Pediatric Gastroenterology and Obesity

When it comes to pediatric gastroenterology, you can count on GI4kids. As the leader in pediatric gastroenterology in East Tennessee, GI for Kids prides itself on offering you and your children the best advice and the finest services in Knoxville and the surrounding areas.

One of the issues the GI4kids pediatric gastroenterology physicians and dietitians deal with is childhood obesity from physical inactivity and a poor diet.

Physical activity is an important component of health and well-being for people of all ages. Children who are physically active may gain immediate and long-term positive effects, such as improved mental health and self-esteem, enhanced performance of daily activities, promotion of bone formation, weight management, and prevention of cardiovascular risk factors.

Today, screen time has been on the rise when it comes to a child’s preferred daily recreation. It is estimated that children in the United States spend 25% of their waking hours watching TV, using the computer, and playing video games as their leisure time.  The American Academy of Pediatrics notes that children who watch five or more hours of TV per day have four-and-a-half times greater risk of being overweight than those who watch two hours or less.

In addition to inactivity, children today have an unhealthy diet that includes more fast foods, sugar-sweetened drinks, and not eating breakfast. Fast food is ready-to-eat, low cost, and easy to take home and serve. Having less nutritional value and much higher in calories, this diet produces more overweight and obesity in children.

In 2007, The American Academy of Pediatrics, recommended avoiding sugar-sweetened beverages, reducing portion sizes, eating 5 to 9 fruit and vegetable servings a day, at least 1 hour of moderate to vigorous physical activity a day, eating breakfast, a maximum of 2 hours of TV, and eating less fast food to reduce the risk of children becoming overweight and obese.

For more information regarding childhood and adolescent obesity, talk to the pediatric gastroenterology professionals from GI for Kids who can help you come up with a plan to keep your kids and teens fit for life.

Pediatric Gastroenterology

Our clinic doesn’t follow the trends, it sets them! GI for Kids is a patient-centered clinic offering pediatric gastrointestinal, hepatology and nutritional services. When a child says “my tummy hurts,” it can be a lot of different things. From intake to diagnosis and beyond, we work with patients and their families to treat GI illnesses, weight issues, mental-health challenges and much more.

Gastrointestinal (GI) bleeding is among the most common gastrointestinal disorders and can range from microscopic bleeding to massive bleeding leading to hypovolemia and shock. In children, GI bleeding requires prompt assessment, diagnosis, and treatment. Two issues should be addressed immediately: the child’s appearance, mental status, blood pressure and heart rate, and the likelihood of ongoing bleeding. It is important to determine whether the bleeding is from an upper or lower GI source because this will help in the diagnosis and treatment.

Many things children eat can look like blood. Red food coloring found in foods like Jell-O or Kool Aid, as well as fruit juices and beets may resemble blood, if vomited. Melena may be confused with dark or black stool from iron supplementation, bismuth subsalicylate, dark chocolate, grape juice, spinach, cranberries, or blueberries. A simple Hematest performed at the bedside can confirm presence of blood in gastric contents or in stools. In the neonate, the Apt test will differentiate maternal from infant blood.

An upper or lower endoscopy can be used to evaluate GI bleeding and is the procedure of choice for a diagnosis; and sometimes used in emergency cases. Where endoscopy is non-diagnostic, a bleeding scan, Mickel’s Diverticulum Scan, Capsule Endoscopy or Angiogram can be used. We have a state of the art endoscopy suite located at East Tennessee Children’s Hospital that is supported by multiple pediatric specialists that include surgeons, anesthesiologists, intensive care specialists, radiologists, hematologists, and other specialists on call, as needed, to help our team manage and care for these patients.

KidsFACT Newsletter “Poop Scoop”

Over the years of serving pediatric patients, we have seen more patients with a chronic disorder called Inflammatory Bowel Disease, which includes both Crohn’s and Ulcerative Colitis. While the exact cause is unknown, it may affect any age, males and females, and, while it can affect one child, it often runs in families. Realizing the great need for families affected by this disease to have a place to come together in a casual setting to share stories, talk about treatments, and support each other, Dr. Youhanna Al-Tawil, through the GI for Kids clinic, started this non-profit group called KIDSFACT.

