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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 food allergy.

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 "underachievers."

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 person.

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:

  1. 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.

  2. 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!

  3. 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?"

  4. 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!

  5. 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 effectively.

  6. 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. .

  7. 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.

  8. 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.

  9. 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 child’s pediatrician. Please read our full disclaimer.

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