Functional Abdominal Pain in Children
Abdominal pain can be due to many causes ranging from gut problems, bladder, kidney or even lung, genital or hip causes. Concentrating just on the gut, pain may be due to damage to the gut wall (usually inflammation or infection) or altered function of the gut. If your child has been diagnosed of Functional Abdominal Pain of Childhood it reflects a problem with the function of the gut and not with the structure of the gut or any damage to the gut wall. It occurs typically in children aged 4 –17 years.
Like many pains in childhood they can be there for months or even years that’s why a review every now and then is helpful.
Your doctor usually suspects the illness based on history and careful examination. There are several tests which are usually carried out which should include a urine analysis. Often your doctor will do further tests such as a blood test looking for evidence of inflammation or infection and exclude problems with absorption of food. This can show up as nutritional deficiencies caused by dysfunction of the gut wall. A stool test can also look for evidence of inflammation or infection caused by irritation of the gut wall. Your doctor may also request a simple ultrasound scan of the abdomen which is safe and can be very informative. It is important that your doctor is confident the pain is not a referred pain from lungs, genitalia or hips.
Sometimes I send your child to see a gastroenterologist if you are very worried before doing test which are unnecessary.
Several investigations are often not helpful which include stool cultures for parasites or worms, or allergy tests unless there are good indicators in the history. A test for H.pylori is also often not needed as H.pylori can be present but may not be the cause of the pain. An endoscopy (test with a camera fitted on a long tube inserted into the gut or stomach) is also not necessary. X-rays with or without contrast involves high radiation of the abdomen and potentially reproductive organs and are only needed if there is a specific reason but not for functional abdominal pain in childhood.
First of all it is important that parents understand that Functional Abdominal Pain of Childhood is real but not dangerous. Most children will worry more about the pain if you are also worried or tell your child that you think there is something wrong with them. It helps a lot if they see that you are relaxed and reassuring. You should approach it similar to when they hurt themselves after a fall and be aware that Functional Abdominal Pain of Childhood can also hurt ‘a lot’. You should be there for your child, comfort and reassure them because you know it will get better again.
Functional Abdominal Pain of Childhood is similar to a simple headache which is painful but not dangerous and goes away with simple measures.
Simple measures include looking carefully at their diet and increase fibre intake and fruit and vegetables. It also includes avoiding fizzy drinks and carbohydrate rich foods or high caloric food with little fibre in it. You should make sure your child goes regularly to the toilet for a poo, without pain or discomfort. I come across very few children who could not tweak one or two things in their diet and or their drinking habit.
At the time of the pain a warm drink, a massage, short rest or a warm water bottle will help. A glass with milk and honey may work wonders and may be all the ‘medicine’ needed.
Often these pains are worsened in a time your child is worried about other things which may be with friends, school, or within the family. It is important that they are not interfering with daily activities or enable children to get out of things they are keen to avoid. Examples for this is avoiding to go to school, take part in physical exercises, eating meals they would like to avoid or something similar.
I usually recommend to see a doctor when they first occur to make sure there is no other underlying cause which your doctor often can exclude with taking a good history and examine your child carefully.
You certainly must see a doctor if you are worried.
A child with Functional Abdominal Pain of Childhood should be regularly reviewed. The frequency of such a review varies but, in my view, should not be at least every 6 months.
You also must see a doctor sooner if any of the following occurs:
The symptoms change in nature, timing or site.
Your child is losing appetite or weight.
Your child has a change of stool pattern (going to the toilet), diarrhoea, bloody stools, fever or recurrent ulcers around the mouth or bottom.
The abdominal pain wakes your child at night.
This information is provided by Dr W Muller and will be regularly reviewed and updated.