Interviewer: Hirschsprung use a lot constipation in pediatric, what is constipation?
Interviewee: Constipation is the passage of infrequent hard stools the cause discomfort to the child.
Interviewer: Many times we kids who are breastfeed and they get to go everyday or two or three the stool comes out nice and soft. Is the sign of constipation?
Interviewee: No. that is a normal situation for a certain breastfeed and it’s important actually that pediatricians recognize that because the tendency is to treat it and that can just lead to further problems.
Interviewer: In other word sometimes is not going it doesn’t constipation, is that correct.
Interviewee: That’s correct.
Interviewer: The key point is not going or going with that with the big bulky hard stool.
Interviewee: With discomfort right.
Interviewer: With discomfort, and how can we approach say a new baby that maybe constipated what will be approach in the beginning.
Interviewee: Well it’s important with the new baby to determine time exact of the symptom begin because there is one disorder called Hirschsprung Disease which must be at least considered in all infants because that will not respond any treatment.
Interviewer: What is this Hirschsprung Disease?
Interviewee: Hirschsprung Disease is a situation where the nerves that allow the distal and foreign of the rectum to relax the stool are not properly form and so the child actually cannot pass the stool and cannot pass gas.
Interviewer: How is the present is just constipation?
Interviewee: Usually it presents in the newborn fear of period as and obstruction with the distention of the abdomen and vomiting that’s greenish vomiting and a failure to pass any stool at all. That’s the most common presentation.
Interviewer: But sometimes doesn’t always follow that rule.
Interviewee: One has to be sure with every child you treat with constipation that we can at least consider could be Hirschsprung Disease and look for clues and the history of the physical examination that is it not.
Interviewer: If the kid have normal stool production in the first year and in long time the torture in it and start to get constipated, is that a red flag for Hirschsprung Disease or something else?
Interviewee: No, that is not Hirschsprung Disease; Hirschsprung Disease will not have a period of normal bowel movements followed by constipation.
Interviewer: That’s the key point here is that true?
Interviewee: But if my child is being torturing and it’s not making stool that’s the different of constipation, what we call that?
Interviewer: That’s stool holding behavior, there are a number of times where constipation seems to be initiated and that is introduction of whole milk into diet, toilet training in the start at school. This are times where if the diet changes or when the child is not ready to be constipated or the child is not willing to move bowel or stool so the kids tend to hold back. And once they hold back the stool is get harder and larger and more uncomfortable to pass and then in fact the constipation become a—
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