Chronic recurrent abdominal pain is a common problem in pediatrics. Even though it is a harmless condition, it can be an overwhelming source of parental stress and anxiety. It is one of the most common reasons for visits to a general pediatric practice.
The official American Academy of Pediatrics definition of chronic recurrent abdominal pain requires the recurrent pain to have lasted for more than three months and to occur at least once a month. The pain is usually vague, but it can be quite intense, and it is not generally associated with eating.
The Many Faces of Pain
Your child may experience abdominal pain for many reasons. Some children have sensitive stomachs and are more prone to experience intestinal discomfort. Numerous triggers have been found to induce abdominal pain, including stresses at school, a diet high in fat and oil, and even migraines. The first step in solving your child’s abdominal pain problem is a visit to your pediatrician.
The doctor will obtain a detailed history about your child’s diet, bowel-movement patterns, any potential stresses in your child’s life, changes in routines, and presence of intestinal disorders in other family members.
Abdominal pain that is caused by something benign should never wake a child up from sleep or cause any unintentional weight loss. Other warning signs that may indicate the presence of a serious medical condition include the following:
- Blood in the stool
- Chronic diarrhea
- Persistent vomiting
If your child experiences abdominal pain along with any of these symptoms, you should seek medical attention immediately. In addition, if there are other members of your family who have serious gastrointestinal disorders, this should also prompt you to have your child checked sooner rather than later.
The Brain in the Belly
A growing body of scientific evidence points to a “functional” trigger as the cause of chronic abdominal pain in children. When your child suffers from abdominal pain, in other words, there isn’t really anything “wrong,” per se. Instead, it may be that your child’s body is misinterpreting normal cues from the gut and signaling them as harmful or painful.
Just as the complex nervous system inside the brain can sometimes cause harmless headaches, the network of intestinal nerves can sometimes trigger pain in the belly. Even though some headaches can be the harbinger of something serious, most headaches are benign. This is also true for abdominal pains.
Unbeknownst to most people, the intestine is covered by a network of nerves so intricate and highly sophisticated that it rivals the complexity of the neuronal system inside the brain. This intestinal nervous system can automate the digestive movement of the intestine independently of any controls from the brain. Not surprisingly, such a complicated system can sometimes misfire and interpret innocuous signals as harmful. This is what most scientists believe happens when a child experiences a functional pain from the intestine.
When food traverses the length of the intestinal tract, the pressure inside the intestine changes as a clump of food is squeezed from one segment to the next. Normally, most people do not sense this pressure change. For children with functional abdominal pain, however, the oversensitive nervous system in the intestines inappropriately registers this pressure change as pain. Even though nothing is really wrong with the digestive process, their body senses discomfort.
More Tests, Please
The responsibility of the parents and pediatricians is to differentiate the vast majority of children with functional abdominal pain from the minority with serious digestive illnesses. For the most part, the doctor can rule out most dangerous conditions simply by taking a comprehensive history from the child and the parents. The description and timing of the pain with other associated symptoms can exclude most serious medical conditions.
If the history alone is insufficient to exclude a dangerous cause for the abdominal pain, the doctor will order additional blood tests and a stool analysis. X rays are not a very useful means of diagnosing chronic abdominal pain, and they are seldom used in the workup.
Coping with Chronic Recurrent Abdominal Pain
After your pediatrician has reassured you that everything looks fine and the pain originates from an overly sensitive gut, what can you do to alleviate the pain? The pain is definitely real; it’s not just in your child’s head.
It is important to maintain your child’s routine despite the pain. Some children may try to take advantage of the situation and use the pain as an excuse to skip school or chores. As a parent, you cannot allow your child to benefit from this situation, or you might unknowingly prolong the situation.
Most experts generally recommend a diet high in fiber as a means of reducing the intensity and frequency of stomach pain. Lowering the amount of fat and oil your child eats can also help alleviate the pain. That’s because oily substances in the gut slow down intestinal movement, which can worsen a functional pain.
Most functional abdominal pain can be managed with dietary modification alone. Medication use is discouraged; if it is prescribed, the managing physician must use it judiciously. Using medication may reinforce the idea that there is something wrong with the intestine, which is not the case for the vast majority of children with chronic abdominal pain.