STOMACH PAIN IN CHILDREN

ABDOMINAL PAIN IN KIDS


Pinpointing the cause of a child's stomachache can be tricky. The key isn't just focusing on where the pain is, but also looking at what other symptoms he's having (or not having).

If your child says he has a stomachache when it's time to head to school, some stress could be to blame. If he just had supper and dessert and he's complaining of a stomachache but has no other symptoms, it may be nothing more than having eaten too much. But if he's feverish and vomiting or has diarrhea in addition to tummy pain, you can be sure something more serious is going on.

In most cases, abdominal pain is not serious and it gets better without treatment. In addition, there are treatments available for pain that does not go away.

Signs and symptoms — Features that suggest an organic disorder depend upon which disorder is present, but may include one or more of the following:

• Pain that awakens the child
• Significant vomiting, constipation, diarrhea, bloating, or gas
• Blood in the stool
• Unintentional weight loss or slowed growth
• Changes in bowel or bladder function
• Pain or bleeding with urination
• Abdominal tenderness

What causes tummy trouble in children?

The conditions below are the most common causes of stomach pain in children, although many others are possible. If your child suddenly becomes ill, has pain in his stomach that doesn't seem to go away or is getting worse, and you're at all concerned, call his doctor. It's always better to err on the side of caution.

1. Gastroenteritis or "stomach flu"

Is your child vomiting or suffering from diarrhea in addition to abdominal pain? If so, he could have gastroenteritis, also known as stomach flu. It's the most common illness after upper respiratory infections.

Doctors use the term gastroenteritis to describe any inflammation of the stomach and intestines caused by a viral or bacterial infection. Viruses are the most common culprit, including rotavirus, adenovirus, calicivirus, and astrovirus.

Gastroenteritis can also be caused by a potentially more serious bacterial infection, such as Salmonella, Shigella, Staphylococcus, Campylobacter, or E. coli. Still other cases are caused by parasites such as giardia. Your child's symptoms may be mild or severe, and they may last for just a few hours or for days, depending upon the cause.

Because a virus is usually to blame for gastroenteritis, you can't treat it with antibiotics. But that doesn't mean you should sit back and wait for the ailment to run its course. If gastroenteritis is causing your child to vomit or have diarrhea and a fever and loss of appetite, it can quickly lead to dehydration, so it's important to make sure that your child is drinking plenty of fluids while he battles the illness.

Watch for signs of dehydration and give the doctor a call if you think your child may be becoming dehydrated. If he shows serious signs of dehydration, take him to the emergency room.

As soon as you can, you'll want to reintroduce your child's normal diet, avoiding only fatty foods.

2. Milk allergy or lactose intolerance

If your child has a milk allergy, his immune system is responding to the proteins found in milk. Milk allergies occur most often in babies and children. Symptoms include vomiting, diarrhea, stomach pain, and rashes. In severe cases of milk allergy, a child may experience a life-threatening reaction called anaphylactic shock.

Lactose intolerance happens when a person's body isn't producing the enzyme needed to digest lactose, the primary sugar in milk. Symptoms include diarrhea, nausea, abdominal cramps, bloating, and gas. Lactose intolerance is uncommon in young children and usually shows up later in childhood or during the teen years.

To pinpoint the cause, a doctor will recommend that you keep all dairy (including milk, cheese, ice cream, pudding, etc.) away from your child for a few days and then slowly reintroduce it. If your child's stomach troubles start up again, you've nailed the culprit.

For kids with a milk allergy, soy milk may be the answer, but it's not for everyone: Five to 10 percent of kids who are allergic to milk are also allergic to soy. In that case, you'll need to talk to your child's doctor or a nutritionist about how to make sure your child gets enough calcium from other foods.

If your child is lactose intolerant, the solution is easier. He can probably continue to have dairy as long as he takes a synthetic form of lactase, which you can find in an over-the-counter supplement. You can also buy lactose-free milk products.

