Chronic abdominal pain

Overview

More than one-third of children complain of chronic abdominal pain, defined as pain that lasts for two weeks or longer. The pain may be persistent or recurrent. Chronic abdominal pain in children and teens often poses unique challenges for patients and parents, causing worry for parents and interfering with the child's normal routine.

Causes

Because diagnosing the cause of chronic abdominal pain can be difficult, it's important to visit a qualified pediatric gastroenterologist with experience in the field.

In a small number of children, abdominal pain is caused by an underlying, identifiable condition. Most commonly, these include constipation, stomach and intestinal problems such as lactose intolerance, celiac disease or irritable bowel syndrome (IBS). Less common causes include inflammatory bowel diseases, specifically ulcerative colitis and Crohn's disease. However, in most children, the pain has no identifiable cause, which does not mean that it isn't real. This is known as "functional abdominal pain."

Signs & symptoms

Symptoms of chronic abdominal pain caused by an underlying condition may include:

• Pain that wakes your child
• Significant vomiting, constipation, diarrhea, bloating or gas
• Blood in the stool
• Unintentional weight loss or slowed growth (height)
• Changes in bowel or bladder function
• Pain or bleeding with urination
• Abdominal tenderness or fullness (mass)

Symptoms of chronic abdominal pain with an unknown cause (functional abdominal pain) may include:

• Pain that is difficult to describe and locate, or centered around the belly button
• Pain that is usually unrelated to meals, activity or bowel movements
• Pain that typically lasts less than one hour

Most children with functional abdominal pain don't have problems with growth, weight loss, fever, rash, joint pain or swelling.

Many children with functional abdominal pain have a family history of functional digestive problems such as IBS.

Stress or anxiety may trigger functional abdominal pain. The pain may occur during periods of stress or change, such as the birth of a new sibling, illness of a family member or starting school.

In some cases, a child can develop chronic abdominal pain related to a need for attention. However, it's important to note that a child rarely "fakes" pain. Acknowledge that your child's pain is real and offer sympathy, support and reassurance, but take care to avoid reinforcing the pain by giving it undue attention.

Diagnosis

In diagnosing the cause of your child's chronic abdominal pain, the doctor will first record a detailed history of your child's symptoms. Blood tests, stool and urine tests, and imaging tests of the stomach and pelvis also may be recommended.

In addition, a pain diary that tracks your child's pain during the course of a week can be very valuable in determining the cause of pain. At the end of each day, you or your child will record information about any symptoms your child experienced. Your child's pain diary should include information on the following:

• Time of day pain started
• Whether pain occurred before, after or nowhere near a meal
• The type of pain and severity on a scale of 1 to 10
• How long each episode lasts
• Where the pain is located in the belly
• What was done to help the pain (what worked and what didn't work)
• What your child was doing right before the pain began
• If the pain was related to something your child ate (for example, dairy products)
• If the pain awakened your child
• Your child's location when the pain occurred (at school, home, etc.)
• When the pain occurred (certain days of the week, etc.)

Treatment

Treatment will depend on the severity of your child's pain, his or her age and whether a cause has been identified. The goal is to manage the pain and help your child return to normal activities.

A combination of treatments may be recommended, including medication, behavioral therapies and dietary modifications. It often takes time to determine the cause of your child's pain and the most effective treatment.