The mission statement defines this non-profit group. On a daily basis, KIDSFACT strives to improve the quality of life and advance the latest information on IBD to better treatments and ultimately some day to a cure. KIDSFACT raises awareness through sponsoring educational seminars, fundraising events, family activities, and research opportunities. A newsletter will be another avenue to reach these patients and families, as well as broaden its mission to the community. The roll-out of the first issue of “Poop Scoop” is scheduled for April, 2015. Please contact Ashley Treadway if you are interested in receiving this newsletter.

Drawing for Free Camp Oasis Summer Camp in April, 2015

KidsFACT is sponsoring (3) GI for Kids patients to attend this years Camp Oasis Summer Camp Program at Camp Will-A-Way in Winder, Georgia. The drawing will be held here on Monday, April 6, 2015. KidsFACT will provide the camp fee and a $200 travel allowance for the child. domain list . The family will be responsible for all transportation arrangements and camp registration.

For registration information go to website and then KidFACT events and meetings. Information on the camp, and all the details for attending the camp, visit the CCFA website: oasis/.

Summer Fast-Food Choices for Kids

Children today are eating more fast foods, more sugar-sweetened drinks, more snacks, and not eating breakfast. Fast food is ready-to-eat, low cost, and easy to take home and serve.  While fast food is considered to have less nutritional value and higher in calories, many of these restaurants are now working hard to improve their menus to offer more healthy foods.

It is summer, and children are out of school and families are involved in various activities outdoors. When it is time for lunch or dinner it may be easier to just stop at a fast food restaurant to pick up something.  One of the issues the pediatric gastroenterologists and dietitians at GI4kids prides itself on is offering parents and children the best information and advice on diet and exercise to prevent childhood obesity.

Below we have compared several foods we know kids love to eat—especially during the hot summer:

McDonalds – 240 calories, 12g protein, 8g fat
Burger King – 230 calories, 9g protein, 9g fat

*Ice Cream cones
McDonalds – 170 calories, 5g protein, 4.5g fat
Burger King – 160 calories, 4g protein, 4g fat
Chick-fil-A – 260 calories, 7g protein, 6g fat

*Chicken Sandwich
McDonalds – 370 calories, 14g protein, 17g fat
Burger King – 640 calories, 29g protein, 36g fat
Chick-fil-A – 440 calories, 28g protein, 18g fat

*French Fries
McDonalds – 230 calories, 2g protein, 11g fat
Burger King – 190 calories, 2g protein, 8g fat
Chick-fil-A – 310 calories, 3g protein, 16g fat

*Chicken nuggets
McDonalds – 190 calories, 9g protein, 12g fat
Burger King – 190 calories, 8g protein, 11g fat
Chick-fil-A – 270 calories, 28g protein, 13g fat

At GI for Kids, we offer a weight management program, Bee Fit 4 Kids, that can help parents and children learn healthy dietary habits and increasing their physical activity.


*Information taken directly from restaurant menus.

Esophageal Injury Secondary to Caustic Ingestion

Esophageal Injury Secondary to Caustic Ingestion


What is a caustic ingestion?

A caustic ingestion, which is a medical emergency, occurs when a child ingests a toxic substance.  This is often a household cleaning material or laundry detergent. There are two forms of caustic ingestion- an alkaline agent or an acidic agent- this is determined by the pH of the substance.

Examples of Toxic substances in the household:

  • Common household cleaning products such as oven or drain cleaners.
  • Laundry detergent pods are often ingested as they are colorful and attract the attention and curiosity of the child.
  • Hair relaxers.

Age group most at risk: Toddlers and Preschool age children.


  • Choking or difficulty swallowing
  • Vomiting or the vomiting of blood
  • Bleeding from the mouth
  • Abdominal pain or chest pain
  • Respiratory distress

Treatment:  A caustic ingestion or suspicion of one is a medical emergency

  • Often the child will need EGD-Upper endoscopy to evaluate the extent of the damage to the esophagus or stomach.
  • Respiratory support may be needed if upper airway is injured.

