Tummy aches: How to know when there's a problem
October 12, 1999
Web posted at: 11:27 AM EDT (1527 GMT)
By Daphne Miller, M.D.
The words "my belly hurts" have a way of striking terror in the hearts of parents. They immediately imagine their child being rushed into the operating room with a ruptured appendix or other emergency. However, most belly pain in children has no identifiable cause. This is even the case for children who complain of belly pain on a regular basis, a syndrome that many doctors refer to as recurrent abdominal pain (RAP).
As a parent, it is important to distinguish between belly pain that needs immediate medical attention and belly pain that can wait for a regular doctor's appointment. Of course, there are no hard and fast rules, so if you have any uncertainty, call your doctor for advice.
Pain that needs immediate attention
Children with belly pain should be evaluated right away if they have:
Sharp belly pain in one specific spot (especially around the belly button)
Pain that wakes them up from sleep
So much pain that they cannot stretch their legs, walk or jump
Vomiting and inability to keep down fluids
Blood in their stool
Fever of 104 or higher
An overall appearance of illness, including a change in skin color or muscle tone, lethargy, confusion or unusually high irritability
On the other hand, a child who reports vague belly pain all over the belly, without any of the symptoms above, can usually wait a day or two before going to the doctor. In the meantime, the pain usually gets better on its own.
It's important to note that these guidelines apply to children who can talk. To be on the safe side, you should contact your doctor right away if your child is preverbal and cries whenever you touch his or her belly.
Finding a cause is difficult. Up to 15 percent of school-aged children experience RAP, says an April 1989 study from the Journal of Consult Clinical Psychology. RAP is defined as episodic attacks of abdominal pain over a period of at least three months. When doctors first see a child with RAP, they usually take a careful history and perform a thorough physical exam. In most instances, the history and physical reveal enough information to identify anything serious that could be going on inside the child's belly. Rarely are laboratory tests needed.
Only about 10 percent of children with RAP end up having an identifiable problem, according to a July 1990 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Many parents walk away from the doctor's office feeling disappointed that the doctor did not make a definitive diagnosis. It seems hard to believe that a child could be in so much pain without there being something seriously wrong.
The pain is real and troubling, but it is not caused by something that can be seen with an X-ray (or other test) or treated with surgery or drugs. Many RAP experts theorize -- and a number of studies suggest -- that the pain is actually an expression of psychological stresses in a child's life or a plea for attention.
Because the cause may be psychological, there are certain factors that children with RAP have in common. Some of them include:
Parental fighting or a divorce
A family dynamic that discourages the open expression of feelings
A parent who also complains of stomach pain on a regular basis
A parent who works long hours and is not very involved in the child's life
An ill or depressed parent
A death in the family
With this in mind, often the best treatments are not physical, but behavioral. A parent with a child who has RAP might try the following:
Make sure that you pay regular attention to your child and that you don't just reward him or her with attention when there's a complaint of pain.
Identify the stresses that are linked with the belly pain and try to deal with them. Counseling may be helpful.
Try to keep a normal daily routine especially when it comes to school attendance -- and try to keep your child from missing school because of belly pain.
Be attuned to your own pain complaints. Children may learn "pain language" from their parents. A number of recent studies have found a link between a child's stomach pain and the anxiety and depression level of the child's parents. This isn't to say you are causing your child's pain -- children are sensitive barometers of what goes on in the family and, naturally, become worried when you do.
Consider putting your child on a high-fiber diet with lots of fruits and veggies -- constipation has been identified as a factor in some children with RAP.
Give your child a two- to three-week trial of a dairy-free diet to see if he or she improves; lactose intolerance may also play a role in RAP.
Most importantly, do not be frustrated when your doctor does not find a definitive cause of the belly pain. Instead, consider this news as a positive diagnosis and convey this enthusiastically to your child. Often times, reassuring your child that nothing is seriously wrong is the first step toward a cure.
Daphne Miller is a family doctor practicing in a community clinic. She is affiliated with the Department of Family and Community Medicine at the University of California, San Francisco.Copyright 1999 WebMD, Inc. All rights reserved.
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The Nemours Foundation: My Stomach Hurts!
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