's best to make as little fuss as possible about your child's
bowel movements. At age two or three, children begin to see
their bowel movements as their own concern, something they
are rightly in charge of; later they develop modesty about their
bottoms and what does—or doesn't—come out. It can be diffi-
cult to respect a child's privacy and avoid making a child too
self-conscious while helping the child make the necessary
changes in diet and behavior.

If you find that these simple remedies aren't working, consult
your child's doctor. There are many over-the-counter medica-
tions available to treat constipation, but I recommend you use
them under a doctor's guidance. Even something seemingly as
harmless as mineral oil can interfere with vitamin absorption,
or cause pneumonia in a child who inhales some into his lungs
(for this reason, it's not recommended for children under age
three). Children who use laxatives sometimes become depen-
dent on them. The guidance of an experienced doctor should
help you avoid such pitfalls.

Psychological constipation. There are two varieties of consti-
pation that are largely psychological in origin. They start most
frequently between age one and two. If children at this age have


one or two painfully hard movements, they may hold back for
weeks or even months afterward for fear of being hurt again.
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