Constipation and Gas
What it feels like: Cramping and uncomfortable bloating are the usual symptoms.
What's going on: If your child has gone for two or more days without pooping, you can reasonably assume that constipation is causing her stomachache. In fact, constipation causes almost half of all acute abdominal pain in kids, according to a recent study in the Journal of Pediatrics. But even if she does go to the bathroom regularly, she could still be constipated. "Some kids will tell you they have a bowel movement every day, but they're not eliminating everything from their colon properly," says Dan Thomas, MD, a pediatric gastroenterologist at Childrens Hospital Los Angeles. Gas is produced when food (especially sugar) is broken down by bacteria in the large intestine. This is a normal process, but some kids develop more gas than others. If your child is lactose intolerant, eating dairy products will cause painful gas.
What to do: Make sure your child is getting enough fiber and fluid, and watch the "white" foods. "Eating a lot of bread, pasta, rice, potatoes, milk, cheese, apples, and bananas can cause constipation," says pediatrician Laura Jana, MD, coauthor of Food Fights. Whole-grain cereals and pear juice can help ease the symptoms, but check with your pediatrician to see whether your child may also need an over-the-counter stool softener like mineral oil, MiraLax, or GlycoLax. (Don't give your child an adult laxative.) For gas, try to pinpoint the particular foods that cause it, such as beans, carbonated drinks, and fruit drinks. Reading the picture book It Hurts When I Poop! by Howard J. Bennett, MD, can help explain the situation to your child.
What it feels like: Children can have reflux at any age. Babies spit up frequently, and they're usually fussy during feedings and when lying down. Older kids feel a burning sensation in the chest and mid-abdomen, which may wake them up at night.
What's going on: The muscle that normally shuts off the esophagus doesn't close properly, allowing the harsh acidic contents of the stomach to wash back up. Many babies have some reflux but outgrow it by about 6 months. When it lingers longer, it may be gastroesophageal reflux disease (GERD), which can require medication.
What to do: Talk to your doctor about getting a prescription for heartburn medication. A recent study found that the number of kids ages 4 and under taking drugs for heartburn and other gastrointestinal conditions has increased more than 50 percent since 2002. One reason may be the rise in obesity, which changes the dynamics of the esophageal muscle, says Benjamin Gold, MD, professor of pediatrics at Emory University School of Medicine, in Atlanta. Reflux can be triggered by certain foods, so it's a good idea to keep track of what your child has been eating, and then make adjustments. Frequent culprits: fatty fast foods, spicy foods, acidic fruits (like oranges), peppermint, chocolate, caffeine, and eating large meals or eating too close to bedtime. Over-the-counter antacids can help provide immediate relief for kids ages 2 and up.
Functional Abdominal Pain
What it feels like: There's recurring pain around the belly button, which is often worse first thing in the morning and when your child goes to bed. The ache may last for hours at a time or come and go over the course of several weeks or longer, and even be severe enough to make him double over in pain.
What's going on: Some kids simply have oversensitive intestines, so that anything from a virus to normal gas can hurt -- and hurt for a while after it's passed. "It's similar to the way that skin that's been burned can remain sensitive for a long time," explains Carlo Di Lorenzo, MD, chief of pediatric gastroenterology at Nationwide Children's Hospital, in Columbus, Ohio. Stress is the other major cause of intermittent abdominal pain. Nerves in the intestines that have a direct connection to the brain cause everyone's tummy to react when they get scared or excited -- but some kids have a heightened brain-intestine connection, making their stomach more responsive to stress. Cathleen Barnhart took her daughter, Maggie, to the pediatrician after the third-grader repeatedly went to the school nurse crying about a stomachache. "I thought that it might be tied to anxiety, and the doctor confirmed it," says Barnhart, of White Plains, New York.
