Just a tummy ache or something more?
While digestive disorders may seem like something that only affect adults, they are also becoming more common with children. If your child is having prolonged tummy aches it may indicate something more is going on.
“Most of the time abdominal pain is triggered by stress and anxiety in kids, like if they are starting school they may get gastroenteritis and recover from it, but the pain and nausea may take a couple more days to recover from,” said Dr. Kadakkal Radhakrishnan, pediatric gastroenterologist at Cleveland Clinic Children’s.
Constipation is another common cause of abdominal pain in children. “It can happen when kids start potty training because some children do not want to sit and they hold it in or when they are starting preschool and do not want to use the bathroom and withhold,” said Radhakrishnan.
Most frequently doctors will see functional constipation. “Functional constipation happens 99 percent of times where the child is not eating a high fiber diet or there is a change in the bowel that causes the stool to harden or thicken up and it hurts when the child goes to the bathroom so he withholds it,” said Radhakrishnan.
There are some simple fixes for constipation. Remedies like prune or pear juice can act as a laxative to make the baby go better. Increasing daily water intake can also be beneficial.
Great strategies to avoid constipation include helping your child set a regular toilet routine and encouraging him to get moving. Exercising as a family as well as maintaining a balanced diet can make a difference. If your child does not like to go to the bathroom, set aside 10 minutes or so after a meal where he just sits on the toilet and waits to see what happens. Always talk to the pediatrician before giving your child any medication for constipation even if it is over the counter.
Crohn’s disease is another source of discomfort. “We see 20 percent or one out of five patients with Crohn’s in pediatrics,” said Radhakrishnan. More Crohn’s is seen than ulcerative colitis. “It is an inflammation of the gastrointestinal tract and anywhere from the mouth to the bottom can be affected whereas ulcerative colitis basically means inflammation of the large intestine only,” said Radhakrishnan. Treatments are scaled based on severity including oral medications that are managed by a pediatric gastroenterologist.
Spitting up in babies can be associated with gastroesophageal reflux. “We see a group of babies who cannot tolerate formulas and we do a small dose of acid-blocking therapy,” said Radhakrishnan. Not all babies that spit up have reflux, but it may be more of a concern if your baby has difficulty feeding, arches his back or cries. In an older child, symptoms of reflux may include swallowing problems and chest discomfort which of course warrants having him see a doctor.
The American Academy of Pediatrics recommends thickening formula with a small amount of baby cereal; be careful not to overfeed your baby by considering smaller and more frequent feedings but being sure that total daily intake is sufficient to keep up with normal growth and development. It is a good idea to keep your baby in an upright position for the first hour or so after feeding. Older kids should avoid fried and fatty foods. Know that peppermint, caffeine and some asthma medications can make the lower esophageal sphincter relax. If you can identify a food causing heartburn or reflux, eliminate it from your child’s diet for a week or two and then reintroduce it. If symptoms reoccur, take it out of the diet for a period of time.
A lot of kids are affected by celiac disease. “Celiac disease is the body reacting to a protein called gluten in wheat, barley and rye by developing inflammation of the small intestine and the incidence in the community is 1 in 100,” said Dr. Radhakrishnan. Classic symptoms include weight loss, irritability or non-specific signs like abdominal pain, diarrhea or vitamin D deficiency. “We check for celiac disease with a blood test looking for certain antibodies in the blood and if they are elevated we suggest the child undergo an endoscopy to look for changes to confirm the diagnosis of celiac,” said Dr. Radhakrishnan. Once diagnosed, kids have to go on a strict gluten-free diet where they should not even be sharing plates or utensils with others to prevent cross-contamination. “Seven percent of children with Down syndrome have celiac disease so they need to be screened for it as well,” said Dr. Radhakrishnan.
Know when to seek help. Abdominal pain can be due to a lot of causes. “Most of the time we do not find anything in children,” said Radhakrishnan. It is better to be safe and get your child checked if you are worried. “Abdominal pain that is persistent and lasting beyond a week or affecting functionality where the child is doubling over in pain or waking up in the middle of the night with pain, should start with contacting the pediatrician who can facilitate a referral to a gastrointestinal doctor,” said Radhakrishnan. By listening to your child and intervening early if there is a problem, his tummy troubles may improve in no time.