Kids Gastro Care - Paediatric Gastroenterology Service

14/12/2025

The aim of a paediatric colonoscopy, is to have a thorough look at the lining of the colon and the last portion of the small intestine (called the terminal ileum) for any irregularities such as ulcers, polyps or signs of inflammation.

There has to be a strong indication to consider a colonoscopy in the first instance. Symptoms including chronic (longstanding) diarrhoea and abdominal pain, passage of blood or weight loss and abnormal blood or stool test results are all good reasons.

In this image captured during a paediatric colonoscopy, the lining of the colon (also called the mucosa) looked fine.

Occasionally, there can be a surprise (or incidental) finding.
In this picture from inside the colon, at the junction of the small and large intestines in an area called the caecum, I could see a pinworm. There were several more in the small intestine and other sections of the colon.

These pesky parasites usually wiggle their way around the colon to exit via the back passage, usually at night. Once there, the females lay their eggs on the surrounding skin, causing intense itchiness.

After a good scratch, the eggs, now stuck to the scratching finger, or picked up from exposed bedding, towels, underwear or other surfaces, can reenter the digestive tract via the mouth. They hatch into larvae in the small intestine and grow into adults, and the cycle repeats.

This can all happen without the child or anyone else in the family realising. However, the most common symptom is usually an intense itch around the back passage. Sometimes the worms move into nearby surrounding areas and cause vulvovaginitis and urinary tract infections.

As the worms travel around to exit the bowel at night, sleep can often be disturbed because of the itch and scratching, leaving a tired and sometimes irritable child.

Diagnosis is usually made based on typical symptoms, the occasional sighting of a worm crawling about the skin or other orifices (now that is a surprise moment! ) and the presence of eggs. These can be found most easily by putting some sticky tape on the skin around the child's bottom first thing in the morning to pick up eggs that can then be seen under a microscope.

Sometimes we diagnose these infections during a colonoscopy, although that wasn't the reason for doing the colonoscopy in the first place.

Treatment involves the child and often the whole household, using anti-parasitic medications (available to buy over the counter) such as Mebendazole.

Alongside this, strict hygiene measures, most importantly with regular handwashing and laundry of bedding, underwear and pyjamas.

A surprise finding, but one with a straightforward treatment.

03/11/2025

It is fascinating to see how the management of Eosinophilic oesophagitis, a gastrointestinal allergic condition that has become more prevalent over the last few years, continues to evolve. Eosinophils, a type of cell commonly found in other allergic conditions, including: Asthma, Eczema and Hayfever, find their way into the oesophagus or foodpipe. They don't usually live there. When they do get in, they can cause a variety of symptoms and often negatively impact an affected individual's ability to swallow food.

Getting the diagnosis right is a crucial first step and needs paediatric endoscopy and the right biopsies collected from the foodpipe.

Diet, drugs and rarely dilatation (stretch) of the oesophagus play key roles in treating the eosinophilic inflammation of the food pipe or dealing with any structural changes that may have occurred.

Dietary approaches can be very effective, and the expertise of a highly qualified paediatric dietitian is essential.

A better understanding of how the condition develops, the cells and biological signalling pathways involved, means that more targets for treatment are available than a few years ago. Newer medications look very promising.

As always, it is so important to work with each family and child or young person, to personalise the approach taken to the unique individual and their circumstances

EoE can be a challenging disorder for patients and their providers. Jenifer R. Lightdale, MD, MPH, offered some “clinical pearls” for managing this ...

04/09/2025

The number of children and families suffering with constipation is huge. An often quoted statistic is that a quarter of the patients in a paediatric gastroenterology clinic have constipation.

From my experience of dealing with this in clinics, it is best to get on top of this early with a healthy diet, decent fluid intake, and the use of laxative treatment is often needed. Simple measures can be really helpful.

Checking for red flag symptoms and screening for other (though rare in the majority) potential diagnostic possibilities is important

Guidance from experienced medical and nursing professionals and amazing charities like Eric, with their superb resources, is important to improve the situation for children.

