Stomachaches: Worried about the Wrong Organ? (Pedcast)

Topic Introduction

Pediatricians see a lot of children with stomachaches. It is estimated that about 10% of the childhood population have a stomachaches as often as 3X/3months, the definition of a syndrome pediatricians call recurrent abdominal pain. These children not only suffer great pain, but they miss a lot of school and other activities of childhood. Children with recurrent abdominal pain need to have some tests to make sure that they don’t have a serious disorder but fortunately, most of the time there is nothing seriously wrong with them. That is not to say that there is nothing wrong, just nothing seriously wrong with their intestines. The lack of a major disease of the gut is great news for these families but leaves everyone with a real dilemma, what is wrong with these children how do you help the child? That’s the topic that we are going to explore today so sit back and get ready for another edition of Portable Practical Pediatrics

Musical Introduction

What Happens When a Child Has Recurrent Abdominal Pain?

So what happens when a child starts to have frequent stomachaches. What should a parent do? First, I recommend that these children be brought to their pediatrician where their pediatrician will take a history and explore as many factors about the pain as they can. Next comes a physical exam where the pediatrician looks for signs of serious illness such as anemia, enlarged internal organs, weight loss, or jaundice. Finally comes some simple lab tests like a urinalysis, some blood tests, and maybe a stool culture and analysis. Fortunately, most of the time, we find nothing unusual on any of these tests.  The most revealing part of this evaluation turns out to be the history; things that we learn by asking and listening.  Things like how much school the child has missed, is there a bully at school, how are things going at home, is the child sleeping OK, is the child struggling academically, are there expectations on the child that they can’t meet etc, etc.  Assuming that the child does not have signs and symptoms of serious gut disease, then what? So, we have probably learned a lot about this child’s emotional makeup and found absolutely nothing on their physical exam and laboratory studies. Can we offer the child and their family no help or enlightenment as to what the child’s problem is?  No, we actually have a lot to offer them as far as diagnosis and treatment.  Let me explain further.

 

Which Organ is Causing the Child’s Problem?

It turns out that most of the time, a child who has recurrent abdominal pain doesn’t have a disorder of their intestines, or liver, or gallbladder, or spleen, or really any organ in their abdomen– no rather they have a disturbance of mood. Isn’t it ironic that their parents bring them to the doctor thinking that something is wrong with their stomach and it turns out that, in most cases, there is really something wrong with their brain–the child has a disturbance, an anxious response so to speak, in the way they react to daily stress or to their own gut sensations. In my experience, I find that the children with anxious temperaments are the ones that fall into the cycle of having recurrent abdominal pain. These children are wired from birth so to speak to have a very anxious response to things they find unpleasant and part of that anxious response is an alteration of their intestinal motility. Their brain says to their intestines when they are under stress, either stop moving and get ready to run or empty fast and get ready to run. Yes, they have an anxious temperament, that is the tendency to react to things in an emotional way, that causes them much distress–typically stomach distress. Maybe there is a new baby in the house that is making them nervous, lonely, or unloved, or maybe their diet is very rigid and unhealthy because they are scared to try new foods or textures, or maybe they are afraid of having pain with pooping and therefore have become very constipated, or maybe they are so anxious that they have developed extra stomach acid and therefore heartburn. Whatever the particulars are for that child, your pediatrician will most likely be able to figure that out and help lessen your child’s pain.  The pain and distress are real but the genesis of the recurrent nature of the pain is the child’s emotional makeup!

How Should Parents Help?

So, if you have a child with a lot of stomachaches I suggest you take them to your pediatrician and discuss this symptom with their healthcare provider. Make sure that your child’s doctor has enough time to get a thorough history, do a physical exam, and order appropriate lab tests if they think they are indicated.  Assuming that these things are all normal and your child’s pediatrician thinks that maybe some psychological intervention may be of help, keep an open mind about interventions such as cognitive behavioral therapy, counseling, self hypnosis, or maybe just reassurance by your child’s pediatrician that everything is OK. All these things can be of great benefit to your child. Let’s face it, what way to better lower a parent and child’s anxiety and worry than to have a caring, knowledgeable person that the family knows and trusts —like their pediatrician, tell them that everything is OK and that there is nothing seriously wrong.

Outro

Well, you now know what the definition of  recurrent abdominal pain is in a child and a little more about how the child’s temperament  plays into this diagnosis. Now your beginning to think like a pediatrician! Great. That free pediatric education you are getting is really paying off. If you enjoy Portable Practical Pediatrics, make sure to subscribe at my blog www.docsmo.com or on iTunes in the podcast section of the iTunes store. You can also follow me on Facebook, Google +, or Twitter.  This is Doc Smo, hoping this pedcast takes a little of the heartache out of your child’s next stomachache.  Until next time.

 

 

Smo Notes:

  1. Review article about recurrent abdominal pain

http://pediatrics.aappublications.org/content/115/3/e370

 

2. Recurrent Abdominal Pain in Childhood

Philip Bufler, PD. Dr. med.,*,1 Martina Gross, Dipl.-Psych.,2 and Holm H Uhlig, PD Dr. med.3
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103980/#E33

 

4. Treatment of Recurrent Abdominal Pain

– http://global.oup.com/us/companion.websites/fdscontent/uscompanion/us/pdf/spirito/Janicke.pdf

4 Comments

  1. Cynthia Little says:

    Dr. Smolen, As I’m sure you remember, my girls were both very anxious after their Daddy went to Heaven and they were only 7&9 years old. That also happened to me when I was 7 my Daddy passed away as well. These kinds of stomachaches are the worst because you have no control over that, but parents can try to reinforce as much love and stability as possible even in the hardest of times. Our family, Church family and friends tried to love us through it. And especially having a precious Pediatrician, You, helped more than you will ever know. These tummy aches are real. They hurt very badly. But the reason is from a hurting heart. Parents need to take time every day to listen to their children. They have plenty to say if we are willing to take them seriously and give lots of hugs. CL

    • DocSmo says:

      Mrs. Little, Thanks for sharing your comment with my blog audience. Maybe you are right, we should be treating the brain, the heart, and really the whole child! Give my best to your girls. Doc Smo

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