As Seen In Reaching Out: When to Visit a Doctor, Urgent Care, or Emergency Department when Faced with GI Issues 

Raul (Rudy) Sanchez, M.D., Nationwide Children’s Hospital – Columbus, OH  

Patients with CdLS can have various gastrointestinal (GI) symptoms. Many symptoms include feeding troubles, vomiting or reflux, belly pain, and constipation. Hopefully, we can determine when to contact your primary physician versus when to consider a visit to the Urgent Care/Emergency Room.   

A primary care physician (PCP) or pediatrician is often consulted for long-term care issues, such as feeding difficulties, especially in infancy. Some pediatrician offices have lactation consultants on staff to help with feeding issues in infants with all medical problems. Discussing concerns about weight loss or poor weight gain with the PCP is an excellent start, as the PCP can monitor growth parameters over time. Another issue to discuss with your doctor is constipation or difficulty passing regular bowel movements. The PCP can follow and initiate treatment for simple or common constipation issues. The PCP can also evaluate whether a referral to a Gastroenterologist (GI) is needed for more specialized evaluation and treatment. If you have an established GI doctor, you can also relay these questions to them, and they can assist with the assessment and management of many of these issues.   

Visiting an urgent care facility (UC) or an emergency department (ED) indicates that more concerning issues are occurring with your loved one. Vomiting to the point of not being able to tolerate liquid intake raises the concern for dehydration and warrants visiting one of these more urgent settings. Signs of dehydration include significant fatigue or tiredness, sunken eyes, higher heart rates, and decreased urine output. In such scenarios, it is essential to have a physician assess whether the patient requires intravenous fluids. Additionally, if the recurrent vomiting has a brighter green color, a red color-like blood, or a “coffee ground” brown appearance, it may indicate a more serious underlying issue. This will require imaging, such as an X-ray, to start. This is another crucial scenario to present to the UC or ED.  

In the clinical setting, constipation can be managed in the long term; however, it can lead to more urgent issues. If your loved one has not had a bowel movement in 3-4 days or longer AND has other symptoms such as vomiting, visible abdominal distention, or significant abdominal pain, this should be evaluated immediately. Visiting a facility with imaging capabilities, such as those offering X-rays, would be ideal.  

These examples cannot encompass every possible scenario or issue. They help highlight what to be looking for. One rule I believe is excellent to follow: if you have significant concern or your intuition tells you something is not quite right with your loved one, do not hesitate to call your doctor or visit a UC/ED for evaluation.