This part of paediatric gastroenterology is, in my opinion, shamefully quite often neglected in comparison to other Gastro conditions, despite the evidence that children with constipation can have a significantly reduced quality of life, affecting them physically, emotionally, socially, and of course at school as well.

We still have a long way to go to break taboos about poo.

The number of children being admitted to hospital with constipation is at a 10-year high.

31/03/2025

Wow! This was an interesting short read all about poo from the BBC website.
It is always worth checking on your child's poo (and your own poo) once in a while as you can get some understanding of your child's gut health.

Once again the microbiome seems to have a role here as well. More and more research points to the interaction and impact of our gut microbiome on gut function and in the long term also on the body's cardiovascular and neurological systems.

Don't miss out on an easy opportunity to check over your child's gut health...Remember to have a good look before they flush!

It may sound bizarre to some, but take a picture of it if you see something a bit odd. Your friendly neighbourhood GP or paediatric gastroenterologist (Spiderman fan!) will probably want to have a look at what it is you've seen too, make sure you have some decent lighting and zoom in, just please don't drop your phone!!

I discussed some of this in more detail in a Much Ado About Poo blog post a few years back.
https://www.kidsgastrocare.co.uk/poo-in-children-a-simple-guide-for-parents-to-normal-and-abnormal-poo-patterns-in-kids

The ideal poo is a 'type 3' or 'type 4' – cracked or smooth sausage – delivered once per day.

07/03/2025

It was so good to have a refresher on this alternative way to do an upper GI endoscopy or gastroscopy (camera test).
And it was great to catch up with my Adult Gastroenterology colleagues from the Royal Free that lead the way with this.

03/11/2024

This is a fantastic step in the right direction by TFL!

Time and again I have heard this concern from patients and families in my paediatric gastroenterology clinics.

I hear how they are so stressed at the thought of travelling because of a lack of access to toilets on their journey.

It doesn't matter if it is Irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or some other bowel or bladder issue.

Just knowing you can reach a toilet more easily whilst travelling to and from school, college or work, could help transform some peoples lives.

Billie Nicholls, who has ulcerative colitis, says some people don't have the luxury of waiting.

01/03/2024

Returning to the gastro groove again after a long pause to recover from surgery for a sports-related injury.

So it means a lot to receive lovely feedback like this from a family seen in a recent Kids Gastro Care paediatric gastroenterology clinic in Elstree.

31/08/2022

Have you sought advice from an independent practitioner about your child's diet out of a concern it may be having an impact on their health.

Or have you been recommended to see someone about your child's nutritional status or to help you to introduce some dietary changes?

Food and the gut are of course inextricably linked.

Reviewing the diet of a child can be an important aspect of a paediatric gastroenterology assessment.

Making a change to a child's diet can be therapeutic in some situations. For example going Gluten free after a confirmed diagnosis of Coeliac disease by a paediatric gastroenterologist.

Doing this safely and with the support of the correct personnel is essential especially in children so as to avoid unnecesary exclusions from their diet at a time when they are needed for healthy growth.

Here is a great article from the British Dietetic Association that offers a clear explanation about the differences between a dietitian, nutritionist, nutritional therapist and other diet experts.

It is always good to know more about those you're seeking advice from.

Are dietitians and nutritionists the same thing? And if not, what is the difference between a dietitian, a nutritionist and a nutritional therapists?

14/08/2022

Great to see an updated guideline on Eosinophilic oesophagitis (EoE) published this month in Gut journal, one of the leading publications in the field of gastroenterology. EoE is a condition that affects people of all ages. The way it presents itself in (younger) children can be vague and vary with age including feeding issues and refractory reflux. In older children and adults, it is a common cause of food getting stuck in the gullet. Once a secure diagnosis has been made with endoscopy and biopsies, therapy is based on dietary changes or medication use.

Background Eosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both....