Children's National Health System

When symptoms affecting the gastrointestinal system don't resolve in a timely manner, consider consulting a pediatric gastroenterologist who can provide specialized care. Additional Resources for Complicated Gastrointestinal Cases PROBLEMS WITH CONSTIPATION and diarrhea are quite common but occasionally can be difficult to manage and may indicate underlying conditions, such as celiac disease, Crohn's disease, or food allergies. An important goal of the Division of Gastroenterology, Hepatology, and Nutrition at Children's National Health System is to maintain close working relationships with community pediatricians to provide guidelines for initial evaluation in the pediatrician's office and for referral, according to John Snyder, MD, Division Chief. For example, most pediatricians are very comfortable dealing with children with acute diarrhea. However, if the diarrhea persists and especially if it contains blood or is associated with weight loss, a referral to a gastroenterologist may be needed. Constipation is also a very common gastrointestinal problem, and a pediatrician usually does initial evaluation and treatment. Referral to a specialist is needed for difficult-to-treat cases that raise the possibility of underlying diseases, such as Hirschsprung's disease, thyroid disease, or motility disorders. A RANGE OF SPECIALIZATIONS For pediatric patients with chronic gastrointestinal conditions, Children's National has assembled a team of experts who can help children and their families manage ongoing needs. Children's National physicians offer multidisciplinary expertise in many areas, including abdominal pain and ulcer disease, aero-digestive disorders, celiac disease, constipation, feeding and growth problems, food allergy, inflammatory bowel disease, intestinal rehabilitation, liver disease, motility disorders, and psychological problems. For example, the celiac disease program teaches children to live with a | | | R U L E S O F T H U M B | Chronic constipation and both acute and chronic diarrhea may gluten-free diet while maintainwarrant referral. Specialists at Children's National Health System recommend: ing good health and peace of mind. Physicians, nurses, nutriCONDITION FIRST-LINE EVALUATION CONSIDER REFERRAL tionists, and psychologists work AND THERAPIES together to help families and children cope with the condition. Constipation Six servings of fruits and vegetables Problems persist after treatment each day; plenty of fluids; daily vigorous For those who have suffered exercise; non-absorbed stool softeners intestinal trauma from any cause, whether a disease or a Acute diarrhea Check for infection; give attention to If there is fear of dehydration, consequence of surgery, the fluids and electrolytes send to emergency department intestinal rehabilitation program is comprised of a team of Chronic bloody Check for infection Not gaining adequate weight; physicians, nurses, nutritionists, diarrhea problems persist after treatment social workers, case managers, and psychologists who assess Chronic nonTreat any dietary abnormality (e.g. limit Not gaining adequate weight; nutritional needs and prescribe bloody diarrhea fructose intake; ensure sufficient fat intake; problems persist after treatment comprehensive treatment plans. start food diary; evaluate fiber intake) Providers in the intestinal rehabilitation program also care for pediatric intestinal TO VIEW DETAILED REFERRAL GUIDELINES for a variety of pediatric gastrointestinal problems, transplant patients. visit www.ChildrensNational.org/GIReferral. GASTROINTESTINAL 15

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