Poop has become a major topic of discussion in the Scott household. That's because 4-year-old Caroline, who has frequent stomachaches, is a "holder"--the term doctors often use to describe a child who won't use the toilet when a bowel movement beckons. Her mom, Colleen, of North Attleboro, Massachusetts, has tried pleading with Caroline and also bribing her, explaining that her belly wouldn't hurt if she went regularly. But, overcome by an irrational fear that she can't clearly explain, Caroline waits until she has to go so badly that poop leaks into her underwear. When an X-ray recently confirmed that Caroline's bowels were packed, her doctor prescribed a stool softener and laxative. Once that did its job, however, she went right back to holding.
Abdominal issues are so common that nearly half of school-age kids suffer more than one gastrointestinal symptom weekly, according to a study at Ann and Robert H. Lurie Children's Hospital of Chicago. Those situations aren't serious unless they affect your child at school or in activities. In some cases, a child may simply have a temporary issue (or just not want to go to school!). But if symptoms persist or are especially bothersome, you'll want to talk to your pediatrician, says Cary Sauer, M.D., endoscopy director and pediatric gastroenterologist at Children's Healthcare of Atlanta. Our guide to problems both short-term and chronic will help you understand what's really going on with your little one.
Functional Abdominal Pain
Some 15 percent of kids complain of periodic pain around their belly button, but their doctor can find no signs of blockage, swelling, or infection (such as fever or severe pain). Without a clear physical reason for the trouble, the diagnosis will be functional abdominal pain (FAP), also known as worried stomach. Still, the pain is real, explains Jesse Reeves-Garcia, M.D., director of the division of gastroenterology at Miami Children's Hospital. Doctors believe that some kids are simply more sensitive to the pressure in their intestines caused by triggers like gas, food (especially if it's spicy), and stress--which makes sense when you consider that so many nerve endings live in the digestive tract that scientists call it our second brain, says Dr. Reeves-Garcia.
How it's diagnosed Doctors usually limit testing to blood, urine, and stool, unless the pain occurs with vomiting, bloody diarrhea, or other symptoms that could indicate a food allergy or inflammatory bowel disease. In that case, expect an X-ray, ultrasound, and/or upper endoscopy, where a probe with a tiny camera is placed down your child's throat to get a sample of the esophageal lining.
Best treatment Drugs generally aren't needed; instead, doctors recommend helping your child identify and minimize common triggers. Teach him how to distract himself when he feels the pain coming, maybe by listening to music or playing an iPad game, says Richard Gilchrist, M.D., a child and adolescent psychiatrist at Nationwide Children's Hospital, in Columbus, Ohio.
Irritable Bowel Syndrome
When general stomach pain accompanies bowel movements, which typically include diarrhea or constipation, your child likely has irritable bowel syndrome (IBS). As with FAP, experts blame a heightened sensitivity in the digestive tract, explains Bruno Chumpitazi, M.D., a pediatric gastroenterologist at Texas Children's Hospital, in Houston. About a third of children who have IBS--which tends to run in families--outgrow it, but the rest are affected for years, often into adulthood.
How it's diagnosed Doctors typically diagnose IBS based on symptoms (and sometimes blood, stool, and urine tests) without conducting invasive medical exams, since they almost always come back negative, explains Dr. Chumpitazi.
Best treatment Talk to your doctor about dietary changes, supplements like fiber, or OTC diarrhea drugs or laxatives. He may also prescribe an antispasmodic drug to relax the muscles or a very low dose of an antidepressant to calm the digestive tract.
GI doctors are increasingly excited about an eating plan for kids with IBS. Called FODMAPS, it eliminates groups of carbohydrates (such as lactose and fructose) that seem to create excessive gas and pain. The diet has helped so many children at Texas Children's Hospital that they've recently begun a major study. Knowing which foods are forbidden is complex: Apples, broccoli, and high-fructose corn syrup are all no-nos, for example, but bananas, green beans, and regular sugar are okay. (It may help to get a dietitian on board. Find one at ibsfree.net; click on "Find a FODMAP dietitian.")