3. Constipation and changes in diet

The most common stomach problem in young children — who are continuing to add more and more foods to their diet — is constipation. Constipation is defined as not having a bowel movement for two to three days and then passing small hard stools.

If this is the case for your child, sit tight. After a few weeks, his digestive system will adjust to the changes in his diet and he'll start having regular bowel movements again.

You can help jumpstart the process by making sure your child is getting enough fluids throughout the day. And on the days when he seems particularly constipated, feed him foods that produce looser stools (like apricots, pears, prunes, and peas) and cut back on those that tend to cause firmer stools (like bananas, apples and applesauce, carrots, rice, and squash).

In addition, exercise can help get the bowels moving, so encourage your child to be active.

4. Upper respiratory illness

Believe it or not, the common cold and the flu can give a child a tummy ache. That's because much of the mucus produced during an upper respiratory illness drips down the throat. When your child swallows it, it can irritate his stomach.

Some children vomit to clear the mucus out of their system. It's not pretty, but it usually does the trick and the pain goes away.

Sometimes a more serious respiratory illness can give a child a stomachache as well. If your child has a sore throat, fever, and headache along with his tummy problems, he may have strep throat. Call your doctor immediately if you suspect that your child's stomachache may be related to a strep infection. This illness is caused by Streptococcus bacteria and needs antibiotic treatment.

5. Appendicitis

The classic symptoms of appendicitis are abdominal pain (especially in the lower right quadrant of the abdomen), fever, and vomiting. If your child has taken acetaminophen/paracetamol  and it hasn't reduced his fever, his pain is worsening, and he can't keep anything down, including water, he may have appendicitis. Take him to his doctor or the emergency room.

6. Gas

You know as an adult how much having gas can hurt. It's painful for children as well. And it's a likely culprit behind persistent tummy pain that your doctor can't find a reason for.

You might try to note what your child has recently eaten when he has a bout of gas. One possibility is too much juice. Many juices — including apple juice and cherry juice — contain sorbitol, a nondigestible form of sugar.

It is recommended that children drink no more than 4 to 6 ounces (about 1/2 to 3/4 cup) of juice a day. Besides causing stomach upset, more than that can ruin his appetite for other nutrient-rich foods and cause tooth decay

ABDOMINAL PAIN DIAGNOSIS

To determine the cause(s) of abdominal pain, the child's doctor or nurse will ask questions about the child's medical history.. The doctor or nurse will also perform an exam. Blood tests are sometimes needed if there are signs of an organic disorder.

Pain diary — A pain diary is a way to keep track of a child's pain during his or her usual daily activities. Typically, you record over the course of one week. At the end of each day, you or the child records information about the day's pain, including:

• How bad the pain was (using a 1-5 or faces pain rating scale)
• When pain occurred
• If the pain prevented activities (school, sports, play)
• Where the pain was
• Possible triggers (food, activities, stressors, thoughts, feelings)
• How long the pain lasted
• If anything helped the pain go away

You can review pain diary with the doctor or nurse at the next office visit. Pain that occurs only during school hours or only at home suggests a functional disorder.

ABDOMINAL PAIN TREATMENT

If the initial evaluation suggests an organic disorder, the likely causes of pain will be investigated and a treatment plan will be developed.
However, chronic abdominal pain in children is most often caused by a functional disorder. There are a variety of treatments that can be helpful, but no single treatment is best. Thus, most experts recommend trying several treatments. This may require several visits with the doctor or nurse, especially if pain has been a problem for a long time.
It is important for parents to build a good relationship with the child's doctor. This will allow the doctor to continue his/her evaluation and try various treatments. A functional disorder does not mean that the child does not have pain or that it's "all in their head".
The first goal of treatment is to help the child return to normal activities. A second goal is to improve the child's pain. However, it may take some time to figure out what is causing the pain and find the best treatment. Thus, another important aspect of treatment is for the child's doctor or nurse to help you and your child cope with pain.
Although functional abdominal pain can be triggered or reinforced by a desire for attention, it is rare for a child to "fake" pain. Acknowledge that the child's pain is real and offer sympathy, support, and reassurance. But also take care to avoid reinforcing the pain by giving it undue attention.

