When tummy ache doesn’t go away… it is time to see a doctor, says Dr Amornphun Gaensan (Pediatric Gastroenterologist and Hepatologist)
Any pain that persists for more than two months is called chronic pain; it can be intermittent or persistent in nature. Such chronic abdominal pain in children is caused by both organic and functional disorders. While most children have functional disorders, there are a few cases of organic disorders. Since most cases of chronic stomach aches are functional, it means, they do not have any identifiable cause!
Organic disorders are problems that can be identified in the child’s body. They include gastrointestinal disorders and may be accompanied by nausea, vomiting, headache, fatigue or alarm symptoms. In such cases, the family health history shows a tendency towards gastrointestinal problems such as inflammatory bowel disease, pancreatitis, Helicobacter pylori, food allergies, lactose intolerance, or chronic GI infection. The following are some causes of chronic functional abdominal pain in children.
Functional Dyspepsia is stomach pain, nausea, vomitting, usually following a meal. It can present with either acute or chronic abdominal pain, and is caused by too much acidity and can be treated with anti-acid medication. Stress and consumption of extremely spicy or sour food, soft drinks and tea and coffee cause acidity. If the child complains of upper abdominal pain, she needs a lifestyle change to ensure good health.
Irritable bowel syndrome is of two kinds. In children, IBS-C which presents with constipation is seen more often than IBS-D, which presents with diarrhoea. The pain can be relieved with anti-spasmodic medicines, and increased water and fiber intake will help maintain better health and prevent constipation. Family history is important for diagnosis, after organic causes are excluded.
Functional abdominal pain is caused by hypersensitivity to pain or psychosocial factors including stress and anxiety. Starting school can lead to separation anxiety for your tot, and hence chronic abdominal pain. Spend time with your child and relieve her anxieties about school, and the stomach ache will slowly reduce. Loss of a loved one, problems with friends or at school have also been known to cause abdominal pain. In severe cases, the doctor will diagnose functional abdominal pain through a process of elimination, if there are absolutely no organic causes.
If you see these symptoms, take your child to your pediatrician, as the cause tends to be organic more than functional:
For diagnosis, a detailed history of the pain is most important, and includes characteristics of pain such as frequency, intensity, location, and association with food, events, times and other symptoms such as vomitting or diarrhoea. Family history of gastrointestinal disease is also important, as is the social and emotional history of the child. Parents can maintain a pain diary to better understand a child’s pain occurrence. Over a week or two, you have to record the following information: intensity and length of pain; time and location; if it interfered with any activity like school, sports, movie time, meals; if it was triggered by specific food, activities, words; and how it was relieved. The doctor will study the pain diary to treat the child better. The second step is a physical examination, followed by an investigation of blood, urine and stool samples. Ultrasonography, Xray or CT scan of the abdomen, colonoscope and gastroscope are also conducted in some cases.
Behavioral therapies are sometimes useful for children and adolescents when chronic abdominal pain affects their daily activities. Cognitive-behavioral therapy, hypnosis, biofeedback, and psychotherapy are some tools used to help children. A high-fiber diet and plenty of water are useful in maintaining normal bowel movements.
The Second Class Honors M.D., Faculty of Medicine, Chulalongkorn University, 2003.