Healthy infant stools range from yellow to green to brown and all are normal. Breastfed babies typically have mustard-yellow, seedy stools while formula-fed babies tend toward firmer, tan-to-brown stools. Babies on amino acid formulas like Neocate may have very dark green, almost black stools — this is expected. The colours that warrant urgent attention are: bright red (fresh blood), black and tarry (possible upper GI bleeding), and pale chalky white (possible biliary obstruction — needs same-day assessment). Green stools alone are rarely concerning.
Yes, this is very common and is called infant dyschezia. Babies are learning to coordinate relaxing their pelvic floor while pushing with their abdomen, and this learning process can look and sound quite uncomfortable. As long as the stools are soft when they come out, this is not constipation and does not need treatment. It typically resolves by 3-4 months. Stimulating the anus with thermometers or suppositories is not recommended as it can interfere with the natural learning process.
Normal stool frequency varies enormously. Newborns may pass stool after every feed (up to 8-10 times/day). By 2-3 months, breastfed babies may go from several times daily to once every 7-10 days — both can be normal if the stool is soft and baby is comfortable and growing well. Formula-fed babies typically go at least once daily. The key indicator is consistency (soft) rather than frequency. If stools are hard, pellet-like, or painful to pass, that is constipation regardless of frequency.
Yes — around two-thirds of healthy babies regularly bring up milk (posseting/physiological reflux). It peaks around 4 months and typically resolves by 12-18 months as the lower oesophageal sphincter matures. As long as your baby is gaining weight, feeding happily, and not in distress, this is a laundry problem rather than a medical one. We become more concerned when there is poor weight gain, persistent irritability during feeds, feeding refusal, back arching, or respiratory symptoms.
This is one of the most common concerns parents raise. Osmotic laxatives like Movicol (PEG 3350) and Osmolax are safe for long-term use in children. They draw water into the bowel to soften stool and are not absorbed into the body. A 2021 JPGN study found children taking PEG for an average of 8.7 months had completely normal electrolyte, liver, and kidney function. There is no evidence of dependency. Stopping too early is the main reason constipation recurs — we recommend at least 3-6 months maintenance. Think of it like a cast for a broken bone.
No — soiling (encopresis) is almost always overflow incontinence caused by chronic constipation, not a behavioural problem. When the bowel is very full of hard stool, softer stool higher up leaks around the blockage without the child knowing. The bowel becomes so stretched that the child loses the normal urge to go. This is genuinely not something they can control, and punishment or shame will make things worse. With proper treatment — disimpaction, maintenance laxatives, and a toileting programme — soiling almost always resolves.
Toilet avoidance is extremely common in constipated children who have experienced painful bowel motions. Make toilet time positive and pressure-free: footstool (feet flat, knees above hips), child seat insert, 3-5 minutes maximum. Praise sitting (not producing stool), consider sticker charts. Time sits after meals to use the gastrocolic reflex. Some children benefit from continence physiotherapy for proper posture and relaxation techniques. It can take weeks to months of gentle consistency — but it works.
Current ASCIA guidelines recommend introducing common allergenic foods — peanut, egg, cow’s milk, wheat, soy, tree nuts, fish, sesame — around 6 months (not before 4 months), alongside breastfeeding where possible. Strong evidence shows early introduction before 12 months may reduce allergy risk, particularly for peanut and egg. Introduce one new allergenic food every few days. If your child has severe eczema or an existing food allergy, discuss the approach with your doctor first as supervised introduction may be more appropriate.
Not necessarily, though the two are related. Moderate-to-severe eczema is a risk factor for food allergy — around 30-40% of children with significant eczema will have one (most commonly egg or cow’s milk). However, many children with eczema do not have food allergies, and removing foods without proper assessment can cause nutritional deficiencies and may actually increase allergy risk. Discuss suspected allergies with your doctor rather than eliminating foods independently. Skin prick testing or specific IgE tests can guide assessment.
Unsettled behaviour in babies is very common and rarely caused by breast milk. Before considering formula changes, ensure good feeding technique, appropriate burping, and exclude other causes (overtiredness, overstimulation, normal developmental fussiness). If CMPA is genuinely suspected — persistent vomiting, blood in stool, severe eczema worsening with feeds, significant feeding refusal — a maternal dairy elimination trial for 2-4 weeks is the first step for breastfed babies, not switching to formula. We prefer to support continued breastfeeding where possible.
Faecal calprotectin is a simple stool test measuring a protein released by white blood cells in the gut. It is an excellent screening tool for intestinal inflammation — particularly IBD. A normal result makes IBD very unlikely and can often avoid the need for colonoscopy. An elevated result doesn’t automatically mean IBD (infections and other conditions can raise it), but it tells us inflammation needs investigation. The test is non-invasive, easy to collect at home, and one of the most useful screening tools in paediatric GI.
