Meet our board certified pediatric gastroenterologist: Dr Anthony Porto
I am a board-certified pediatric gastroenterologist with an interest in celiac disease and infant nutrition. I always knew I wanted to be a pediatrician. When I was in the 2nd grade, I interviewed my pediatrician for a school project.
I became a pediatric GI because I wanted to be able to educate parents on how nutrition can affect children’s health. I was overweight as a child so I wanted to use what I learned to teach future generations.- What I like best about being a doctor is the relationships I have built with each child and parents. I love getting to know the whole family because this information is key to treating the child’s symptoms. As I have been a doctor for nearly two decades, when one of my patients starts college, I feel lucky enough to have been a part of the their life and proud of what each one has accomplished.
I love working with Bobbie because the company has been innovative in providing a safe and legal alternative for families who want to use infant formula imported from Europe.Dr Porto
I live in CT with my husband, two young children and our dog, Rosie. I exercise almost everyday. I enjoy bike riding and yoga. I have run 2 marathons and over a dozen half marathons. I ran up the steps/climbed the Empire State Building (as one of my vertical runs!). I also love building Legos and my home office is full of them (as anyone who has done a Zoom call with me would know)!
I am the co-author of The Pediatrician’s Guide to Feeding Babies and Toddlers and I contribute articles to numerous national medical societies, on-line health blogs and news outlets.
We polled our IG audience, and these are the five most asked questions for our pediatric gastroenterologist, Dr Porto:
1- What is the difference between cow’s milk protein allergy and lactose intolerance?
This is a great question as cow’s milk protein allergy (CMPA) and lactose intolerance can often be confused. Children who have a milk allergy have an intolerance to the milk protein while lactose intolerance is due to an inability to digest the milk sugar. Babies typically present CMPA with visible blood in their stool (sometimes flecks or streaks), and the stool is often loose and mucousy. This type of milk intolerance is usually resolved by 1 year of life.
Individuals with lactose intolerance have decreased levels of lactase, the enzyme needed to digest lactose. It can present with diarrhea or abdominal distention. Most infants can tolerate lactose but may have a temporary intolerance after a stomach bug. Lactose intolerance becomes more common during childhood as lactase levels may decrease.
2- Are probiotics necessary for infants?
Probiotics are thought to increase beneficial bacteria in the gastrointestinal tract. Current evidence shows some benefit to using probiotics to lessen the severity of diarrhea during a stomach bug, prevent diarrhea associated with antibiotic use and help with eczema. There is also some evidence that it can help decrease the symptoms of infantile colic. Probiotics are felt to be generally safe, but there is no evidence for widespread supplement use in all children.
3- How can you tell if there is blood in your baby’s poop?
Stools may take on many colors in infancy – yellow, brown or green are normal colors. The color and consistency of stool will vary in the first few months of life. Colors that may warrant a discussion with your physician are red and black tar-like stool. A red color may indicate blood from an allergy, blood from rectal fissures caused by constipation or blood from other causes while black tar-like stool may suggest digested blood. In some instances, a doctor can order a stool test, to assess for microscopic and small amount of blood, as the color of the stool may appear normal.
4- How do I know if my baby has acid reflux? And what is the difference between GER and GERD?
Gastroesophageal reflux (GER) is the movement of stomach contents into the esophagus, and possibly out through the mouth and nose. Gastroesophageal reflux is often referred to as spitting up. Though it may be messy and lead to a pile of laundry, it is often a normal process that occurs in many babies.
When reflux in babies is associated with symptoms or complications, or if it persists beyond infancy, it is considered a disease and is known as gastroesophageal reflux disease (GERD). Both GER and GERD can present with spit-up, recurrent vomiting and such as prolonged or interrupted feeds. Symptoms more likely to be seen in GERD include more moderate to severe feeding concerns, weight loss or poor weight gain and occasionally respiratory symptoms including wheezing and cough.
5- What is infant constipation and how do I know if my baby is constipated?
Constipation in babies is a common reason for a visit to both the pediatrician and pediatric gastroenterologist. It is defined as a delay in or difficulty passing stool that lasts for two or more weeks. When discussing stool patterns, it is important to think about frequency, consistency and ease of passage. Frequency varies based on the individual and age.
Infants may not stool for many days— up to 10 to 14 days can be normal— especially related to stool of breastfeeding infants!
Consistency can be on a spectrum of watery, soft, formed and hard. When a stool is soft (about the consistency of peanut butter), it is not painful for your child to pass, and your child is still acting normally and eating well, it is likely not constipation. Ease of passage or straining is difficult to assess in infants since they will usually make a “poopy” face while stooling.
Anthony Porto, MD, MPH, FAAP, is a board certified Pediatric Gastroenterologist, AAP Spokesperson, co-author of The Pediatricians Guide to Feeding Babies and Toddlers and Bobbie Medical Advisor.