'My Tummy Hurts': How to Solve Common Stomach Problems

Poop has become a major topic of discussion in the Scott household. That's because 4-year-old Caroline has frequent stomachaches and 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 returned to holding.

Abdominal issues are so common that nearly half of all school-age kids suffer more than one gastrointestinal symptom weekly, according to the Journal of Pediatrics. Those situations aren't serious unless they affect your child at school or in activities. Sometimes, a child may simply have a temporary issue (or 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.

Read our guide below to learn more about problems, both short-term and chronic, will help you understand what's really going on with your little one.

Functional Abdominal Pain (FAP) in Kids

Some 15% 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 a 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 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.

According to the American College of Gastroenterology, symptoms of functional abdominal pain in kids can include:

• Pain around the belly button
• Sudden pain or slow build-up of pain
• Pain can be constant
• May feel full after only a few bites of food
• Dyspepsia (pain in the upper GI)
• Pain with bowel movements

How functional abdominal pain is diagnosed in kids

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 for functional abdominal pain in kids

Drugs generally aren't needed. Instead, doctors recommend helping your child identify and minimize common triggers. Teach your child how to distract themselves when they feel 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 (IBS) in Kids

When general stomach pain accompanies bowel movements, including diarrhea and 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.

Symptoms of IBS in kids can include:

• Cramping, bloating, and gas
• Changes in bowels (diarrhea and constipation)
• Dizziness
• Feeling an urgent need to have a bowel movement
• Not feeling like the bowels have emptied all the way
• Mucus in stool
• Belly pain that is constant or recurring

How IBS is diagnosed in kids

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 for IBS in kids

Talk to your doctor about dietary changes, supplements like fiber, or OTC diarrhea drugs or laxatives. They 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. This plan eliminates groups of carbohydrates (such as lactose and fructose) that seem to create excessive gas and pain.

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.")

Gastroesophageal Reflux (GERD) in Kids

More than half of babies have reflux, but nearly all will have stopped spitting up by age 2. Still, between 2 and 10% of kids develop gastroesophageal reflux disease (GERD), in which food or acid comes back up, even though kids don't generally feel this. Instead, most children experience abdominal pain, a dry cough, recurrent throat-clearing, and less interest in eating, says Dr. Sauer.

Common symptoms of GERD in kids can include:

• Burping, gagging, choking, and/or coughing
• Coughing fits only at night
• Hiccups (may be chronic)
• Fussy during mealtimes
• Vomiting regularly
• Stomach pain

Less common symptoms of GERD in kids can include:

• Frequent ear infections and colds
• Wheezing or rattling in the chest
• Sour taste in the mouth or bad-smelling breath
• Sore throat when waking up
• Tooth decay and tooth loss

How GERD is diagnosed in kids

Doctors typically rely on symptoms, although if the problem is severe, a pediatric gastroenterologist may have a tiny, flexible tube inserted into your child's esophagus for 24 hours to record each incidence of reflux. They may also need an endoscopy, which is done in an outpatient center while your child is sedated.

Best treatment for GERD in kids

Some kids with GERD need to take a proton pump inhibitor drug like Prilosec for several months to stop the acid.

Consider limiting foods more likely to cause trouble, such as fried and fatty fare, tomato sauce, and pizza, particularly if they seem to make your child feel worse afterward. Dr. Sauer recommends avoiding fruit juices (particularly citrus), soda, and carbonated beverages because of the high acid content; milk and water are better options.

Constipation in Kids

This can be brought on by something minor, like a change in diet or routine, or even needing to use an unfamiliar toilet. But for some kids, it soon escalates because stools get harder the longer they wait, making elimination more difficult—and, for younger children, frightening. A packed colon can also stretch to the point where it stops working properly.

Many parents believe that kids need to have a bowel movement every day, says Barbara Doty, M.D., associate clinical professor of family medicine at the University of Washington School of Medicine, who sees a lot of constipation in her family practice in Wasilla, Alaska. But most doctors consider it a problem only when kids have a BM fewer than three times in a week or if stools are especially large, small, dry, or painful.

Signs of constipation in kids can include:

• Fewer than three bowel movements a week
• BMs are dry, hard, or difficult to pass
• Stomach or belly pain
• Small amounts of wet or pasty stool in underwear

How constipation is diagnosed in kids

An X-ray will determine how much stool is backed up inside. To detect (and possibly move) the stool, your pediatrician may perform a rectal exam, suggest a glycerine suppository, or prescribe a mild oral medication to stimulate the bowels.

Best treatment for constipation in kids

Ensure your child loads up on vegetables, fruits, whole grains daily, and lots of water. You also want to establish good bathroom habits so they don't get used to holding it in. Teach them to head for the bathroom as soon as the urge strikes or to sit for ten or so minutes right after breakfast or supper, Dr. Doty advises.

