| Abdominal pain is a very common complaint, especially in school age children. By some estimates, about 10-15% of children between the ages of 4 and 16 will complain of abdominal pain on a weekly or even daily basis.
Abdominal pain can be acute pain, meaning it happened all of a sudden, or it can be chronic or long term. Among the associated factors that can help determine the cause of abdominal pain include the presence of diarrhea, constipation, fever, and weight loss. The exact location of the pain can also be helpful, as well as how long the pain lasts, what makes it better (especially if you have been using over the counter medications) and what makes it worse.
Children with acute pain and associated symptoms can usually be easily diagnosed with illnesses such as appendicitis, gastroenteritis, or constipation.
It becomes more difficult and frustrating when children have chronic or recurrent abdominal pain and no other symptoms and a normal physical exam. These children are usually thought to have functional abdominal pain, which may be secondary to stress or having hypersensitive reactions to the normal actions of their intestines. Fortunately, about 30-50% of children with functional abdominal pain will get better with no intervention in 2-6 weeks after they are diagnosed.
It is important to keep in mind that although no organic or medical cause for the pain has been found for children with functional abdominal pain, that doesn't mean that is not real or that the child is making it up.
Some associated findings that make a diagnosis of functional abdominal pain likely include having pain that is localized around the belly button (periumbilical pain). Children with functional abdominal pain should not have fever, weight loss, vomiting, anorexia or poor appetite, pain with urination (dysuria), rectal bleeding, or pain that wakes your child up at night. And it is uncommon in children under the age of 4 years.
Similar conditions include irritable bowel syndrome, which causes crampy abdominal pain and bowel movements that alternate between normal, constipation and diarrhea, and functional or nonulcer dyspepsia, which can cause upper abdominal pain, excessive belching, nausea, hiccups, bloating and heartburn.
Other common causes of chronic abdominal pain include:
- constipation: cramping lower abdominal pain, usually in a child with a history of having infrequent bowel movements
- esophageal reflux: children with reflux may have a sour taste in their mouth and a burning substernal chest pain. The pain may be worse at night and after meals.
- food intolerance (lactose intolerance): usually chronic pain that follows eating or drinking certain foods and is accompanied by bloating, gas and diarrhea.
- ulcers: burning epigastric pain, usually worse before meals, at night and in the early morning. Children with ulcers usually also have vomiting and a family history of ulcers. They may also have blood in their stool. The pain may be relieved by antacids and by eating.
- chronic gastroenteritis: pain usually also accompanied by diarrhea and or vomiting and may be caused by a parasite.
- inflammatory bowel disease: Children with ulcerative colitis and Crohn disease diarrhea, usually with bleeding, cramping abdominal pain, obstruction (a blockage of the intestine), malabsorption (failure of the intestines to absorb minerals and nutrients), and weight loss or poor weight gain.
Although often not necessary for most children with chronic or recurrent abdominal pain, testing may include a urinalysis, complete blood count (CBC), erythrocyte sedimentation rate (ESR - a marker for inflammation), stool cultures (for parasites and bacteria), and/or a stool test for blood. Further testing, if required, may include a plain xray (KUB), upper GI, abdominal (and/or pelvic) ultrasound or CT scan, or endopcopy.
Treatments
Although no specific medical treatment is usually required for most children with functional abdominal pain, certain dietary modifications can sometimes be helpful.
These include:
Increasing fiber: Increase the amounts of fruits and vegetables that your child eats. Raw, unpeeled fruits and vegetables (especially beans, sweet potatoes, peas, turnip greens, raw tomatoes and corn) have the most fiber. Popcorn also has lots of fiber in it. Give enough grams of fiber to equal their age in years plus 5 each day (check the nutritional label for high fiber foods and snacks with at least 3-4g of fiber per serving). Vegetable soups are especially high in fiber and also add more fluid to your child's diet.
Increasing bran in your child's diet by offering bran cereals, bran muffins, shredded wheat, graham crackers, or whole wheat bread.
A lactose free diet can sometimes be helpful, epecially if lactose intolerance is suspected.
It can also be helpful to decrease or avoid foods that seem to trigger your child's abdominal pain, especialy caffeine and foods high in sorbital, such as certain fruit drinks, sugar free gum and fruit snack candy. It is also a good idea to make sure that he is getting adequate sleep, proper nutrition (eating three meals a day and two nutritious snacks), and regular exercise. Also make sure that your child is not overwhelmed by school and/or extracurricular activities.
When required, medications, including an H2 receptor antagonist (blocker), such as Zantac (Ranitidine), or a low dose of a tricyclic antidepressant can be used.
Pain Behavior Management
For children with daily abdominal pain that is not thought to have a treatable organic cause, it is important to help your child learn to deal with the pain to minimize the disruption it can cause to his life. It is important to keep in mind that even with proper treatment, your child will probably continue to have some pain. You can help by:
- insisting on school attendance. If pain occurs in school, make arrangements so that he can lie down for a short period of time, take any necessary medications, and then return to class when the pain improves.
- restricting activities to schoolwork (no TV or videogames) or bed if he can't go to school
- minimizing the attention that is paid to the abdominal pain behavior. Too much attention can help to reinforce the pain.
- rewarding him when he does his normal activities even though he has pain
- help your child to relax and minimize stress in his life
Important Reminders:
- Be patient. This is a chronic and frustrating problem, but one which most children outgrow.
- Avoid using over the counter medicines on a daily basis, unless instructed to do so by your physician.
- See your Pediatrician if your child's pain is worsening, if he has chronic diarrhea, constipation or vomiting, if the pain regularly wakes him from sleep, if there is blood or mucus in her bowel movements, or if your child is involuntarily losing weight.
- A referal to a Pediatric Gastroenterologist for difficult cases can sometimes be helpful.
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