Abdominal Pain in Children
Dr. Peter Nieman

Most pediatricians enjoy looking after children. In order to be a good pediatrician, one has to have the same qualities necessary of a good parent, and patience tops the list. When it comes to looking after a child with chronic abdominal pain, a big dose of patience may be required.

Just how common is chronic abdominal pain in children? It is common enough that an average-sized pediatric practice sees at least one child who suffers from it every few days. These patients tend to be females in their preteen years; they are oftentimes driven perfectionists and have sensitive personalities. The problem may get so bad that the child misses school, drops out of extracurricular activities, sees more than one specialist, tries alternative remedies out of sheer frustration and becomes worse instead of better. The stress this condition places on the family, the school, marital harmony and the child is somewhat like shelves buckling under the heavy weight of too many books.

The diagnosis of a child with recurrent abdominal pain, sometimes described as functional abdominal pain, may only be made after a thorough exam and assessment. A parent may be asked to help by paying close attention to the child’s symptom pattern — possibly keeping a diary of symptoms and behaviors. Experts from the academic world tell us that this type of abdominal pain can be followed over time in a regular, calm, reassuring fashion. However, the diagnosis of recurrent abdominal pain does not typically include these symptoms:

  • Loss of weight
  • Vomiting on a consistent basis
  • Regular nightime symptoms severe enough to wake the child up
  • Blood in the stool

This childhood condition is fascinating, because it illustrates how the body and mind can interact. For example, why does our gastrointestinal tract often take center stage when we are under stress? Why not the big toe? Why not the earlobe? We do not know conclusively why functional abdominal pain occurs. My academic colleagues are still looking for the "smoking gun" and probably will continue to add to an already impressive list of possible reasons and theories. Certain conditions seem to potentially worsen this troublesome abdominal pain, however: constipation, a low fiber diet, a teacher who is harsh, divorce in the family, a demanding athletic coach or music teacher, bullying, or a perfectionist attitude in either the patient or her parents.

Where can parents find help when this painful challenge starts to toss the family against the rocks? It helps to have a caring and supportive physician, but that in itself is rarely enough. Education may be your most important resource. Further reading is recommended and a number of good books are available. And, you may want to consider going to a pain specialist and/or a psychologist.

With the recent media attention given to appendicitis and how a missed diagnosis may often lead to complications, it comes as no surprise that a diligent parent would be worried about a misdiagnosed appendicitis. Just remember that the pain associated with appendicitis rarely comes and goes. Instead, it tends to get progressively worse and it is usually associated with other symptoms such as vomiting, fever, loss of appetite or pain over the area where the appendix is located (half-way between the belly button and the right hip bone).

In medicine, we are taught to never say never. Yet, I personally have never seen a child with chronic abdominal pain whose symptoms cannot be followed closely, and with reassurance — as long as there is no vomiting, nighttime symptoms, blood in the stool or weight loss. If these other symptoms are present, then these children need further testing and examinations, but if they are not, the child can usually be managed in a firm, but supportive and caring way. The children should not be allowed to use their symptoms, unfortunate as they may be, to manipulate those around them.

Finally, my advice to parents is that they should always try to do their best and be patient. A doctor may never be able to do what time often offers a child with recurrent abdominal pain: healing.

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