Recurrent abdominal pain in children: Is this real pain?

Carleene Grant-Davis, Child & Baby health

This has got to be the most frustrating symptom for parents. And for paediatricians too!

Abdominal pain in children is the most common recurring pain symptom that physicians see. Every child complains of abdominal pain at least once in their lifetime. However, the experience of recurrent episodes of abdominal pain over a period of several months is a common problem among school-age children. Are they really experiencing pain?

Recurrent abdominal pain (RAP) affects approximately 10 to 15 per cent of all school-age children. However, fewer than 10 per cent of children with RAP are ever found to have an organic cause for their pain. Some of the common organic causes are:

• constipation,
• gastritis,
• urinary tract infections
• gastroesophageal reflux disease
• lactose intolerance or milk allergy
• dysmenorrhoea

In more than 90 per cent of children with recurrent abdominal pain, no distinct organic cause is found and hence the term functional abdominal pain has been applied to these cases. In simple terms, the pain is thought to be as a result of an abnormal increase in the gut's motility and contractions or a heightened sensitivity to the normal gut motility and contractions. Hence, although the pain is real, there is nothing dangerous causing it.

The pain usually occurs intermittently over a period of several months. It is frequently described as vague, around the belly button or poorly localised. The pain typically does not awaken the child from sleep, is not associated with any other symptoms, and although it may disrupt their routine temporarily, it does not stop them from carrying out their daily activities. The pain usually increases during periods of stress.

What can you do?

• Most children with RAP get better with time.
• Consult your physician to rule out an organic cause.
• Keep a diary of when the pain comes, how long it lasts, what helps, where the pain is located, etc.
• Your child should go to or stay in school even if the pain is present; allow for as little disruption as possible in daily routine.
• Parents and the school should approach the pain in a consistent manner.
• Give over-the-counter pain medicines (no aspirin).
• Distract your child with toys, books, games, etc.
• Try gentle rubbing of the belly.
• Check with your child or the school for stresses such as teasing, bullying, etc.
• Seek further medical care if:
• The pain is worse or more frequent.
• The pain is located in one place (other than the belly button).
• Pain wakes your child up at night.
• Pain comes with eating.
• Heartburn.
• Unexplained fever.
• Weight loss.
• Diarrhoea or constipation.
• Nausea or repeated vomiting.
• Your child looks pale, tired or disoriented during or after the pain.
• Urinary pain or frequent urination.
• Blood in stools (red or black stools).
• Seek immediate medical care if:
• Vomiting red blood or material that looks like coffee grounds.
• Belly is swollen or bloated.
• Pain and tenderness in one part of the belly.

Dr Carleene Grant-Davis is a consultant paediatrician and head, Dept of Paediatrics, Cornwall Regional Hospital; email: yourhealth@gleanerjm.com.