Does your child have abdominal pain?

As a young child growing up just outside of New York City, I complained of stomachaches every Wednesday afternoon before going to ballet class. I vividly remember those days. Initially, my mother was very concerned because I had repeatedly begged to enroll in ballet school and was clearly very excited about the opportunity. Little did I realize what I was getting into! This particular Manhattan-based ballet school was bent on creating professional ballerinas. As a shy, cherubic, roly-poly newbie to the dance scene, I was not prepared for the intensity of the class. My mother quickly picked up on the pattern and realized that I was having a physical reaction to the stress from the rigorous dance class. Fast forward many, many years later, and here I am, a pediatric gastroenterologist, taking care of hundreds of children each year with chronic abdominal pain.

What is chronic abdominal pain?

Chronic abdominal pain is undoubtedly one of the most common complaints of children who come in to my office. In order to be termed “chronic,” the symptoms must be present for at least eight weeks. Fortunately, in the vast majority of cases, serious medical problems are not usually the cause, but rather secondary to “functional abdominal pain of childhood.” Functional abdominal pain of childhood is a very common condition in which there is no identifiable disease process. The terminology “functional” abdominal pain can be surprisingly misleading since many children have a hard time functioning with the pain. The pain is very real and at times severe enough to cause interference with normal routines including school attendance and participation in other activities. Some triggers that might elicit functional abdominal pain include: excitement, social anxiety, separation anxiety, stress, and dietary habits. It is important to realize that positive as well as negative events can trigger physical or emotional reactions.

But sometimes, the pain is caused by one of the many diseases and conditions that cause abdominal pain in children including: constipation, lactose intolerance, celiac disease (gluten intolerance), gastroesophageal reflux, and inflammatory conditions of the bowel including Crohn's disease and ulcerative colitis. Sometimes it can be very difficult to sort out whether a child has a serious medical condition or functional abdominal pain, and.the severity of the pain does not necessarily help in determining the cause of pain.

What symptoms should I look for?

By now you are probably asking yourself, “So how do I know if my child’s stomachache is from a serious medical condition?” Warning signs to watch for include: waking up at night with abdominal pain, vomiting, diarrhea, blood in stool, fever, poor growth, pain in the joints, delay in puberty, associated heartburn, and/or family history of gastrointestinal or liver disease. For school-aged children, it is important to explore potential triggers arising at school. Is there a bully picking on him/her? Are there social issues with other students or a teacher? Does your child avoid using the bathroom at school? Is your child shy and develops stress when a teacher calls on him/her? Is he/she having problems with difficulty in a certain class? Was there recent loss of a relative leading to separation anxiety every time a child is separated from their parents?

What you can do to help your child

Many times when I’m seeing a patient in consult, the child brings up a problem that they are having at school or home. Often, parents exclaim, “Wow! You never told me about that!” To help avoid surprises in the physician’s office, try to set aside time every day to speak with your child about the “happenings” of their day. This will open up the door for a conversation if there is something bothering him/her. If the stomachaches appear to be “functional abdominal pain,” reassurance is often very successful. Consider seeking counseling from a psychologist, guidance counselor at school, or religious group. Learning relaxation techniques can also be very effective in controlling your child’s symptoms. If this does not help, discuss the symptoms and circumstances surrounding the complaints with your child’s physician so that he/she can determine the need for further testing and/or medical treatment.