Abdominal pain and stress — Stress can worsen pain, whether the source is functional or organic. Children with chronic pain can be depressed or anxious as a result of their pain and their efforts to get relief. Many children benefit from relaxation and behavioral therapies to address these aspects of their pain.

Positive attention — During periods of change or stress in families, it can be hard to spend enough time with your child. In some cases, the child will develop chronic or recurrent abdominal pain related to his or her need for attention. It may be helpful to schedule time every day that is devoted solely to the child. Scheduled time (positive attention) is preferable to time spent together when the child complains of pain (negative attention).

Relaxation techniques — Older children and adolescents with functional abdominal pain can learn brief muscle relaxation techniques such as deep breathing exercises. These techniques should be performed for 10 minutes at least twice every day, and can also be used during times of pain. A family member can act as "coach" if necessary (provided this attention does not provide positive reinforcement for the pain, as described above).

Behavioral therapies — Behavioral therapies may be recommended for children or adolescents with functional abdominal pain. Cognitive-behavioral therapy, hypnosis, biofeedback, and psychotherapy help to reduce a child's anxiety levels, help them to participate in normal activities, be involved in their treatment, and help the child better tolerate the pain.

A therapist or counselor can listen to the child and provide encouragement while preventing the child from withdrawing from important activities such as school. This type of treatment is most likely to be successful in children who have pain related to stress, but it is a good option for anyone with chronic pain.
Some children and families are resistant to the idea of behavioral therapies. However, seeing a therapist does not mean that the child's pain is not real or that it's "all in their head." A therapist can help the child and family to cope with the pain and support the child's transition back into normal activities (eg, school).

Dietary changes — Studies have not shown that making changes in the diet are helpful for children with chronic abdominal pain. However, the following changes might be helpful in selected children.

Lactose — Lactose is a type of sugar found in milk and milk products. Children who are lactose intolerant often have symptoms of cramping pain, bloating, or gas related to eating or drinking lactose-containing products.

A lactose-free diet can help to ease these symptoms; this is done by eliminating milk and milk products or by using lactase enzyme replacements. If abdominal pain does not get better after two weeks, the child can restart milk and milk product. There also are tests for lactose intolerance, which can be used if the diagnosis remains uncertain.

Fiber — Eating high-fiber diet might improve symptoms in children who have constipation. In children who are afraid of moving their bowels (stool withholding), a "clean out" treatment is often recommended before adding fiber to the diet.

Other changes — In some children, there are foods, drinks, and medicines that make symptoms worse. Common triggers include:

• High-fat foods
• Caffeine
• Foods that increase gas (beans, onions, celery, carrots, raisins, bananas, apricots, prunes, Brussels sprouts, cabbage, cauliflower, broccoli, asparagus, wheat germ).

Medicines that can cause upset stomach include non-prescription pain medicines, such as aspirin and ibuprofen.

Medicines — Medicines might be needed for some specific causes of abdominal pain. Talk to your child's doctor  before trying medicines.

WHEN TO SEEK HELP FOR ABDOMINAL PAIN

Parents of children with chronic or recurrent abdominal pain who also have the following signs or symptoms should call their doctor immediately:

• Bloody stools, severe diarrhea, or recurrent vomiting
• Abdominal pain that is severe and lasts more than one hour, or severe pain that comes and goes and lasts more than 24 hours
• Refusing to eat or drink anything for a prolonged period
• Fever greater than 102ºF (39ºC), or fever greater than 101ºF (38.4ºC) for more than three days. The table describes how to take a child's temperature.
• Pain when urinating, needing to urinate frequently or urgently
• Behavior changes, including lethargy or decreased responsiveness

Parents should inform the doctor if the following symptoms develop, or if they have general concerns about their child's abdominal pain:

• Chronic constipation (having less than two to three bowel movements per week)
• Loss of appetite, weight loss, or becoming full after small amounts of food