Just to be clear: Yes, my child is under medical care. No, I am not asking for medical advice, merely for observations or (perhaps) insight from someone in the field.
Background: 6 months ago, my 6 year old child began throwing up in the mornings. We tried feeding her before bed, and as soon as she just woke up in the morning (on the theory that perhaps it was low blood sugar). It didn’t help. We took her to our PCP, who diagnosed reflux and began treating with Zantac 2X/day. The vomiting stopped.
But, if we miss 2 doses, she gets horrible stomach pain and throws up again. Further discussion with her Ped, when this continued after so many months (I mean, if we missed a dose or two, she’d throw up), led to the Ped sending us to the local Children’s Hospital to see a specialist.
We got there, and the first thing the nurse did was warn me that the GI doc would probably want to do a rectal exam. And I thought “Huh? A rectal exam on a 6 year old kid with reflux?”
So he came in. and I had the impression he had a diagnosis already decided before he ever looked at her. He decided she must be constipated. He said 90% of the kids who come into his office are constipated, and she must be, too. Every question he asked was a leading question: “Does your stomach ever hurt?” “Do you have to strain to go poop?” He told me Zantac has a mild laxative effect, so missing a dose would naturally make her …constipated. Then he said he wanted to do a rectal exam to confirm it. I refused. He said that was fine, but the treatment would be the same regardless: 4 months of a prescription laxative, Miralax (nasty possible side effects).
He dismissed all my thoughts and observations, including things like “if congenital hiatal hernia like her ID twin, why didn’t it show up until now?” and “test for H. Pylori?” and everything I said, like “she tells me several times a week that she has to swallow down stomach contents which have suddenly come up into her mouth”. Either they were irrelevent or they confirmed…constipation.
Look. I’m no doctor, but I’m reasonably sure that my Ped is smart enough to have a) diagnosed or at least suspected constipation and prescribed a laxative herself and b) done a rectal exam herself if she felt it necessary. There was hardly a need to send us to the hospital for this.
Also, unless there was an impaction in the sigmoid colon itself (which, being home with my child 24/7, I’m sure I would have heard about before now from my child), a digital rectal exam would not find it.
And there’s this warning from the nurse. If she saw fit to warn me, this doc must do this as a routine. Yet I consider this quite an invasive and potentially traumatic exam (and moreso since at the time, my child was nearly hysterical at the thought of having to have a blood draw). I would no more permit it to be done to a young child as a matter of routine than I would permit a vaginal exam.
Is it normal for a pediatric GI doc to expect to do such an exam as a matter of routine? My gut feeling at the time was that he gets some sort of jollies from it, or some kind of feeling of power…but he’s an employee of an elite children’s hospital, so that would seem out of character for the institution.
(For the record, we do also have an upper-GI study (barium swallow) scheduled, which should tell hopefully tell us a lot about the reflux. But we also have a follow-up appointment with this man, and I’d rather see ANYBODY else in his office than him, just now. And expect to change our followup appointment after consulting with the Ped on Monday. I’m extremely uneasy about giving a small child a lengthy course of laxatives, which can mess up her electrolytes and the natural flora in her gut, when I am by no means convinced she is or ever was constipated at all.)