By Howard J. Bennett, MD
Stomachaches account for numerous visits to pediatricians' offices. Parents often worry that a kidney infection or appendicitis is responsible for the pain. Although serious disorders can cause abdominal pain, the problem is usually due to something less worrisome.
Abdominal pain can be divided into two types. Acute pain has been present for less than a week. It can come on suddenly or it can build slowly over the course of a day. Pediatricians see children with this type of pain every day. Recurrent pain, on the other hand, has been present for a period of weeks, months or years. Ten to fifteen percent of school-aged children will seek medical care for recurrent abdominal pain.
Most cases of recurrent abdominal pain are caused by stress, constipation or a problem such as lactose intolerance or food allergy. Diets that include lots of foods with high-fructose corn syrup bother some children.
When doctors see children with recurrent pain, they start with a detailed medical history because that often suggests a diagnosis. For example, it is important for parents to check the frequency and consistency of a child's bowel movements because adults are usually unaware of what goes on in the bathroom after their children are toilet trained.
Pain that occurs more often during the week than on weekends or holidays is likely to have a stress component. However, weekends are not necessarily stress-free. Children may still have to deal with sports, religious school or family issues such as parental separation or divorce.
Serious causes of abdominal pain, such as ulcerative colitis and Crohn's disease, are much less common in a general pediatric setting. However, the incidence of celiac disease in the United States is one in 133 people. Because celiac disease can present with subtle symptoms, you should consider the diagnosis if your child has recurring stomachaches, loose stools, constipation or poor growth.
Everyone has to deal with stress. Fortunately, people and animals are equipped with the tools they need to fight or run away depending on which strategy is most likely to succeed. This process is called the fight-or-flight response. However, this response does not only kick in when some extremely dangerous situation is imminent.
The day-to-day stress that people deal with (worrying about paying bills or interacting with peers at school) can trigger a variation of this response. It is less intense, but lasts longer. But the same biologic responses that would give a person extra strength in dangerous situations can produce physical symptoms when facing ordinary stress: rapid heart rate, feeling tense, nervous or queasy, stomachache and having sweaty palms.
A good way to explain this phenomenon to children is to ask if they have ever gotten "butterflies" in their stomach before a soccer game or when they had to speak in front of their classmates.
Stress causes abdominal pain when the nerves in a person's intestinal tract overreact to the normal process of digesting food and pushing waste out of the body.
Three facts are important to keep in mind regarding stress-induced abdominal pain. First, children are often unable to verbalize what is bothering them. Second, the situation that causes them stress may not occur at the same time they are having pain. Third, even though stress is the trigger, the pain is very real.
Dealing with stress-induced abdominal pain is trickier than managing a problem like constipation or lactose intolerance. In general, eating a healthy diet is important, and in some people, taking probiotics can help reduce pain. The following steps can also help:
- Try to figure out where the stress is coming from by talking to your child about school, friends, home, etc. Talk to your doctor for guidance on how to address the problem.
- Turn off the fight-or-flight response (see below).
- In some cases, referral to a specialist is indicated. Pediatric gastroenterologists are experts at treating recurrent abdominal pain. Mental health therapists can be helpful for children whose stress-induced pain does not respond to suggestions provided by their doctors.
Helping children turn off the fight versus flight response
Because there is no threat or animal that wants to eat you, you do not need your body to get ready for a fight. Your heart does not need to speed up and your muscles do not need to tense. You can turn off the fight verses flight response by helping your body calm down.
- With your mouth closed, breathe in very slowly through your nose.
- Imagine that you are trying to blow up a balloon that is in the lower part of your belly.
- Feel your belly rise as you breathe in.
- Keep inhaling until you cannot anymore.
- Hold your breath for one or two seconds.
- Very slowly, let the air out through your lips as though you were breathing through a straw.
- Keep exhaling until it feels like there is no air left in your body.
- Do not breathe for one or two seconds.
- Repeat the breathing exercise five or ten times.