NURSING CARE OF A FAMILY WHEN  For many children, a GI tract disorder is

A CHILD HAS GASTROINTESTINAL diagnosed largely by presenting

DISORDER symptoms such as those just described.

 In other instances, x-ray studies with a

contrast medium (barium) or an
endoscopic examination may be needed
to confirm the presence of an anomaly.
Ultrasound or magnetic resonance
imaging (MRI) also may be helpful.

 Another important assessment area is

laboratory testing for electrolyte balance
ASSESSING GASTROINTESTINAL
through serum analysis or fluid
ILLNESS IN CHILDREN
concentration through urinalysis.
 quickly become dehydrated, especially if
DISORDERS OF THE STOMACH
vomiting or diarrhea is a symptom.
AND DUODENUM
 This means they need to be assessed for
signs of fluid loss, such as poor skin
turgor, dry mucous membranes, or lack of
tearing.

 Compare the child’s current weight with

past weight measurements, if available.
Unless the child is an adolescent who has
been actively dieting, there is never a
normal reason for weight loss in children.

 Ask parents to describe what they mean

by diarrhea as some parents mistakenly
confuse normal newborn or infant stools
Gastroesophageal Reflux
with diarrhea.
 the regurgitation of stomach secretions
 As a rule, all children with diarrhea, into the esophagus through the
especially small children, need to be seen gastroesophageal (cardiac) valve occurs
by a health care provider because fluid mainly in infants and adolescents.
and electrolyte changes occur rapidly in
 Gastroesophageal reflux in infants occurs
children because of the greater percentage
from a neuromuscular disturbance in
of fluid held extracellularly rather than
which the gastroesophageal (cardiac)
intracellularly.
sphincter and the lower portion of the
 esophagus spasm and allow easy (barium swallow) will further show the
regurgitation of gastric contents into the involved sphincter and the reflux of
esophagus stomach contents into the esophagus,
especially if the infant’s head is tilted
 If the amount of the reflux is large or
downward.
constant, an infant does not retain
sufficient calories and will fail to thrive. THERAPEUTIC MANAGEMENT.
 In addition, aspiration pneumonia or
 The traditional treatment of GI reflux is
esophageal stricture from the constant
to feed infants a formula thickened with
reflux of hydrochloric acid into the
rice cereal (1 tbsp of cereal per 1 oz of
esophagus can occur.
formula or breast milk) while holding
ASSESSMENT. them in an upright position and then
keeping them upright in an infant chair
 Vomiting appears effortless and is not
for 1 hour after feeding so gravity can
projectile; it begins much earlier in life
help prevent reflux.
than the vomiting associated with pyloric
stenosis.

 The child may be irritable and may

experience periods of apnea. Inserting a
probe or catheter through the nose into
the distal esophagus and determining the
pH from secretions can show whether
gastric secretions are entering the
esophagus (if the pH is less than 7.0, then
acid is present).

 Esophageal manometry is used to

measure the strength of the esophageal
sphincter.  An H2 receptor antagonist such as
ranitidine (Zantac) or a proton pump
inhibitor such as omeprazole (Prilosec)
may be prescribed daily to reduce the
possibility of the stomach acid contents
irritating the esophagus.

 If medical therapy this way is ineffective,

a laparoscopic or surgical myotomy
procedure (narrowing of the esophageal
 Fiberoptic endoscopy or esophagography sphincter) may be performed.
 Assess nasogastric tube drainage and any
vomitus for coffee-colored drainage
(although this is normal for the first 24
hours) that would indicate bleeding from
the surgical site.

REFERENCE:

 Pillitteri, Adele. Maternal & Child Hea
lth Nursing: Care Of The Childbearing &
Childrearing Family. Philadelphia, PA :
Lippincott Williams & Wilkins, 2007.
Print.