Chronic Abdominal Pain In Children

What is chronic abdominal pain in children?

Children ages 5 to 17 may have chronic abdominal (ab-DOM-i-nal) pain. Chronic abdominal pain occurs in your child's abdomen at least three times in three months. Chronic means long-lasting, or something that happens over and over. The abdomen is the area between the chest and the hips, and holds the organs of the digestive system. These organs include the stomach (belly), intestines (bowel), liver, gallbladder, pancreas, and spleen. The digestive system in your child's body breaks down and absorbs what he eats and drinks.

What causes chronic abdominal pain in children?

The four most common causes of chronic abdominal pain in children are:

• Abdominal migraine: Very bad abdominal pain with a headache. Your child's eyes may also be sensitive to light.
  
  
• Functional abdominal pain: Pain which has no known cause. Your child may not want to do things he enjoys because of the pain.
  
  
• Functional dyspepsia: Upper abdominal pain that does not go away when your child has a bowel movement (BM).
  
  
• Irritable bowel syndrome (IBS): Abdominal pain that goes away when your child has a BM. Your child's BM's may also look different, or he may have more BM's than usual.

• Anxiety (worry) and stress may be caused by school problems, physical abuse, or problems at home.
  
  
• Infection.
  
  
• Inflammation (swelling).
  
  
• Menstrual cycle (period) for females.
  
  
• Poor sleep.
  
  
• Your child's bowel does not empty right or is too relaxed.

What are the signs and symptoms of chronic abdominal pain?

Signs and symptoms of chronic abdominal pain will come and go. Your child may have them for a day or more, they may go away, and return again. Your child may feel pain in all areas of his stomach, and he may not want to eat. Your child may not want to do his daily activities, such as school or sports. Other signs and symptoms your child may have include any of the following:

• Bloating (stomach feels full and big) and gas.
  
  
• Constipation (having hard, dry stools which are difficult to pass), or diarrhea (loose, watery BM's).
  
  
• Cramping (very bad squeezing abdominal pain).
  
  
• Growth failure (not getting taller or gaining weight as expected).
  
  
• Headache or photophobia (eyes are sensitive to light).
  
  
• Nausea (feeling sick) or vomiting (throwing up).
  
  
• Weight loss.

How is chronic abdominal pain diagnosed?

• Your child's caregiver will want to know your family history of abdominal pain or problems. You will be asked what medicines your child takes, and how he eats and sleeps. Tell your child's caregiver about any other health problems he has. Tell your child's caregiver if your child has missed activities because of his pain. Tell your child's caregiver if your child has been more stressed or worried lately.
  
  
• Your caregiver will examine your child, and may have your child rate his pain using a pain scale.
  
  
• Your caregiver may do blood tests as well as any of the following tests:
  
  
  • Abdominal ultrasound: This is a test that is done to see inside your child's abdomen. Sound waves are used to show pictures of your child's abdomen on a TV-like screen. X-rays may also be done. These are pictures taken of the organs inside your child's abdomen. Caregivers use these pictures to look for problems such as blocked intestines.
    
    
  • Colonoscopy: This is a test that is done to look at your child's colon. A tube with a light on the end will be put into your child's anus (rear end). The tube is then moved up into his colon for caregivers to see if there are any problems.
    
    
  • CT scan: This test is also called a CAT scan. An x-ray and computer are used to take pictures of your child's body. Your child may be given dye, also called contrast, before the test. Tell the caregiver if your child is allergic to dye, iodine, or seafood.
    
    
  • Endoscopy: For this test, a scope is used to see the inside of your child's digestive tract. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may find problems with how your child's digestive tract is working. Samples may be taken from your child's digestive tract and sent to a lab for tests.
    
    
  • MRI: This test is called magnetic resonance imaging. During the MRI, pictures are taken of your child's abdomen. Your child will need to lie still during his MRI. Never enter the MRI room with an oxygen tank, wrist watch, or any other metal objects. This can cause serious injury.
    
    
  • Pregnancy test: If your daughter has started having periods, a pregnancy test may be done.
    
    
  • Stool and urine samples: A sample of your child's stool (BM) and urine is collected and sent to a lab for tests. The BM and urine may show if a germ is causing his abdominal pain. This helps caregivers learn what medicine is best to treat your child.

How is chronic abdominal pain treated?

Caregivers may not find a medical problem that is causing your child's abdominal pain. If no problem is found, caregivers will work to decrease your child's symptoms, so that he can return to his normal activities. With treatment, your child's abdominal pain may decrease, happen less, or go away. It is possible that your child may have chronic abdominal pain as an adult, with or without treatment. Your child may be treated with one or more of the following:

• Cognitive behavioral therapy: This therapy is done to help your child learn to cope with stressful things. Your child will learn how to decrease or cope with his abdominal pain if it happens when he is scared or worried.
  
