Gallstones in Children: Causes, Symptoms, and Age-Appropriate Treatments

What Are Gallstones?

Gallstones are hard, pebble-like pieces that form in your gallbladder, usually made of cholesterol or bilirubin. Gallstones can range in size from a grain of sand to a golf ball. Your gallbladder can make one large gallstone, hundreds of tiny stones, or both small and large stones.

When gallstones block your bile ducts, they can cause sudden pain. This pain is called a biliary colic. If they’re left untreated, it can cause serious complications.

However, most gallstones don’t cause blockages and are painless, also called “silent” gallstones. Silent gallstones usually don’t need medical treatment.

Types of Gallstones

Gallstones are generally of 2 types.

a) Cholesterol Gallstones 

They are composed primarily of hardened cholesterol, common in both adults and children. They are yellow-green in colour.

b) Pigment Gallstones 

They are made of bilirubin and are more common in children with certain medical conditions. They are dark in colour.

Causes of Gallstones in Children

An important diagnostic feature for gallstones in adults is—fat, fertile females in their forties. However, the causes for this are slightly different for children. 
Below are some of the causes commonly noticed from different medical research studies:

1. Genetic Predisposition

Genetics can be a causative or risk factor for gallstones. If you have a family history of gallstones, then there is an increased likelihood of its development in your child. Your child’s genetic profile can make them more prone to higher cholesterol levels, which leads to the formation of gallstones.

2. Medical Conditions

Certain medical conditions can increase your risk factor for gallstones. Some of these medical conditions are given below:

• Hemolytic disorders (e.g., sickle cell anaemia or hereditary spherocytosis) increase your bilirubin levels.
• Obesity and rapid weight loss can alter your bile composition.
• Cirrhosis
• Infections in the bile ducts
• Crohn’s disease
• High triglyceride levels
• Low HDL cholesterol
• Metabolic syndrome

3. Diet and Lifestyle

Diet is a very important factor in the prevention of gallstones. A diet high in fat and carbohydrates and low in fibre may contribute to gallstone formation.

4. Medications

Many potent drugs affect your liver activities, increasing gallstone formation. Drugs, such as ceftriaxone (a common antibiotic), can increase the risk of gallstone formation, especially in young children.

5. Hormonal Changes:

Hormonal changes can affect the metabolism of cholesterol levels in your child’s body. Adolescents generally experience extreme hormonal changes, which may cause an increased risk of gallstones.

6. Gallbladder Dysfunction:

Impaired gallbladder functioning can cause issues with its emptying, which can lead to stasis of bile and further stone formation.

Symptoms of Gallstones in Children

Gallstones usually do not cause any symptoms. But if a gallstone blocks one of the bile ducts, it can cause sudden, severe abdominal pain, known as biliary colic.

Other symptoms may develop if the blockage is more severe or develops in another part of your digestive system.

Abdominal Pain (Biliary Colic)

Gallstones can cause sudden, severe abdominal pain that can usually last for 1 to 5 hours, although it can sometimes last just a few minutes.

The pain can be felt:

• In the centre of the abdomen (tummy)
• Just under the ribs on the right-hand side – it may radiate from here to the side or shoulder blade

Common Symptoms

• Abdominal pain, especially in the upper right or middle abdomen.
• Nausea and vomiting.
• Loss of appetite.
• Jaundice (yellowing of the skin and eyes) if bile flow is obstructed.
• Dark urine or pale stools.
• Fever and chills (may indicate an infection like cholecystitis).

Silent Gallstones

In some cases, gallstones may not cause symptoms and are discovered incidentally during imaging tests. They are known as silent because they do not cause any symptoms.

Diagnosing Gallstones in Children

If your child is experiencing symptoms of gallstones, your healthcare provider will suggest certain blood and imaging tests. Blood tests can detect inflammation, infection or jaundice and give indications of which organs are affected. Imaging tests will help locate the source and location of the blockage in your child’s biliary tract.

Common Diagnostic Tools

Healthcare providers use special imaging tests to find and locate gallstones. Some of these are as follows:

a) Ultrasound

Ultrasound is the best and first-line imaging test to visualise any abnormalities in your internal organs. They can help confirm the presence of gallstones. Ultrasound uses sound waves to create an image or picture of your child’s internal organs.

b) Blood Tests

Blood tests can show signs of infection or inflammation of bile ducts, gallbladder, pancreas, or liver. It can also help identify any other underlying conditions that have not yet been diagnosed.

c) Advanced Imaging

CT scan, cholescintigraphy, endoscopic retrograde cholangiopancreatography (ERCP)or MRI can provide more detailed visualisation if any complication is suspected. This helps in accurate diagnosis and treatment. 

Age-Appropriate Treatments for Gallstones in Children

The treatments for gallstones in children need more care and observation due to their young age. Some of the treatments available are:

1. Watchful Waiting (Asymptomatic Gallstones)

If your child has silent gallstones that have been found incidentally and are not causing any symptoms, then regular monitoring is usually sufficient.

