Gastroenterology Disorders in Children:
A guide for parents

You may have heard of the saying “You are what you eat.” When it comes to our little ones, it’s more like “You are what you digest.” As an accredited paediatric dietitian, with years of experience in helping children with gastroenterology disorders, I’m here to guide you through the fascinating world of your kids' digestive systems.

My purpose for writing this article is to help you expand your knowledge of your child’s digestive health. Yes it is complex and in many ways intimidating, especially when you see first hand the pain your little one is experiencing, but I am here to help support you through this difficult situation and ultimately create solutions you can apply at home.

So take a deep breath and let’s embark on this journey together.

What are gastroenterology disorders?

In simple terms, gastroenterology disorders in children are conditions that affect the digestive system. Yes, that’s the system responsible for breaking down the food we eat, extracting nutrients and providing the energy needed to grow, learn and play. A pretty important system indeed!

There are many types of gastroenterology disorders children experience. These include diseases such as

Gastroesophageal Reflux Disease (GERD)
Coeliac Disease
Inflammatory Bowel Disease (IBD), including Crohn's Disease and Ulcerative Colitis
Irritable Bowel Syndrome (IBS) - bloating, diarrhoea, constipation
Eosinophillic Oesophagitis
Pancreatic diseases
Hirshprungs Disease
Bowel resections and ileostomies
Malabsorption disorders
Tube feeding intolerances

And also more general yet still critical conditions such as

Abdominal pain
Abdominal migraine
Diarrhoea
Chronic constipation
Failing to thrive or faltering growth
Difficulty feeding
Food intolerances and allergies

How do gastroenterology disorders affect your child’s wellbeing?

As each gastroenterology disorder affects children differently, it’s hard to give a simple answer to this question. But in general, if children are suffering from a gastro related illness, they aren’t adequately absorbing the nutrients their body needs to thrive.

As I said earlier, during this time of rapid brain and body growth, it’s about focusing on improving what your body can digest. The effects of not addressing the digestion issues of your child early on are likely to happen later on in life and include a weakened immunity, poor overall physical health, compromised emotional well-being and irrational social behaviours.

Prompt diagnosis and proper management are essential to minimise the impact of these disorders on the long-term health and well-being of your child.

How can you tell if your child is experiencing a gastroenterology disorder?

There are so many symptoms your child may be experiencing and a thorough medical history is important to helping your clinician decide on the best way forward. Symptoms ranging from loose stools, mucousy stools, blood in stools, diarrhoea, constipation, reflux and vomitting can all be signs of a digestive issue.

A paediatric dietitian can support with diagnosing conditions that cannot be diagnosed with tests. These include allergies or intolerances. However it is important to review these symptoms with your GP or gaining a referral to a gastroenterologist who will perform blood tests and in some cases perform a endoscopy and colonoscopy.

Gastroentrologists can help ruling out conditions such as Eosinophillic Oesophagitis, Coeliac’s Disease, malabsorptive conditions, Inflammatory Bowel Disease and Hirschprungs disease. All of which symptoms can look fairly similar which is why it is important to have a team around you to support you and your child. Once diagnosed paediatric dietitians can support with the follow up dietary changes required for these conditions.

Eosinophillic Oesophagitis can look like reflux, food bolus impaction and what looks like selective eating and can often coincide with other intolerances which present like diarrhoea too. Diagnosing this requires a Gastroentereologist and endoscopy.

Coeliac’s Disease presents vastly different across each child such as low iron, constipation and diarrhoea. You can request a coeliac serology with your GP to rule this out.

Crohn’s disease and Ulcerative colitis also presents very differently from low iron to normal bowel motions to diarrhoea. This requires a stool sample which can be done with your GP as well as a referral to a gastroenterologist.

Hirschprungs also presents variably from constipation to vomitting to bloating and requires input from your Gastroneterologist.

Elimination Diets

So basically an elimination diet is roughly any elimination of any food for a trial of 1 month. This might be advised by your Gastroenterologist or this could be recommended by myself. Typically however an elimination diet can also be labelled as an intolerance. Typically we would begin this pathway after seeing a Gastroenterologist and they have ruled out any diagnosable causes of gut issues.

These usually include milk, egg, wheat or soy. For example maybe your doctor ruled out coeliac's but your child has an issue with wheat. Or you have ruled out all causes of your child's diarrhoea and perhaps it is dairy or soy as the cause.

Some families can be quite disappointed after seeing their Gastroenterologists and finding there is nothing that the Gastroenterologist has found. Especially when seeing your child in discomfort, with diarrhoea or reflux. But do not despair that is where I come in. Paediatric Dietitian's often are in charge of supporting families with intolerances and elimination diet's after all the nasties are ruled out.

We will work through your child's early feeding history to determine when the symptoms began, what the symptoms are and use this information to deduce what our prime suspect foods are. We then devise an elimination diet for a 1 month trial period. This is called the elimination and reintroduction phase. After the 1 month we reintroduce the suspected allergens to see if this causes a reintroduction of symptoms. This confirms the trigger.

I will then guide you on managing a longer term exclusion diet plan as well as a pathway to outgrow these triggers. Take a look at my non IgE allergy page to get an idea of what this pathway looks like.

How can a certified paediatric dietitian help?

In my years of education and clinical experience I have come across every type of gastroenterology disorder listed above. I have experience as a surgical neonatal and paediatric dietitian, been the lead dietitian with an excellent gastroenterology team at the John Radcliffe Hospital in Oxford (England) have supported preterm infants through their ileostomies and participated in short bowel syndrome, intestinal failure and TOF/ OA clinics. You can say I’ve seen my fair share of complicated cases.

