Chronic Abdominal Pain in Children

Chronic abdominal pain in children usually occurs between the ages of 4 to 16 years and lasts longer than three months. The abdominal pain can be constant or can be associated with eating or abnormal bowel habits.

A special evaluation is required when children experience symptoms such as weight loss, bloody stools, fever, joint pain, fecal incontinence, etc.

Chronic abdominal pain in children is defined by Dr. Apley as an intermittent pain in children ages four to 16 years old, occurs over a period of three months, and is severe enough to affect daily activities. The patients are divided into three groups:

1. Intermittent abdominal pain
2. Abdominal pain while eating; nausea, vomiting, feeling full after eating and abdominal bloating or frequent belching.
3. Abdominal pain with irregular bowel movements, such as diarrhea, constipation or feeling that you are unable to empty your bowels completely.

Chronic abdominal pain can be real or imagined. Stomachaches are often used as an excuse for skipping an activity. However, abdominal pain can be caused by several factors. Abdominal pain is associated with abnormal cramps and nerve receptors in the GI tract including the esophagus, stomach, small intestine, large intestine, colon and rectum.

Children with chronic abdominal pain will have muscle spasms in the gastrointestinal tract upon stimulation, causing allover abdominal pain. Some substances that increase pain include different types of sugars, such as milk sugar, fructose, sorbitol, free fatty acid and bile acid. Studies using the lactose hydrogen breath test (H2 Breath Test) have documented lactose malabsorption in up to 40% of children presenting with recurrent abdominal pain, and the abdominal pain disappears in 70% of the children after avoiding milk sugar.

Some patients experience other symptoms, including headache, paleness, dizziness or nausea due to stimulation of the vagus nerve. In addition, emotional and personality issues in the form of anxiety disorders, depression and low self-esteem are often found in patients with recurrent abdominal pain. Parent-child relationships also influence abdominal pain in children.

1. Severe pain around the navel
2. Constipation or diarrhea
3. Vomiting
4. Abdominal pain that wakes the child at night
5. Pain that moves to a shoulder or leg
6. Weight loss or failure to gain weight
7. Blood in stool
8. Fever, joint pain
9. Bowel leakage
10. Falling asleep after abdominal pain
11. Family history of peptic ulcer, cancer in the digestive system, or inflammatory bowel disease

If during a physical examination, pain occurs when the abdomen is pressed, further investigations will include blood tests, urinalysis, breath test, x-rays, abdominal ultrasound and colonoscopy, as recommended by the doctor.

Treatment varies according to the causes or symptoms. Try to find the cause of the abdominal pain, such as lactose or juice, and avoid those foods. Encourage the child to go to school even when he or she experiences abdominal pain. Give digestive enzymes for milk or yogurt milk to the child.  

If constipation is involved, high-fiber foods are recommended.

Taking medication that relieves muscle spasms in the gastrointestinal tract may lengthen the abdominal pain. If the child has emotional issues and cannot return to his or her activities after changing the environment, please consult a psychologist.