Joey Wahler (Host): It's a topic that can be embarrassing to discuss and therefore is often avoided. But it can also be necessary to talk about. Namely your child's bowel movements and possible gastro issues. So we're discussing everything you want to know about your kids poop. Welcome to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. Thanks for listening. I am Joey Wahler. Our guest, Dr. Lauren Dankner, Pediatric Gastroenterologist at Valley Health System. Dr. Dankner, thanks for joining us.

Lauren Dankner, M.D. (Guest): Thanks for having me.

Host: All right, so there you have it. We are going to talk about what is the poop with kids poop, right? Let's start with the youngest children. How often should infants and younger kids do their business?

Dr. Danker: So that's a good question. I get that a lot. Younger infants, I would say it varies tremendously. And it also depends on what they're feeding. So breastfed babies can stool differently than formula fed babies. Anywhere from five to 10 times in a day, every time they feed, versus once a week. So as long as there's no other alarming symptoms and the stools are looking normal when they come out, then typically all of those can be normal.

In the slightly older kids, I would say more along the lines of every one to two days would be normal.

Host: Gotcha. How about the color or the shape of our poop? What would an unusual color or shape possibly be an indication of?

Dr. Danker: Yeah, so more so the color, I would pay attention to things that would be concerning would be, red, which can indicate bright red blood, black which can indicate, an upper intestinal bleed, and a pale or a tan colored stool, which in certain cases can indicate a blockage in the bile system.

Many times the red or the black is unrelated to bleeding and you know, it can be just a matter of what the child ate that day or a side effect of a medication that they may have taken. So it's important to ask your doctor if you see those.

Host: Okay. So let's talk about some of these gastro conditions that may be present, including constipation, and diarrhea. What usually causes each of those?

Dr. Danker: So constipation, there's a number of reasons why children get constipated. I would say by and large, the most common reason is what we call functional constipation. Meaning that it's just a matter of their diet and behaviors and there's no other underlying pathology or no underlying disease. The less common reasons for constipation can include an anatomic issue. So, stenosis or narrowing in the lower intestinal tract, even a milk protein intolerance that we see in younger children. There can be something called Hirschsprung's disease, which is a very specific and rare disorder related to the nerve cells. And then in older kids, occasionally we'll see celiac disease or thyroid issues, other motility or movement disorders, and something called anismus, which is when the child doesn't actually know how to poop properly. So it's important to take a good history and physical exam into account.

Host: And how about diarrhea?

Dr. Danker: Diarrhea can come from a number of reasons. So for us, we need to know how long it's been going on, what the poops look like. And based on the child's history, we can sort of try to identify what may also be going on, if there was travel, if there was an unusual food exposure, if there's weight loss.

So for the acute diarrhea, typically I think more of an infection, things like bacteria and viruses and parasites, certain medications can give you acute diarrhea, so that's lasting less than two weeks long. Whereas chronic diarrhea can come from any number of things ranging from irritable bowel syndrome or inflammatory bowel disease, which is inflammation in the tissue itself.

There's chronic infections. We see malabsorption, which is improper digestion of the foods that we're eating. So that can either be a congenital issue or something that you acquire over time. Certain food allergies can give you chronic diarrhea. And something that we see actually quite frequently in the younger kids is called toddler's diarrhea, which often presents, in one, two, three-year-old kids who are growing well and gaining weight appropriately. And it can often improve just with diet changes and reducing the amount of juice or excess fruits that they're eating.

Host: How about for constipation and diarrhea? How about medicines either oral medication or for constipation possibly suppositories.

Dr. Danker: So for diarrhea, I would say it definitely depends on the reason why the child is sick. So I don't usually recommend that parents treat diarrhea at home unless we know what the underlying reason is. If there's an infection, they would typically see their doctor, sometimes need a prescription. But I don't usually typically recommend antidiarrheals without knowing the reason why the child is sick.

For constipation, there's a number of medications, that we do try. First, sort of line drug is called MiraLAX is the brand name. It's the most commonly used. It's quite safe and effective at softening the stools. If we need to sort of escalate our treatment for constipation, then sometimes we'll use a stimulant laxative, which gives a little more umph instead of just softening the stools and suppositories, I use just on an as needed basis if the child is really quite backed up. But I would say for any of those medications, I would only recommend using them under the guidance of a pediatrician or a GI specialist since we use them off label in pediatrics, meaning, they're indicated in adults, but we do use them, under the guidance of physicians, which are, then used quite safely in kids as well.

