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QUESTION: My 30 month old daughter was taken to an emergency department about a month and a half ago with chronic abdominal pain recurring in waves bad enough for her to scream, blood and mucous in her stools, diarrhea the week before and no constipation. After an examination from the doctor we were sent home with no explanation. Then i got a referal to a paediatrician about a month ago when the symptoms would not subside. She increased bowel motions and had pain at least once a day. He sent a stool sample away for colitis and campylobacter. But what worries me is that the bowel motions have become more regular since then with blood and pain every motion if not every second motion. There is about 1/2 a tspoon to 1 teaspoon of blood in and around the stool, and it is a red to dark red colour. Can you please help me?

ANSWER: Hi Samantha,

Blood in stools is not normal at all and cannot be ignored. She needs to be carefully evaluated to find out the underlying cause: Meckel's diverticulum, Cow milk protein allergy (CMPI), Colitis and Polyps are some of the possiblilities that need to be considered...

Please talk to your pediatrician.

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


www.KumarChildClinic.com

+91-9818356846

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

QUESTION: She's had cows milk since she was 1, would symptoms develope this long after? It all only started about a month and a half ago, with quite rapid onset.The 3 doctors i've seen seem to be quite laid back about it all too.

ANSWER: Hi Samantha,

Yes, CMPI is still possible... May be microscopic blood loss was present for sometime; and now it has progressed to this stage....However, as I mentioned earlier also, other possibilities also need to be considered.

Laid back attitude is definitely not warranted/ desirable here. She needs careful work up.


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


www.KumarChildClinic.com

+91-9818356846

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

QUESTION: Should any of the conditions you described above have been picked up with an abdominal examination? Or only with stool samples and colonoscopy etc? Just wandering as she had her abdomen examined on three different occasions and they have told me its "unexplainable" pain as they cannot feel anything.

Answer
Hi Samantha,

In Colitis, there can be some tenderness of abdomen, but can be normal ("unexplainable"). In all other conditions, abdominal examination would be normal. Polyps can sometimes be suspected on digital rectal examination.

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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