  
• Medicines: Aspirin and nonsteroidal anti-inflammatory (NSAIDs) medicines may cause abdominal pain. If you give these medicines to your child, ask your caregiver if you should stop giving them. Caregivers may give your child the following medicines to help decrease his abdominal pain:
  
  
  • Antacids: This medicine decreases stomach acid that may be causing your child pain.
    
    
  • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.
    
    
  • Antidiarrheal medicine: This medicine is given to decrease how much diarrhea your child is having. Some of these medicines coat the intestine (bowel) and make the BM less watery. Other antidiarrheal medicine works by slowing down how fast his bowel is moving.
    
    
  • Antinausea medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up).
    
    
  • Selective serotonin reuptake inhibitors: These medicines may be used to help decrease your child's anxiety. These medicines also may help to relax the top part of your child's abdomen. Do not stop giving this medicine to your child unless your child's caregiver tells you to.
  
  
• Surgery: Surgery is rarely needed, but may be done if there is something wrong with your child's abdomen. This could be because an organ in your child's abdomen is out of place, or not working right. A blocked intestine is an example of why your child may need surgery. Your child's caregiver will let you know if your child needs surgery.

What can I do to help decrease my child's chronic abdominal pain?

• Diet changes: You may be asked to write down the foods your child eats. Avoid giving your child greasy, fatty foods. Greasy, fatty foods include fried foods, cheeseburgers, hot dogs, and desserts. If your child has trouble with hard BM's, it is helpful to have him eat more fiber. High fiber foods are fruits and vegetables, dark green and orange vegetables, and legumes (dry beans). Do not give your child gassy foods such as broccoli, cabbage, and cauliflower. Avoid giving him soda and carbonated drinks, as this may also cause your child to have gas. Foods and drinks with sorbitol and fructose should be avoided if your child has diarrhea and bloating. Some food and drinks with sorbitol and fructose are fruit juices, candy, jelly, and sugar-free gum. Drinking enough water, and eating small meals more often, may help decrease your child's abdominal pain. Your child should drink 6 to 8 glasses of water daily.
  
  
• Encourage your child to keep doing the things he likes to do: If you focus on your child's pain, it may keep getting worse. Stay hopeful that your child will feel better, and keep him doing his usual activities. Have your child talk about things that worry him. Find out if there are stressors at school by talking with your child's teachers. By doing this, you can help your child learn to cope better. When your child has pain, help him by giving him something to do or think about. This may help take his mind off the pain, so he can focus on what he is doing.
  
  
• Heat: Putting heat on your child's abdomen when he is having pain may help decrease his symptoms. Never put a heating pad against your child's bare skin. Always put a towel between the heat and your child's skin.
  
  
• Keep a diary of your child's pain: A diary may help your child's caregiver learn what is causing your child's abdominal pain. Include when the pain happens, what your child is doing, how long it lasts, and how it feels.

When should I call my child's caregiver?

Call your child's caregiver if:

• Abdominal pain wakes your child up at night.
  
  
• Your child's BM's are hard, or painful to pass.
  
  
• Your child has a fever.
  
  
• Your child has new mouth sores, trouble swallowing, or is losing weight without trying.
  
  
• Your child is not drinking liquids, and is not urinating.
  
  
• Your child has a new rash.
  
  
• You have questions or concerns about your child's care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your child's abdominal pain becomes worse then normal, and spreads to his back.
  
  
• Your child's BM has a large amount of blood in it, or looks like black tar.
  
  
• Your child cannot stop vomiting, or vomits blood.
  
  
• Your child has diarrhea for 1 to 2 weeks.
  
  
• Your child has trouble breathing, and his skin looks pale (very light-colored or white).

Where can I find support and more information?

Having chronic abdominal pain may be a life-long problem for your child and your family. Talk to your child's caregiver, family, or friends about your feelings, and have your child do the same. Contact the following for more information:

• International Foundation for Functional Gastrointestinal Disorders
  P.O. Box 170864
  Milwaukee , WI 53217
  Phone: 1- 414 - 964-1799
  Phone: 1- 888 - 964-2001
  Web Address: http://www.iffgd.org
  

• American Gastroenterological Association
  4930 Del Ray Avenue
  Bethesda , MD 20814
  Phone: 1- 301 - 6542055
  Web Address: http://www.gastro.org
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.