Host: Can urinary issues be related to constipation?

Dr. Danker: Yes, definitely. So, sometimes we'll actually see patients referred from a urologist, after children are having urinary accidents after the time of toilet training and the underlying reason can be constipation. So it makes it harder for them to fully empty their bladder when they're full of poop.

Host: Gotcha. Now, switching gears, other conditions here can include, a bloody stool, which you alluded to a little bit earlier and also a stool blockage. What typically in a nutshell causes those?

Dr. Danker: So blood can come from either the inside or the outside. It ranges in severity. So in infants, I would say the more common reason for seeing blood is something called a cow's milk protein intolerance, which responds very well to just changing the milk that we give the baby. In older kids, the more common reason that we see bleeding with a hard stool is a fissure which is like a little tear on the outside that can be quite painful.

And sometimes you can get a hemorrhoid as well, either on the inside or the outside. And all of these would look like bright red blood. The other sort of less common reasons, are polyps. Typically non-cancerous in children, vascular changes or vascular bleeds. So coming from an abnormal blood vessel or something called a Meckel's diverticulum, which is a, again, a rare, disorder that we see in children and it can bleed quite rapidly, and it's typically painless.

The stool blockage looks very different. But typically is in children who are very constipated. We call it a fecal impaction, and there's really a mass of poop stuck in the colon, usually in the rectum and the kids can look quite sick. So they can be vomiting. They could have leaking of poop around this big, hard mass. Often this will come to our attention or sort of have the history of this kid hasn't pooped in two to four weeks. And it can even need a sedated procedure to physically remove that amount of poop.

Host: Okay. Now how about having accidents? How normal is that? And what can that mean?

Dr. Danker: So poop accidents are definitely normal usually around the age of toilet training. So while the kids are still learning how to do their business and figuring out when to get those cues to stop playing and get out of their video games or whatever distraction they're doing, often that will contribute to an accident. But in kids who have a history of being constipated, my concern is always that there can be something called encopresis.

So in kids who tend to get backed up and hold in their poops intentionally, you can get leaking of poop around a big, hard rectal mass of stool. And you can have either full sized poops, or little smears in the underwear. So this is actually quite common, but most kids and parents don't talk about it. So if that's something that you're seeing, please bring that to your doctor's attention.

Host: Couple of other things, please. So generally speaking, how do parents know when gastro symptoms may be from a serious illness?

Dr. Danker: So often, I would say it's not the parent's job to know. And I would always start with seeing your pediatrician who can refer out to a specialist. It's always better to ask because sometimes they don't know if it's serious or not, but I would say the major red flags for us would be blood in the poop, constant diarrhea, any changes related to weight loss or not growing well, diarrhea waking them up from sleep or affecting their appetite or not allowing them to stay hydrated. Those would all be reasons why I would see a doctor. If it's a sort of a one-time episode of diarrhea or the kid is constipated for a couple of days, usually that's not a major emergency.

Host: And so in closing, I think it's safe to say, am I right, your message would be that as you're attending to your kid, just be noticing any changes or anything that doesn't look right and act on it without waiting, right?

Dr. Danker: Yes. So when I get the history of kids having these issues for a long time, it makes it a little bit harder sometimes to change the way the kids are pooping, especially for the constipated kids. So I would say definitely address it sooner rather than later. If your kid is having prolonged episodes of accidents, certainly bring it to your doctor's attention. And if there's ever any severe pain or obvious bleeding, please seek medical attention. But again, all of these medical conditions that we've talked about are completely treatable. So it's important for parents to remember, even though we don't always talk about poop, we do over here, we do on the gastroenterologist side.

Host: And we do on this podcast, right. We just did.

Dr. Danker: I talk poop all day. I know.

Host: Well, folks we trust, you're now more familiar with everything you need to know about your kid's poop. Dr. Lauren Danker. Thanks again so much.

Dr. Danker: Thank you so much.

Host: And for more information about Pediatric Gastroenterology at Valley, please do visit valleyhealth.com/pediatricgi. That's valleyhealth.com/pediatricgi. To schedule an appointment, please call 201-389-0815. 201-389-0815. For more information about today's topic, please email valleypodcast@valleyhealth.com. Again, valleypodcastvalleyhealth.com. If you found this podcast helpful, please do share it on your social media. And thanks for listening to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey. Hoping your health is good health. I'm Joey Wahler.