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Overview
Abdominal pain is one of the most common medical problems for children. It represents up to 4% of all pediatric office visits and up to 30% of visits to our office. Many children experience abdominal pain.
What causes abdominal pain?
We generally divide pain into two categories: acute pain (recent onset) and chronic pain (longer duration).
Acute abdominal pain
Acute abdominal pain is usually first evaluated by a pediatrician. It can be caused by a variety of problems, including viral infections, constipation, appendicitis, urinary tract problems, or, less commonly, by pancreatitis or gallstones. Appendicitis usually presents with pain in the right lower abdomen, often with fever, and laboratory and/or X-ray abnormalities. If the pediatrician needs help with diagnosing or treating the cause of acute pain, they may send the child to a pediatric surgeon, the emergency room, or sometimes, to one of our doctors, especially if surgical problems appear unlikely.
Chronic abdominal pain is extremely common in children. One in every five school-age kids may experience chronic abdominal pain. Often, the pain is felt around the belly button. It may also be associated with nausea, diarrhea, or constipation. Chronic pain is often divided into two categories: pain associated with a disease like celiac disease or Crohn’s disease or pain associated with abdominal nerves, like pain from irritable bowel syndrome (IBS) or disorders of the gut-brain interaction (DGBI), previously known as functional abdominal pain.
DGBI-associated abdominal pain is the more common of the two types of chronic abdominal pain. It is best described as real pain originating from signals in the nerves that line the gastrointestinal tract or the abdominal wall. This results in what you might think of as a sensitive stomach. For example, a DGBI called irritable bowel syndrome (IBS) is due to heightened sensitivity of the pain nerves in combination with certain foods, stress or certain changes in the gut microbiome that are still poorly understood but real. For children and adults with dyspepsia or abdominal migraines, the normal contractions in the stomach might cause intense pain when the stomach is stretched. Research has shown that patients with IBS, dyspepsia, or other DGBI have higher numbers of pain neurotransmitters within the intestinal lining. This type of pain is rarely caused by a physical blockage, infection, ulcer, or colitis.
Abdominal pain can also be associated with identifiable diseases of the gastrointestinal system. While it is far less common than DGBI abdominal pain, your doctor may decide to test your child for possible diseases causing abdominal pain, including celiac disease, eosinophilic esophagitis (EoE), peptic ulcer disease, Helicobacter pylori (H. pylori) infections, IBD, infections, and pancreatic, gallbladder, and liver disease, among others.
Alarm symptoms
Diseases are more common when there are “alarm” symptoms such as fever, blood in the stool, significant weight loss, jaundice, or abnormal test results (blood, urine, or stool). Alarm symptoms are not typically present with DGBI or with functional abdominal pain.
What factors increase abdominal pain?
Disorders of gut-brain interaction can be triggered by certain foods, constipation, and even stress. Stressors may include a new school, a conflict with friends or family, divorce (or stressed parents), bullying, putting pressure on oneself, or perhaps a recent illness or death. It is important that you carefully consider all of the potential stressors in the child’s life and discuss them with the doctor.
What is the best treatment for stomach pain in kids?
IBS, constipation, or even a DGBI may respond to dietary changes, medications, or therapy with a pain psychologist. Medications used to treat symptoms may include acid-blocking treatments, stool softeners, a high-fiber diet, muscle relaxants, or in some cases, migraine-type medications.
Our doctors are experts in evaluating and treating abdominal pain. Please help by bringing a copy of all previous lab tests and growth records with you to the specialist’s appointment.
Before visiting the gastroenterologist for these problems, it is a good idea to try a few simple dietary changes. A lactose-free diet can be tried for a few days to see if milk (specifically the sugar in milk, lactose) is causing the problem. To follow a lactose-free diet, cow’s milk must be eliminated in the form of milk, cheese, cream, and ice cream for a few days. Sometimes, reducing the child’s intake of junk food, high fructose corn syrup (a sweetener found in many foods that can cause cramping and bloating), caffeine, soda, or excessively spicy or fried foods can help.
Abdominal pain can be very challenging for children and their parents, teachers, and doctors. The good news is that most chronic abdominal pain in children eventually goes away and is not caused by serious health problems. As with any medical condition, please discuss symptoms and any concerns with the medical providers, especially if there are any major changes in symptoms.
To talk to one of the pediatric gastrointestinal specialists at GI Care for Kids about abdominal pain in children, call us at (404) 257-0799 or simply request an appointment now at one of our offices located throughout the Greater Atlanta area.