It is completely understandable to feel anxious. Paediatric endoscopy is one of the safest procedures in children’s medicine, with a complication rate of around 1-2%. General anaesthesia is preferred over sedation for children because it is actually safer (lower complication rate than IV sedation), more comfortable, and allows thorough examination with biopsies. A gastroscopy takes 15-30 minutes, colonoscopy 30-60 minutes. Your child is looked after by a specialist paediatric anaesthetist throughout. Most children eat and drink within hours and go home the same day.
You arrive at hospital and your child is checked in by nursing. They meet the anaesthetist and gastroenterologist. Your child goes to sleep using gas or IV medication. Once asleep, a thin flexible camera (about the width of a little finger) is passed through the mouth (gastroscopy) or bottom (colonoscopy). We examine the gut lining and take tiny painless tissue samples (biopsies). The camera is removed and your child wakes in recovery. Most feel a bit groggy with mild sore throat (gastroscopy) or bloating (colonoscopy) for a few hours. You usually go home 2-3 hours later. Biopsy results take 1-2 weeks.
A hydrogen breath test checks whether your child absorbs certain sugars properly — most commonly lactose or fructose. Your child drinks a measured sugar solution, then breathes into a collection device every 15-30 minutes over 2-3 hours. If the sugar isn’t absorbed, gut bacteria ferment it and produce hydrogen detected in the breath. It’s painless but requires fasting and sitting still, which can be tough for younger children. Not all children with suspected intolerance need one — sometimes a dietary elimination trial is more practical. Dosing must be adjusted for children to avoid false positives.
Fussy eating is incredibly common and in most cases, children grow normally despite a limited food range. We become concerned when it’s accompanied by weight loss/poor gain, when accepted foods number fewer than 15-20, when there is gagging/vomiting with new textures, or when feeding causes significant distress. If your child is tracking their growth centiles and eating from a reasonable range of food groups, patience is usually the best approach. Mealtime pressure typically makes fussy eating worse. A paediatric dietitian assessment can help if you’re worried about adequacy.
A single lower-than-expected weight isn’t always significant — illness, measurement error, or a height growth spurt can cause temporary dips. We look at trends over time. Weight faltering is defined as a sustained drop across two or more centile lines. If this happens, we investigate: inadequate intake, malabsorption (coeliac disease, food allergy), chronic infection, or other illness. Growth is one of the most important indicators of a child’s overall health, which is why we measure it and monitor it over time.
Food Protein-Induced Enterocolitis Syndrome (FPIES) is an uncommon non-IgE food allergy mostly affecting infants. Unlike typical allergic reactions (hives, swelling, anaphylaxis within minutes), FPIES causes profuse repetitive vomiting 2-4 hours after eating the trigger food. Babies can become pale, floppy, and lethargic — it’s frequently misdiagnosed as gastro or sepsis. Common triggers are cow’s milk and soy (~50%), but rice, oats, and grains can also cause it. Skin prick and blood allergy tests are typically negative. Most children outgrow FPIES by 18-24 months.
Gastroparesis means the stomach empties more slowly than normal without physical blockage. Symptoms include early fullness, nausea, vomiting of undigested food hours after eating, bloating, and pain. In children it often follows a viral illness and can be temporary (post-viral gastroparesis). Diagnosis can be confirmed with a gastric emptying study but this is not always necessary. Gastroparesis is often transient for most sufferers in paediatrics and gets better over time. Management includes smaller, more frequent, low-fat meals, prokinetic medications in some cases, and dietitian input to maintain adequate nutrition during recovery.
Mesenteric adenitis is inflammation of abdominal lymph nodes, usually from a viral infection. It’s one of the most common causes of acute abdominal pain in children and can closely mimic appendicitis — pain typically worse at night in the right lower abdomen with fever, mild diarrhoea, or recent upper respiratory symptoms. Diagnosed on ultrasound. It is self-limiting, resolving in 1-2 weeks without specific treatment. Management is supportive: rest, fluids, paracetamol. Not serious and no long-term problems, though it can be quite uncomfortable.
Yes — the gut and brain are closely connected (the gut-brain axis) and stress can cause real physical symptoms: abdominal pain, nausea, diarrhoea, appetite changes. This is the basis of functional GI disorders including functional abdominal pain, IBS, and functional nausea. The pain is genuinely real — not ‘made up.’ It’s driven by heightened gut sensitivity and altered gut-brain signalling, not structural damage. Management works best addressing both physical symptoms (diet, sometimes medication) and the psychological component (reassurance, CBT, gut-directed hypnotherapy).
Colonic polyps in children are quite common — the vast majority are juvenile polyps, which are benign (non-cancerous). They typically present with painless bright red rectal bleeding and are one of the more common causes of bleeding in well children aged 2-10. Found during colonoscopy and removed at the same time (polypectomy), which is curative. If a child has multiple polyps (>5) or family history of polyposis syndromes, further investigation and genetic testing may be needed. A single juvenile polyp is not a cause for ongoing concern.