2. Medications

Medicines containing Ursodeoxycholic Acid (Ursodiol) decrease biliary cholesterol saturation by inhibiting cholesterol absorption in the intestine and cholesterol secretion into bile, as indicated by a decrease in the cholesterol fraction of biliary lipids. It helps dissolve cholesterol-based gallstones over time. However, it is effective only for small, non-calcified stones.

3. Pain Management

Pain relievers (e.g., acetaminophen) are suitable for mild abdominal pain. This helps to manage current episodes of pain along with the prevention of future episodes. Avoid NSAIDs if the gallbladder is inflamed, as it can cause serious complications.

4. Dietary Modifications

A healthy eating plan can lower your child’s risk of gallstones, and regular physical activity can help reach and maintain a healthy weight.

Some dietary recommendations to help prevent gallstones:
a) Add high-fibre foods, such as;

• Fruits, vegetables, beans, and peas.
• Whole grains, including brown rice, oats, and whole wheat bread.

b) Limit refined carbohydrates and sugar.

• Add healthy fats, like fish oil and olive oil
• Avoid desserts and fried foods.

5. Minimally Invasive Procedures

Some of the minimally invasive procedures for your child are as follows:

a) Endoscopic Retrograde Cholangiopancreatography (ERCP): 

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to find and treat problems in the bile and pancreatic ducts. It removes gallstones blocking the bile duct.

6. Surgery (Cholecystectomy):

It is recommended for recurrent or severe symptoms or complications like gallbladder infection.

a) Laparoscopic Cholecystectomy:

This is the most common cholecystectomy. Recovery can take about a week. It is minimally invasive and typically preferred for children.

b) Open Cholecystectomy:

When the gallbladder is severely inflamed, infected, or scarred from other operations, open cholecystectomy is essential. Your doctor may perform a cholecystectomy if problems occur during a laparoscopic cholecystectomy. Your child will probably be able to return to normal physical activity after about a month.

Complications of Untreated Gallstones in Children

Gallbladder stones are mostly unproblematic and do not cause any harm. However, if your child has severe symptoms, then the following complications can be the reason.

a) Cholecystitis:

Cholecystitis is a redness and swelling (inflammation) of the gallbladder. It happens when bile gets trapped in the gallbladder. This causes inflammation and can also cause infection. Cholecystitis can be sudden (acute) or long-term (chronic).

b) Pancreatitis 

Pancreatitis is the swelling (inflammation) of the pancreas. This may happen when digestive juices or enzymes attack the pancreas or due to blockage in ducts. Pancreatitis may be sudden (acute) or ongoing (chronic).

c) Choledocholithiasis

Choledocholithiasis is the presence of stones within the common bile duct. It’s the duct that carries bile away from the gallbladder. Gallstones in this narrow passageway can pose a risk of obstructing the flow of bile. Gallstones in the bile duct which can lead to jaundice and infection.

d) Gallbladder Perforation

Gallbladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. GBP is a problem for the surgeons. Most cases can only be diagnosed during surgery. If inflammation is left untreated, it can even be fatal.

7. Preventing Gallstones in Children

Gallbladder is not an inevitable disease, and some adjustments in your child’s lifestyle can help prevent it.

1. Healthy Diet

• A healthy diet is crucial to prevent gallstones. Encourage your child to eat a balanced meal rich in fruits, vegetables, whole grains, and lean proteins. If your child is a fussy eater, making sauces for kinds of pasta or soups with several vegetables can be an effective method to add nutrients to their diet.
• Limit foods high in fat and sugar like cereals, candies, pizzas, and burgers and try to replace them with homemade healthier alternatives if your child insists.

2. Regular Exercise:

Childhood obesity is a growing concern among many countries today. This can increase the chances of many lifestyle disorders and also gallstones. 

• Regular exercise promotes healthy weight and reduces the risk of gallstone formation.

3. Gradual Weight Management:

Excessive weight is a risk factor for gallstones, but rapid weight loss can be equally harmful. 

• Rapid weight loss can cause increased release of cholesterol from the liver into the bile. This increases the risk of gallstones.

4. Monitor Medications:

• Some medications, like certain antibiotics, can alter your liver functions, which can increase the risk of gallstones in your child. It is, therefore, important to discuss the potential side effects and health risks of long-term medications with a healthcare provider.

Wrapping Up

Gallstones in children are not very common. However, their incidence is increasing day by day. They can cause significant discomfort and complications if left without proper treatment. Early diagnosis is essential to confirm its presence. A combination of age-appropriate medical or surgical treatments can help to manage this condition efficiently. A healthy diet and regular exercise can help prevent and reduce the risk of gallstone formation. If your child experiences severe symptoms, consult a pediatric healthcare provider immediately for proper treatment. If you want to know more about the treatment of gallstones, you can refer to this blog by Nirva Health