These children should be seen by a pediatric gastroenterologist and/or receive comprehensive care through a comprehensive pain management clinic.Ībdominal migraine is a specific type of abdominal pain that is episodic. Coexisting anxiety and/ or depression can be harbingers of long-term problems with abdominal pain and should be treated. In children with more severe symptoms, cognitive behavioral therapy and hypnotherapy have been shown to be helpful. Consuming 60 oz of water per day can help ease symptoms by lessening postural symptoms associated with hypo-hydration. Some children develop symptoms of autonomic dysfunction, typically manifested by dizziness, which occurs particularly with positional changes. Finally, social activities with the child’s friends and others should be encouraged. The child should have a regular sleep schedule, and get at least 8 hours of sleep each night. The child should have some form of physical activity for 1 hour a day, perhaps starting with 5 minutes a day and gradually increasing. Despite the pain, the child should go to and remain in school (can be done gradually if needed). In general, the 4 S’s form the cornerstone of management: school, sports, sleep, and social activities. The family should understand that keeping the child functional will lessen the pain and not vice versa (eg, having a child go to school regularly will decrease pain.) Caregivers should be taught to deal with pain complaints empathetically but not focus excessively on it. When the symptoms are mild and early in the course of chronic pain, simple lifestyle changes can suffice. Suggest making lifestyle changes as the first approach and then offer second-line options. Acknowledging the real nature of the symptoms can be helpful, along with emphasizing that the situation is not dangerous and many children will get better. These disorders are now considered to be disorders of gut-brain interaction and should not be presumed to be made up or in the child’s head. It is important to provide a symptom-based diagnosis of functional pain to the child and the family. When the pain is centrally located and does not vary with meals or stooling, it is consistent with functional abdominal pain. If the pain improves with stooling, it is either functional constipation (pain improves with laxative therapy) or irritable bowel syndrome (pain may or may not improve with laxative therapy). One should consider screening for Helicobacter pylori and then subspecialty referral. When the pain changes with intake of all food, the child either has either some form of gastroesophageal disease or functional dyspepsia. In addition, details regarding changes of the pain when eating and stooling should be elicited. Also, nocturnal wakening with pain is not necessarily a sign of organic disease.Įvery child with chronic abdominal pain should have a thorough history and physical examination, and most children should undergo screening for organic disease (see a “Guide to GI screenings and more”). The closer the pain is to the umbilicus the less likely it is to be organic. In addition to eliciting the presence of red flags, certain symptoms are less likely to be associated with organic disease: pain lasting less than 5 minutes at a time (even when it occurs multiple times a day), pain upon waking, and pain when going to bed. 1 However, chronic abdominal pain in the absence of red flags is rarely associated with organic disease (Table 1). This review focuses on their presentations.Ĭhronic, functional abdominal pain occurs in about 15% of all children. The most common gastrointestinal (GI) ailments seen by a pediatrician include abdominal pain, diarrhea, vomiting, constipation, failure to gain weight, and feeding problems.
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