Now I’m the lead paediatric dietitian at Cubs because it’s my passion to bring support and help to many families who deal with meal time challenges every day. My speciality is gut issues such as gastroenterology disorders. But as a paediatric dietitian you won’t just get a shopping list of foods to feed your distressed child. I work to get to the root of the issue by giving you a plan that leads to a long term solution.

What to do to get the ball rolling:

1. Book an appointment

I’ll meet with you and your child via telehealth or face to face. We’ll discuss your child’s full history from birth until today and answer all your questions.

2. Get a customised nutrition plan

You’ll receive a nutrition plan that meets your child’s specific needs.

3. See your child thrive and their confidence grow

As your child’s digestion improves happiness will return to your mealtimes.

Book an appointment

FAQ's: Your questions answered.

Many of my patients are children with gastroenterology disorders. I’ve put together a list of questions I regularly get asked.

What specific dietary modifications or restrictions do you commonly recommend for my child’s gastroenterology disorder?

Every child’s situation is unique. This is the first step in my process, understanding your child’s discomfort. We’ll discuss what they are eating now, when they are experiencing tummy distress, and the severity of this distress. My goal is to help you find the root cause of the situation and create a nutrition plan you can implement at home that allows them to thrive.

Are there any foods that my child should avoid completely?

Until we discuss your child’s situation it’s hard to say. But from years of experience and training I have a list of trigger foods we will look into, like dairy, gluten, greasy foods, and even fibre-rich foods.

Are there recommended supplements or vitamins I should be giving my child?

As a paediatric dietitian, I always prioritise getting essential nutrients from food, rather than individual or multi-vitamins. However, in certain cases of gastroenterology disorders, where there may be specific nutrient deficiencies or impaired nutrient absorption, their body may need some extra help. That's when we consider adding in vitamins or supplements to make sure they're getting everything they need. Every child is different, so it depends on what your child specifically needs and how they're doing.

Should I be cooking in a particular way to make meals easier for my child to digest?

Yes there is evidence showing that cooking, and also serving food in a particular way, can make meals easier for your child to digest. Here are a few tips for you:

Foods that are softer in texture - try steaming, boiling or slow cooking.
Gentle seasoning - avoid heavy spices or seasonings. These include garlic, onion, chilli powder, strong curry blends and also highly acidic flavours such as lemon zest and vinegar.
Consider giving your child smaller meals, more frequently. Smaller portions throughout the day can help prevent overwhelming their tummy and aid in better digestion.
Be mindful of fibre. Excessive amounts can be challenging for some children with gastroenterology disorders. You can adjust the fibre content by choosing cooked, peeled, or blended fruits and vegetables instead.

How long does it typically take to solve a gastroenterology disorder?

Difficult to put a time on it. It depends on a number of factors - the severity of your child’s situation, their compliance to the suggested diet and their age are some of the considerations. But typically when trialling exclusion diet a minimum of 1 month is recommended. This will change based on your child’s diagnosis.

How long will my child need to stay on the meal plan you recommend?

It’s hard for me to put a length of time on resolving a gastroenterology disorder. I have been able to solve some quickly and some others have taken more investigation, trial and effort. But rest assured, we will get to the root of the problem and determine a nutrition plan that works for them and for you.

Can you give me any strategies or techniques to help my child accept and enjoy the new dietary changes?

Transitioning to a new dietary plan can be challenging for children. From my experience I have developed several strategies and techniques to help your child adapt to this new way of eating.

Involve them in meal planning and grocery shopping. By giving them choices within the recommended options, they will feel a sense of control over their meals (of course, this depends on their age but even really young kids will let you know what they like and don’t in their own special way).

Make it fun and creative - use colourful fruits and vegetables, make them into fun shapes or designs on their plate, let them help prepare like stirring the ingredients, and tasting the food along the cooking process.
Gradual transition is best - instead of making dramatic changes, gradually introduce new foods, to allow them to adjust and develop a taste for the new flavours.
Offer familiar foods with a twist. For example if they love spaghetti, try adding pureed veggies to the sauce for added nutrition.
Role model healthy eating. Let them see you enjoying and appreciating nutritious foods.
Provide education and explanations, at an age-appropriate level. Ask them how they feel on their new diet.
Celebrate successes - acknowledge and celebrate your child’s efforts. Praise their willingness to try new foods, reinforcing positive behaviour.

Overall, patience, persistence and a positive approach go a long way in helping your child accept and enjoy the new dietary changes.

Can you recommend any resources or support groups for parents of children with similar conditions in Brisbane?

For allergy and intolerances I suggest looking at the Australian Society of Allergy and Immunology they have great educational resources on exclusion diets and management plans.

https://www.allergy.org.au/patients/information

For Eosinophillic Eosophagitis (EoE) ASCIA additionally has excellent resources for treatment and management medically and dietetically.

https://www.allergy.org.au/patients/food-other-adverse-reactions/eosinophilic-oesophagitis

Additionally an Australian based charity has a lot of resources and and support groups for families managing EoE.

https://www.ausee.org/

Coeliac’s Disease also has great resources on Nutrition Education Materials Online. Additionally the Coeliac Society of Australia has great resources.

https://www.coeliac.org.au/

https://www.health.qld.gov.au/__data/assets/pdf_file/0026/149930/gastro-coeliac.pdf

Crohn’s Disease has some resources on Nutrition Education Materials Online and for more background information Crohn’s and Colitis Australia has further information.

https://www.health.qld.gov.au/nutrition/patients

https://crohnsandcolitis.org.au/

For irritable bowel syndrome Monash Health has great resources including books and apps. IBS is fairly unlikely in young children and should only be proceeded with after full assessment with your dietitian and gastroenterologist.

http://www.monashfodmap.com/

These are just some of the questions others have asked me. I’m sure you have questions that are specific to your child. Please contact me and we can talk about your child’s particular challenge and get to the root of the issue.

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