What to do: Be low-key. Kids tend to complain less about their stomachaches when their parents try to distract them from the pain rather than pouring on the sympathy, research has found. Dr. Di Lorenzo doesn't recommend ignoring the pain -- it's definitely real -- but don't reinforce it by letting your child stay home from school. The more school he misses, the more anxious he'll be about going back, and that can start the cycle of pain all over again. Instead, have him lie down for 10 minutes or get him involved in an activity. If you can't distract him and his pain is severe enough to make him cry for more than 20 minutes, call your pediatrician. Treatment can range from fiber supplements and antispasmodic medications to low-dose antidepressants (for kids 10 and up). Cognitive behavioral therapy, visualization, and, most recently, hypnotherapy have been shown to work too: Last year, a Dutch study found that hypnosis reduced pain in 85 percent of children compared with 25 percent of kids in a control group. Barnhart's daughter learned how to manage her stomachaches by riding in the front of the school bus (the bumpy ride made the pain worse), breathing slowly in and out, and having sips of water.
Irritable Bowel Syndrome
What it feels like: In addition to general abdominal pain (which frequently occurs at night), a child with IBS usually has bloating and gas. She may also have either diarrhea or constipation.
What's going on: IBS is a cousin of functional abdominal pain. It's more common in adolescents, but some younger kids do get it, particularly if they have a family history of the disease. They tend to have overly sensitive intestines that spasm in response to certain foods and stress. There's no specific test for IBS, but doctors may do some tests to eliminate other possibilities.
What to do: Eating more fiber and less fat can reduce the spasms that cause IBS, and consuming fewer foods and drinks with added fructose (a natural sugar in fruit) and sorbitol can help with diarrhea. Stress-management techniques such as hypnotherapy have been shown to ease IBS symptoms too.
What it feels like: A child has a dull ache that comes and goes, and often occurs in the middle of the night when his stomach is empty. He may also vomit and have bloody stools.
What's going on: Ulcers are relatively rare in American kids, and contrary to popular belief, they're not caused by emotional stress (although it can exacerbate them). Most are caused by the bacteria H. pylori, probably transmitted through food and water. Overuse of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can also lead to ulcers, but this is only likely in kids who take pain relievers for a chronic illness like arthritis or for a sports-related injury.
What to do: Doctors can often identify H. pylori with a simple breath or stool test, though sometimes they need to do an endoscopy (a tube inserted through the mouth) to confirm that a child has an ulcer. If he does, your doctor will likely prescribe acid-blocking medication and antibiotics. To guard against NSAID-related ulcers, be judicious in handing out pain relievers to young athletes, and alternate NSAIDs with acetaminophen to control fever that lasts more than a few days.
What it feels like: The pain, generally around the belly button, can be very intense and last for more than an hour, or even several days. A child may also vomit frequently, lose her appetite, and feel nauseous and headachy. Some kids go weeks or months between episodes. Thirteen-year-old Hayden White began having abdominal migraines when he was in the third grade. "The first time, he lost 10 pounds and needed an IV to replace fluids," says his mom, Jill, of Reno, Nevada.
What's going on: Few people have ever heard of abdominal migraines, but they seem to be caused by the same neuro-vascular triggers that cause migraine headaches. Many children who get them have a family history of migraines and end up developing the headaches later in life.
What to do: See your doctor. Kids who get abdominal migraines can sometimes feel them coming on, and may be able to take medication to prevent attacks. Make sure your child gets enough sleep and eats regular meals and snacks, which can also help.
Could It Be Appendicitis?
Adults who have appendicitis tend to have classic symptoms, but kids usually don't, according to a recent review of studies. As a result, they're often misdiagnosed.
The appendix, a small organ attached to the colon, is still a bit of a mystery, although we know it contains infection-fighting cells. Once it becomes inflamed, it needs to come out before it ruptures and spills bacteria into the abdomen. "A child who has a ruptured appendix may need to be in the hospital for several weeks," says David G. Bundy, MD, assistant professor of pediatrics at Johns Hopkins Hospital. Appendicitis can strike kids of all ages, and the appendix usually ruptures in kids under 4.
Call the doctor if your child's tummy ache seems different than usual or if she has a fever. Particularly suspicious: pain that begins around the belly button and moves to the lower right side, along with vomiting (especially greenish vomit) and diarrhea. Try this test at home: Press down on the part of her belly that hurts, then quickly release your hand. If her pain is worse when you take your hand away, she may have an inflamed appendix. Also ask her to jump up and down to see if that hurts.
Home Remedy Checklist
These home remedies are soothing and safe.
- Warm bath
- High-fiber cereal
- Herbal tea
- Heating pad or hot-water bottle
Originally published in the October 2008 issue of Parents magazine.
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