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|Quick reference medical handouts used
by Pediatric offices
Stomach Pain is Common
Recurrent abdominal pain in children is one of the
most common physical complaints heard by physicians who care for children. Is it the
stomach flu or too much pizza? A case of appendicitis or tomorrow’s spelling test?
These are some of the thoughts that run through parent’s minds when their child
complains of stomach pain day after day. Figuring out the cause of your child’s
repeated stomach discomfort can be difficult for both parents and doctors.
When children with recurrent abdominal pain are
thoroughly evaluated, however, only about one in twenty is found to have a physical
explanation for the symptoms. The remaining ninety-five percent have abdominal pain that
does not arise from a serious medial condition. Medical textbooks have labeled this
problem as "recurrent abdominal pain" and "benign stomachache of
childhood." Whatever the term, the pain is truly experienced by the youngster and
their child’s discomfort is a very frustrating experience for the parents.
Why these children have pain is not completely
understood, but psychological factors may play an important role. The muscles of the
stomach and intestines are richly supplied with nerves. A child’s feelings and state
of mind may initiate these nerves to contract, producing painful episodes of cramping. A
frustrated, worried, or simply unhappy child may manifest these inner feelings with a
complaint of stomach pain. intestinal muscles, producing pain.
Although a physical cause for recurrent abdominal
pain in children is rarely discovered, it is wise to have your child evaluated by their
physician to eliminate any possibility that they might have another medical condition
which causes belly pain. These might include a urinary tract infection, an ulcer, or a
A careful medical history is one of the most
important aspects in evaluating a child with recurrent abdominal pain. In addition to the
usual questions concerning a youngster’s health history, specific inquiries about the
character of the pain are important: How severe? Is it continuous or intermittent? What
makes the pain better? What makes it worse? Does it occur only at mealtimes or in relation
to eating? Does it occur only in school? Does the pain begin on the weekends? Does it
interfere with the child’s play? Is there accompanying fever, diarrhea, constipation
or other symptoms? Parents ability to characterize the nature of the complaint is often
the key to diagnosis.
Children with benign stomachache of childhood usually
have had the problem for a while (months to years). It usually begins in the preschool
years; five years being the peak age of onset. The pain is more common in girls. The
soreness is most commonly located around or just below the navel. The pain episodes, while
sometimes severe, usually last only minutes, but can occur for an hour or more. The child
seems otherwise healthy and there is usually no vomiting, diarrhea, weight loss, loss of
energy or fever. Rarely does the pain wake the child up at night, and for the most part
the child is able to continue with play and most of their activities. Some children
complain of pain every day, while others are bothered only once a week or every couple of
weeks.Sometimes the child may be described by parents or teachers as one who is somewhat
shy and continually afraid of failure. These children are often labeled as
Appendicitis is a condition that comes up in the
minds of many parents when facing their stomach-clutching child. Although the symptoms of
appendicitis vary greatly, a child with this problem usually first complains of vague
discomfort around the "bellybutton". The pain then moves down to the lower right
side, above the hip, and quickly becomes more intense.The child appears sick and
frequently there is accompanying vomiting and fever. Unlike benign stomachache of
childhood, there is a rapid worsening of the pain —it ordinarily requires about
twelve hours for the appendix to become fully inflamed—and the pain never goes away.
The discomfort can become so severe that it hurts the child to straighten up. In fact,
often the youngster assumes a bent over position and walks with the gait of an elderly
The child with recurrent abdominal pain should be
examined by their physician, and, if necessary, have some basic routine laboratory tests,
just to be sure. Both parents and doctors are faced with a major decision concerning what
tests should be done in a child suspected of having recurrent abdominal pain. After the
evaluation, your child’s doctor will be best able to determine which tests are most
appropriate and cost effective to help in the care of your child. Discuss these
possibilities with your child’s physician.
When the cause of the pain cannot be ascertained,
both child and parents need to understand that, although the youngster is physically
normal, the pain is a very real experience for your child. It is also helpful to realize
that most children with recurrent abdominal pain outgrow their complaints and go on to
lead normal, pain-free lives. Learning to accept the condition and being reassured by its
favorable prognosis is the first step in getting your child back into full activity
without pain. (Many times the pain completely disappears once the child knows that nothing
serious is wrong!). The following points are good practical advice for parents:
When your child has pain, use
"concerned neglect." It is important that your child know you care about their
discomfort, but do not go overboard. When the pain occurs, have the child lie down until
they are feeling better. Employ a heating pad or a hot water bottle so the child feels you
believe them. If the pain occurs during periods of responsibility (school, chores, etc),
have the child go back to their obligation in a non-punitive way once the pain subsides.
Try to encourage your child to think of
their stomachache as the body’s way of talking to them, telling them that they are
worried or anxious about something. Ask them to think about what that might be.
Unfortunately, many times the child themselves do not know what is bothering them, and
what might be a stressful situation for one child might be a non-anxiety producing event
for another child. For example, one child might suffer from a stomachache because they are
thrilled to be invited to spend the weekend with their grandparents, while others might
view the same weekend with fear and anxiety, producing the same abdominal pain!
Avoid becoming attentive to your children
only when they are sick. This will cause your child to exaggerate every complaint in an
attempt to get attention. Give them more attention when they are pain free. A lot of
recurrent abdominal pain perhaps would be avoided if more parents heeded the advice on the
bumper stickers, "Have you hugged your kid today?"
The child has to feel that their parents
believe them when they say their stomach hurts, and that they are not "faking"
the pain. This is sometimes hard to do when your child complains in agony of stomach pain
just as the school bus arrives and makes a miraculous recovery the moment the bus
disappears down the street. You might be tempted to punish your child, but don’t,
because the pain was real. It just disappeared when the stress that caused it disappeared!
Beware of over programming your child’s
day. Provide your child plenty of "free" time just to relax. Stomachaches can
sometimes be the "break" your child needs from too many activities and too much
pressure. It is not possible to eliminate all forms of stress in your child’s life
but it is useful to teach your child how to deal with life’s stresses more
Do not discuss this problem with friends or
relatives in the presence of your child. Parents sometimes thoughtlessly transfer their
medical fears to their child. Avoid anxiety producing discussions overheard by children
about someone’s death, accident, divorce, or other misfortunes. .
Occasionally, recurrent abdominal pain is
due to indigestion from eating too much or too fast, from being forced to eat when the
child is not hungry, allergies or intolerances to certain foods, particularly dairy
products. Observing your child’s diet may provide an answer.
Keep a monthly weight chart. A steady weight
gain is good, solid evidence of a healthy child. Monitor your child carefully. Your doctor
should be notified if there is a any change in pain pattern, severity, or frequency, or
the development of vomiting, diarrhea, loss of energy or appetite, or anything else your
intuition tells you to report.
It is important for children to feel
comfortable talking to their parents. This will help the child externalize their feelings
and remove the internalized tension from their stomach. Therefore, children need parents
who are good listeners. Did you know that a typical parent in the United States
communicates with their children an average of only 15 minutes a day, and 12 of those
minutes are spend discussing non-important things such as what’s for dinner. So
reserve a few uninterrupted minutes each day for a friendly talk with your child. Take the
phone off the hook so you won’t be distracted, or go for a nice walk around the
block. It just might be the most important time you spend as a parent. Parental support
and understanding are your child’s best medications for recurrent abdominal pain.
As a reminder, this information should not be relied on as
medical advice and is not intended to replace the advice of your childs pediatrician.
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