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QUESTION: Since he was about 1 & 1/2 months old my son's had constipation (with poop and with gas) and his poop smells like backed up sewer all the time even when i have him pooping regularly, and it olive green with black streaks and loads of mucus.  I have been told he has more than the normal amount of drool.  His belly gets super hard and swollen.  he has been in and out of the er because he goes weeks at a time without pooping and his belly get so swollen and he hurts so bad. this last time though there was nothing but gas constipating him even though he's been eating.  He is always coughing with a mucusy cough and his nose is always full of thick mucus.




At 2 months old he had been constipated for about a week, so I took him to the ER, they gave him a supository and sent him home. I didnt think anything of it cuz babies get constipated. The constipation continued, after another week and his refusal to eat, I took him to urgent care, there they gave him an IV for dehydration and another supository adn sent him to the hospital where he was hospitalized for over a week.  The doctor on the pediatric level ran metabolic tests. While there he had troubles regulating body temp, and the nurse and doctor bothd heard a heart murmer, and his lactic acid levels keep going too high. The doctor ordered xrays and ultrasounds of his abdomen, mri's brain for temperature problem, and an echocardiogram for the heart murmer where they pointed it out ot me. The Pediatritian doctor switched him off of breast milk, and onto Enfamil Gentleease. The constipation continued, I was told try water, pedialite, juice and nothing worked. around 5 months old the pediatritian switched him from Gentlease to Similac Alementum, when the constipation continued the pediatritain added Miralax, first 1 tsp per 8 ounces of water twice a day, then when that didnt help, he increased it to 2 tsp twice a day.  Now with that amount of Miralax, it works when its added along with about 3 bottles of juice/water but the miralax causes him a rash but without it it takes alot more juice and alot less formula just to get him pooping.    He was in the ER one more time since then, a few days ago his stomache was swollen and hard and he was screaming in pain. The ER ran xrays, the results were, his stomache was empty, along with his intestines and colon. The best they could say was he was constipated with gas. After puting a rectal thermometer up his butt the gas was released and his stomach was softer.

ANSWER: Hi Jesse,

I think your doctors are on right track. Please  continue following up with them.

I'm sorry, there is nothing more that I can help you with.

If you have any specific query regarding anything, please revert back.



Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846

---------- FOLLOW-UP ----------

QUESTION: That is just it though, none of the treatments are working, and the doctor doesnt know what else to do.  I have been trying to find ideas on what it could be or possible treatments to try to take back on his next follow up.  

Also this morning, there is a lump about 2 fingers below his sternum that the doctor told me was just a muscle that will connect later as he grows, it has gotten bigger  from the half the size of a pea to a little bigger then one, and it is hard as a rock.  He's had it since he was about 4 weeks old (that i knew of) the doctor sayd it would go away after a few weeks, but it hasnt and now its bigger, what should I think about that???

ANSWER: Hi Jesse,

A "gap" in muscles below sternum in the midline is common (called "divarication of recti" technically) and does not require treatment. It may remain forever. However such a swelling is soft and appears in certain body postures only. A "rock solid" swelling could be a "cystic swelling", and it may also not require specific treatment and may remain like that. Neither of these have any correlation with constipation.

Regarding constipation, It is so difficult to comment specifically without having seen the child and the reports. I don't know if the X-rays (?Barium Enema) shown anything abnormal What were the metabolic tests and reports? Sorry, can't help much on this.

Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846

---------- FOLLOW-UP ----------

QUESTION: They havnt done anything with barium on him.  The tests came back high lactic acid, and they didnt tell me any of the other results.  They told me he has a heart murmer, but they never told me the results of the echocardiogram; his temperature dropped too low for a while and he couldnt keep it at a decent level, so they did an mri to check his thyroid i think it is, and again i never heard back.  I'v shown the pediatritian the lump and told him how hard it is but he doesnt even feel it, he just tells me its that muscle thing.  

thank you for trying to help :D

Answer
Hi Jesse,

In my opinion, in any case with chronic constipation, barium enema (or any other "contrast study" for large intestine: colon) must be done to rule out structural cause of constipation.

Many murmurs are of no clinical significance. The fact that you have not been told about echo suggests that it didn't show anything significant to make note of: likely to be normal. Ditto for thyroid.

The lump, as I told you, is unlikely to be significant from constipation point of view; and even otherwise.

Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846

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Dr. Puneet Kumar

Expertise

I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query requiring specific diagnosis of a particular subject.

Experience

I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 15 years of experience in the field.

Organizations
Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (http://www.kumarchildclinic.com)

Publications
(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. http://www.pediatricsciences.com/issue/view/1050000010 (f) Regular column, “How do I treat” in Pediascene (www.pediascene.com) (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 (http://www.pediascene.com/page.php?cid=6&catid=9&id=132 ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

Education/Credentials
After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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