Los Angeles mom Adriana Mollica became strict about 3-year-old Enzo's bathroom schedule after he started screaming during painful BMs. "I bring his favorite toy or book to entertain him while he's sitting," she says. Enzo's been known to brag that he pooped out a brachiosaurus dinosaur, and his mom is happy to make a game of her son's successes since it takes the agony out of going to the bathroom.

Cases that last several weeks or longer can require a "clean-out" to empty the bowels: a stool softener like Miralax (a tasteless laxative powder) combined with an enema. Doctors may recommend a daily dose of Miralax for children with chronic problems.

Fixing your child's chronic constipation might also end any bedwetting issues they may have, according to research by Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, which found that accidents can result when trapped stool presses on the bladder.

Inflammatory Bowel Disease (IBD) in Kids

The two most serious digestive diseases, Crohn's and ulcerative colitis (UC), are known as inflammatory bowel diseases (IBDs). UC inflames the superficial lining of the large intestine, or colon, while Crohn's can strike anywhere along the digestive system, says Desale Yacob, M.D., a gastroenterologist at Nationwide Children's Hospital.

Symptoms of IBD in kids can include:

• Abdominal cramps
• Weight loss
• Nausea
• Fever
• Joint pain
• Mouth sores
• Bloody diarrhea (especially in UC)

If not caught early enough and properly treated, symptoms of IBD can cause:

• Malnutrition
• Stunted growth
• Fatigue
• Intestinal blockage
• Anemia

How IBD diagnosed in kids

Once the primary-care doctor suspects IBD, they may do blood work and, at the same time, refer your child to a pediatric gastroenterologist (GI). Pediatric GIs use X-rays, abdominal MRI or CT scans, upper endoscopy, and/or colonoscopy.

Best treatment for IBD in kids

Treating IBD in kids really depends on the severity of the case. Some children have to rely on formulas such as Pediasure or Ensure for most of their diet. Other kids may need powerful medicines, including steroids, anti-inflammatory drugs, or the same immunomodulatory drugs used to treat cancer. (A small number of kids with advanced UC who don't respond to drugs get relief only when part of their colon is removed; this doesn't help with Crohn's since the disease affects the small intestine too.)

Felicia Haywood, of Chicago, was initially horrified when a doctor prescribed the immunosuppressant Imuran for her then 3-year-old son, LaMont St. Clair, who was diagnosed with Crohn's at 16 months. But she has dutifully given him the medication each night for two years, and her son is finally thriving. "He's a regular, happy kid, and he's put on enough pounds that he's finally reached his age-appropriate weight," Haywood says.

Celiac Disease in Kids

Children with this autoimmune disease have no choice but to avoid even the tiniest speck of the grain protein known as gluten. Otherwise, it sets off a reaction that causes serious damage to the walls of the small intestine, along with severe stomach pain, diarrhea, and constipation. This is why kids who aren't diagnosed for years suffer from problems like growth delays, iron-deficiency anemia, and thin bones, says Dr. Chumpitazi.

Be sure your doctor considers celiac if your child's digestive problems include weight loss, migraines, joint pain, or tingling in the hands or feet. There seems to be a genetic component, so siblings are likelier to have celiac disease if one child has it.

Symptoms of celiac disease in kids can include:

• Abdominal pain
• Cramping and bloating
• Diarrhea
• Constipation
• Vomiting
• Fatigue
• Decreased appetite
• Recurring mouth ulcers
• Weight loss or problems gaining weight
• Poor growth (short stature)

How celiac disease is diagnosed in kids

It's best to have your child tested immediately if you suspect celiac disease. The process begins with a blood test that checks for antibodies. If those are found, the condition is confirmed with an endoscopy to biopsy a villi sample, which are hairlike projections that absorb nutrients in the small intestine.

Best treatment for celiac disease in kids

The only remedy is a completely gluten-free diet, avoiding a long list of foods made from wheat, barley, and rye. (Gluten also often hides in processed foods like luncheon meats, gravy, and soy sauce.) Fortunately, supermarkets increasingly feature gluten-free processed foods.

Omaha mom Jenny Peters, who has four children with celiac disease, says some switches are easy. She'll replace bread in sandwiches with lettuce wraps or corn tortillas or serve rice as a side dish instead of pasta. But other swaps require a bit more creativity. She recalls her daughter Emma sharing homemade flourless black-bean brownies with her third-grade classmates. After they polished off the treats, Emma told them what they'd eaten. "They couldn't believe how good they were," Peters says.

The Bottom Line

If your child comes down with an achy stomach just before school (but isn't vomiting, feverish, or experiencing bloody diarrhea), think twice before letting them stay home, advises Dr. Richard Gilchrist. Kids often get stomach pain from a stressor like a big test or a bully, he says; you're better off teaching them simple slow-breathing techniques to calm their nerves or promising you'll speak to their teacher and send them on their way.

Dr. Gilchrist says that even kids with known GI diseases shouldn't stay home (or see the doctor) unless their symptoms are severe. "By using guidelines developed with your child's physician and spelled out in advance, you'll avoid repeat battles." Plus, your child can distract themselves at school more easily when they're keeping busy and with friends.