Tummy Trouble: The Perplexing Problem of Children's Stomach Aches

Daily Camera / May 13, 2008

By Cindy Sutter

"My tummy hurts."

It's a phrase every parent has heard at one time or another. But when stomach aches become a near-daily complaint, parents begin to worry. When those aches occur frequently for three months, they warrant a special medical term: functional abdominal pain. Unfortunately, the label doesn't mean that doctors have a remedy for the very common problem.

The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition says that about 10 to 15 percent of school-aged children report episodes of recurrent pain. Another 15 percent may have the pain, but not seek medical help.

"We see tons of kids with abdominal pain," says Dr. Edward Hoffenberg, of The Children's Hospital in Aurora and associate professor of Pediatrics and Pediatric Gastroenterology at the University of Colorado Denver. "(With) most of them we don't have an explanation."

Conventional approach

Hoffenberg says the first thing a doctor does is to look for weight loss or fever, which can signal underlying disease. If those aren't present, but the pain is severe enough and frequent enough to affect the child's activities and daily life, tests may be done to check for allergies to foods such as gluten or structural problems such as the twisting of the intestine or a cyst, as well as ulcers or gastric reflux.

In many cases, the tests still turn up negative, and Hoffenberg discusses the possibility of stopping the testing, since there's virtually no limit to the tests that can be done, and accepting a diagnosis of functional abdominal pain.

"There isn't a test for normal is how I put it to them," he says.

In practice, that means essentially helping the child deal with the pain, since most children do grow out of it.

"(If you're) supporting them to do their usual activities ... often it will gradually go away," he says, stressing that parents should make sure children don't make what he calls "secondary gains" from their pain, such as avoiding tests at school.

Such situations can mean that the stomach aches are a reaction to stress.

"It certainly can be stress," Hoffenberg says. "Sometimes, it's a clear transition such as the parents getting divorced ... Their sports team may have a new coach, or it may be a new teacher they don't like."

Hoffenberg emphasizes that even if the cause is stress, that doesn't mean the pain isn't real. The abdomen does contain nerve tissue.
"It's very well innervated, very sensory. It does send signals to the brain," he says.

Studies in adults with irritable bowel syndrome, for example, show that they sense some abdominal discomforts more acutely, whereas others, such as an electrical shock, are perceived less strongly than in subjects without the condition, Hoffenberg says.

"The wiring is different in some people."

Integrative therapy

Other doctors may approach the problem differently.

Dr. Pierre Brunschwig of Helios Integrated Medicine in Boulder may take a somewhat different path from many conventional medical practitioners.

Much as conventional doctors might, he first tries to make a distinction between whether the problem is related to stress or to a physical difficulty. He asks parents to note if there are patterns that might distinguish when the stomach problems occur. Often it may be when a child starts school or a new phase in school.

"You have to peel away who is this kid and why would school be stressful for them," he says. "Do they have issues with great anticipation of things or is this the beginning of a chronic anxiety disorder?"

However, he says, it's important not to get so caught up in the stress idea as to ignore a physical cause.

"Maybe stress at school makes a functional bowel disorder worse. Maybe the school lunches are something they don't tolerate," he says. "We have to be able to look at the child in their full complexity if that's what they need. ... Stomach aches are common. That doesn't make them normal."

If the cause seems to lean more toward the physical, Brunschwig uses stool tests for antibodies to certain foods. This type of testing is controversial and not accepted by many doctors who diagnose allergies using blood tests that show antibodies to foods such as gluten or dairy products.

Brunschwig, however, argues that by the time the intestinal lining has degraded to the point where antibodies show up in the blood, a problem with a certain food may have grown from an insensitivity to a full-blown allergy.

One family's story

Jodi Halsey, an herbalist at Pharmaca Integrative Pharmacy, brought her daughter, Lillian, to Brunschwig, because the girl had suffered numerous problems with ear infections and flu-like illnesses, as well as digestive problems and stomach aches. Her daughter, who was hospitalized several times, had received several different diagnoses, and Halsey was looking for a medical doctor who also had knowledge of complementary medicines such as homeopathy.

Constant antibiotics had altered her daughter's intestinal bacteria, which some research has linked to immune function. Stool testing showed sensitivity to gluten and dairy products as well as a hugely disproportionate amount of yeast in the child's digestive tract.

Three years later, her daughter, now 7, is much healthier. She eats a carefully monitored, mostly gluten free diet and takes probiotic supplements and anti-inflammatory products such as fish oil. Lillian's health has improved to the point that she can have an occasional slice of birthday cake at a friend's party with no ill effects, her mother says. And she has been without the respiratory infections that she frequently suffered with for three years.

Relieving symptoms

Even for families whose children don't have food allergies or physical problems, finding relief from the pain can be a huge help.

Some children feel better when they take over the counter remedies such as gas relievers. Widely available yogurt enhanced with probiotics might also be worth a try.

Pharmaca Lead Practitioner Matthew Becker also says several teas or tinctures can be effective.

"In Europe, people keep a lot of things stocked in their medicine cabinets," he says.

He suggests catnip as a tea or tincture. The plant, which is part of the mint family, is calming to the nervous system and also tastes good. It is best for children who seem anxious.

For those with stomach aches whose moods are more subdued and perhaps a little melancholic, he suggests a tea or tincture of lemon balm.

Raspberry leaf tea is good for loose stools, while fennel tea helps to relieve pain from gas. For irritations of the stomach lining, Becker suggests licorice or slippery elm.

Contact Camera Staff Writer Cindy Sutter at 303-473-1335 or sutterc@dailycamera.com.

© 2006 Daily Camera and Boulder Publishing, LLC.


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