Risks of Caustic Ingestion:

The amount of the toxic material ingested is often small but the degree of injury can still be great.


  • Severe swelling of the mouth, throat or esophagus.
  • Upper airway injury or respiratory distress.
  • Necrosis of the mouth, throat, esophagus or stomach.
  • The long term complications of caustic ingestion include loss of esophageal motility, esophageal stricture or stenosis.
  • Gastric injury is less common in children since they usually do not ingest an amount large enough to reach the stomach.


Visual Effects:



  1. Severe lip and edema ulceration.Caustic Ingestion 14


2.  Severe tongue burn and swelling.

Caustic Ingestion 16


3.   Severe uvula and edema swelling.

Caustic Ingestion 123

  kerr county fcu

Preparing for a Procedure

Preparing for a Procedure

So your patient is going to have an endoscopy and/or colonoscopy… How do you prepare a child for that?

To start, it is helpful to let them know why they are having the procedure done.   Most often, these procedures are done to collect more information and run tests to determine the cause of a child’s illness/discomfort.  Letting the child know that we will get answers from these tests is important.  The scope allows the doctor to take pictures of their digestive system and also collect tissue samples to be analyzed in a lab.  With these answers the doctor can create a treatment plan to address the problem so they will feel better.

The next question to answer is “how?”  Simplifying the truth about what happens during a scope is important for the child to know.  The clean out procedure can be lengthy and unpleasant.  Keeping a sense of humor and allowing potty humor during this process can help things “move along” – so to speak.  Some children become anxious about the preparation for a colonoscopy, so normalizing the process can help.  “They are just getting all the poop out so the doctor can get good pictures.”  Special distractions like movies or video games can create a distraction from the process as well.

Once at the hospital, our staff provides wonderful care and explanations to children so they know what to expect.  Letting them know that they will be asleep and not feel anything is helpful to calm fears.  It is also helpful for them to have an idea of how small the camera on the scope is.  I had one youngster who though the pictures would be taken with a camera like the one his father uses.  That caused much concern until he realized a camera can be very small.  Often the doctor will allow the child to see the pictures from their scopes if they ask.

Some simple and brief explanations before these procedures can help a child get through these important tests.  If you have concerns about how your patients are managing their anxiety prior to medical testing feel free to call our offices.  We are happy to help!

Appetite Changes

Appetite Changes in Children

A child’s appetite naturally fluctuates over the course of their development.  Growth spurts, changes in tastes, periodic illness and increases/decreases in activity level can all play a role in this.  Often we are able to account for these changes and do not worry about it.  There are times, however when we should be concerned about changes in a child’s appetite.

Sustained appetite loss or increased appetite (for 2 or more weeks) accompanied by mood and behavior changes could be a signal that a child is struggling.  When a child is depressed, appetite disruption is one of several warning signs of which we should be aware.  A child’s appetite may change in that they are either eating much more than usual or less than usual.  Sleep is another function that becomes affected when a child is depressed.  A child’s sleep can either increase significantly or decrease.  Trouble falling asleep or staying asleep are cosistent with childhood depression.  It is also not uncommon for a depressed child or teen to start taking naps when historically they have not.

Other indicators of depression include:

  •             Persistent sadness or hopelessness
  •             Withdrawal from friends or activities they used to enjoy
  •             Increased irritability
  •             Poor concentration
  •             Feelings of worthlessness or excessive guilt
  •             Indecision, lack of concentration or forgetfulness
  •             Increased physical complaints i.e., stomach-aches, headaches
  •             Poor motivation
  •             Low energy
  •             Experimentation with alcohol or drugs
  •             Recurring thoughts of death or suicide

One or two of these symptoms does not mean that a child is depressed.  However, if you notice several of these signs at the same time, it may be a good idea to explore changes or stressors which may be causing this.  A referral for a psychological evaluation is always helpful to assist with treatment planning for these children. beimei huaren