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Jun 20, 2009

Mummy, my tummy hurts!

Your child will most probably experience abdominal pain at some point in his or her life. Here’s a guide to help you understand recurrent abdominal pain and what to watch out for.

PAIN in the stomach or intestinal area is generally described as abdominal pain. Your child has recurrent abdominal pain if he experiences at least three episodes of abdominal pain that are severe enough to affect his daily activities, over a period of at least three months. Studies have shown that about 10% of Malaysian school children aged 11 to 16 years suffer from recurrent abdominal pain.

Recurrent abdominal pain by itself is not a disease, but it is a term used to describe a symptom. The cause can sometimes be organic, which means that there is an underlying disorder/disease such as urinary tract infection, lactose intolerance, inflammatory bowel disease, pancreatitis (inflammation of the pancreas), gastritis (inflammation of the lining of the stomach), oesophagitis (inflammation of the lining of the oesophagus), peptic ulcer, or stool retention.

Is the abdominal pain due to an organic disease?

Features that may suggest an organic cause are:

Site of pain: Non-organic pain tends to be in the centre (periumblical). The further the pain is from the centre, the more likely the pain is caused by an underlying disease.

Sleep disturbance: Does the abdominal pain wake your child up in the middle of the night? If so, there is a much higher chance that there is an underlying organic disorder.

Age of child: In general, the younger the child, the higher the chance that there is an organic disease.

Presence of features of organic disease: Fever, blood in the stools, inflammation (of the joints, skin or eyes), weight loss, poor growth, anaemia, jaundice, pain when urinating, high blood pressure, and recurrent mouth ulcers all point to organic disease.

Family history: If there is a family history of diseases such as inflammatory bowel disease, peptic ulcer disease, or renal disorders, your child may be at a higher risk of developing these diseases.

Recurrent abdominal pain may have negative effects on your child’s physical and psychological state. The pain can interfere with his school attendance as well as affect his appetite, sleep, mood, and emotions.

In addition to his overall well-being, all these problems may affect your child’s growth and development. So if your child suffers from recurrent abdominal pain, it is best to bring him to see the doctor.

Your child may be stressed out!

Studies on recurrent abdominal pain in childhood have shown that 95% of children affected with abdominal pain have no underlying diseases. In such cases, the cause of the abdominal pain is often stress or other emotional problems related to anxiety.

Studies conducted by University of Malaya Medical Centre have shown that children aged nine to 15 years who experienced recent significant life events, such as a death in the family, change of address, failure in a major school examination, or bullying at school, have a higher chance of developing recurrent abdominal pain.

You should not disregard your child’s woes when he cries out in pain. Keep in mind that although there may be no obvious medical causes for the pain, it does not mean that the pain is not real or that your child is making it up. It merely suggests that the abdominal pain could be largely caused by stress, anxiety or depression.

If the doctor is unable to detect an organic cause for your child’s recurrent abdominal pain, it could be caused by stress or anxiety. You can help by being aware of the following:

Timing: Note the time that your child began to complain about his “stomach” pain. Did the pain start at the time of a family upheaval? Or did it occur due to problems at school? At times, there may be no obvious contributing factor. Accompanying features: Be aware of other features such as constipation, diarrhoea, headaches, feeding problems, nightmares, or fear of school.

Family history: Ask yourself if there is a family history of stress-related problems such as headaches, dyspepsia (pain or an uncomfortable feeling in the upper middle part of the stomach), irritable bowel syndrome, backaches or menstrual irregularities.

When your child’s stomach hurts

Help your child feel better at home by doing the following:

Get your child to lie down

● Talk with your child about anything that may be causing him to feel anxious or overly stressed

● Distract your child with interesting activities such as reading or playing with toys

● If your child’s abdominal pain does not improve, it is advisable to seek medical help early as there are many possible causes of abdominal pain and it is important not to miss an organic cause.

Caution: Do not give your child over-the-counter medications for the pain, unless prescribed by a doctor.

Keep your child happy

If your child is suffering from recurrent abdominal pain and an organic cause has been ruled out, do work together with the doctor to try to solve the problem. Spend time listening to your child’s worries and fears. It is important for your child to realise that his feelings matter to you.

Besides that, do take the time to look at your child on the whole, your family, your home environment and your child’s school dynamics. As a parent, it is your responsibility to ensure that your child settles in a supportive and understanding environment at home and at school. Help your child stay happy and joyful by taking action immediately as soon as you detect an issue that is bothering him excessively, to the point of causing abdominal pain.

● Prof Dr Christopher Boey is a consultant paediatrician. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting Digestive Health Initiative and the Malaysian Society of Gastroenterology & Hepatology. The programme is supported by an educational grant from Vitagen Healthy Tummies Programme. For further information, please visit PROF Dr CHRISTOPHER BOEY

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