Cyclical vomiting syndrome (CVS) involves recurrent, stereotypical episodes of intense nausea and vomiting lasting hours to days, separated by completely well intervals. Episodes often follow a predictable pattern, triggered by stress, excitement, infections, poor sleep, or certain foods. CVS is related to migraine — there’s often family history. Management includes identifying triggers, regular sleep and meals, and sometimes prophylactic medication. An abortive plan for when episodes start (early anti-nausea medication, dark quiet environment) can significantly reduce severity.
Yes — telehealth is available for many follow-ups and is particularly useful for regional/rural families. It works well for reviewing results, adjusting medications, discussing dietary progress, and monitoring established conditions. Some appointments need face-to-face: initial assessments, growth monitoring requiring accurate measurements, and situations where abdominal examination would change management. Your care coordinator can advise which appointments suit telehealth.
Contact PGV on 03 9345 6644 during business hours. Outside hours, contact your GP, present to your local ED, or call 000 if acutely unwell. Red-flag symptoms needing urgent attention: bilious (green) vomiting, significant rectal bleeding, severe worsening abdominal pain, dehydration signs (no wet nappies 6+ hours, dry mouth, lethargy), high fever with GI symptoms, or inability to keep any fluids down for more than 12-24 hours depending on age.
Vomiting is common and usually viral gastro that resolves in days. However: in newborns, projectile vomiting after every feed (weeks 2-8) may suggest pyloric stenosis — same-day assessment. At any age, bilious (green) vomiting is a surgical emergency until proven otherwise. Blood in vomit needs urgent review. Persistent vomiting causing dehydration (reduced wet nappies, dry mouth, lethargy) needs medical attention. Stereotypical episodes with well intervals suggest cyclical vomiting syndrome. Generally, a vomiting child who is alert, taking sips, and passing urine can be managed at home.
These overlap significantly and can be hard to distinguish. Colic: crying >3 hours/day, >3 days/week in an otherwise well baby, peaks at 6 weeks, resolves by 3-4 months — a developmental phase, not disease. Reflux (posseting): visible in up to two-thirds of infants, usually harmless if growing well. CMPA: consider if blood/mucus in stool, severe eczema, significant feeding refusal, or poor weight gain. Many unsettled babies have no identifiable medical cause — they’re going through a challenging stage. Focus on carrying, movement, white noise, and feeding optimisation before pursuing investigations.
Despite sounding similar, they’re completely different. IBD (Crohn’s disease, ulcerative colitis) involves actual inflammation and bowel wall damage, diagnosed with blood tests, calprotectin, and endoscopy, requiring immunosuppressive medications. IBS is a functional condition — the bowel is structurally normal but overly sensitive, causing pain, bloating, and altered bowel habits. IBS does not cause inflammation, weight loss, bleeding, or growth problems — all tests are normal. IBS is managed with diet, stress management, and symptom medication. Having IBS does not mean your child will develop IBD.
Two completely different conditions, commonly confused. Cow’s milk allergy (CMA) is an immune reaction to milk proteins — can be IgE-mediated (rapid hives, swelling, anaphylaxis) or non-IgE (delayed vomiting, diarrhoea, eczema, blood in stool). Requires complete avoidance of all cow’s milk protein. Lactose intolerance is a digestive problem — insufficient lactase enzyme to break down lactose (milk sugar). Causes bloating, wind, pain, diarrhoea, but isn’t dangerous and doesn’t involve the immune system. Most lactose-intolerant people tolerate small amounts of dairy, hard cheeses, and yoghurt. LI is rare in infants (except temporarily after gastro), more common in older children. Very different management.
MASLD (metabolic dysfunction-associated steatotic liver disease, previously NAFLD) is increasingly diagnosed in children, particularly those who are overweight. Excess fat accumulates in the liver, ranging from simple fatty liver (usually benign) to steatohepatitis with inflammation and potential scarring. Most children have no symptoms — often found incidentally on blood tests. Risk factors: obesity, insulin resistance, type 2 diabetes, family history. Main treatment is lifestyle modification — healthy eating, regular activity, gradual weight management. No approved medications for children yet. Early detection and lifestyle changes can reverse it in many cases.
Key things to discuss with school: unrestricted toilet access at all times (non-negotiable), understanding of urgent need to leave class, awareness that fatigue affects concentration, flexibility around missed days and medical appointments, exam accommodations during flares. A letter from your gastroenterologist explaining the condition and accommodations needed is very helpful — we’re happy to provide this. Decide together how much to share with classmates. For children on immunosuppressants, the school should know about infection risks and report circulating illnesses like chickenpox promptly.
Transition is planned well in advance, starting discussions around age 15-16. The goal is confidence and preparedness for independent management with a smooth handover. Key elements: gradually increasing your teen’s involvement in appointments and medication management, ensuring they understand their condition and when to seek help, identifying a suitable adult gastroenterologist (we can recommend colleagues), providing a comprehensive medical summary, and ideally overlapping appointment periods. For coeliac: independent gluten-free diet management, label reading, and follow-up attendance. For IBD: understanding medication regimens, monitoring, and adult urgent care access. It’s a process, not a single event.