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Diagnosing Stomach Aches

by Sue Hubbard, M.D.

I see a lot of children in my practice with recurrent abdominal pain, and the end of the school year is especially note worthy for causing “stomach aches”. It always takes a little more time to get a good history from the child and parent about the tummy aches. You need to ask where the pain is located, how does it feel (burning, stabbing, crampy?), what things seem to make the pain worse, what makes the pain better, is it worse in the morning or evening, does the pain awaken the child from deep sleep (very important and different than does it keep them from falling asleep). I always try to get a good stool history, which is the most daunting problem, as kids don’t like to discuss their poop! You also need to know if there has been fever, weight loss, recurrent vomiting, blood in stools, rash or other systemic symptoms. Lastly, how long has it been going on, days, weeks, months and does it cause them to miss school, play dates, after school activities etc. routinely.

In the majority of cases after a thorough history many of these “tummy aches” are worse in the morning, do not wake them up from sleep, do not prevent the child from going to dance or soccer and if they stay home from school seem to be better before lunch, really have not changed their appetites except when the tummy hurts, and there has been no weight loss or other systemic symptoms. On physical exam the pain is usually right in the middle of the abdomen with no localizing areas (this is called peri-umbilical), and usually a good sign. Their abdomens will be soft and if you exam them while talking (to distract them) you get the sense that they are not tender, they do not have any masses, have good bowel sounds and there are no specific areas of pain.

Many of these kids are diagnosed with functional abdominal pain (FAP), which is the ongoing presence of abdominal pain for which no physical explanation or findings can be found. A child with FAP often is challenging as the problem is benign, but the symptoms of recurrent stomachaches cause a lot of stress to the child. Education for the family and child is probably the most important part of their treatment. It is helpful to summarize the child’s symptoms and exam and explain that although the pain is REAL, there is most likely not a serious underlying disease (like cancer, tumor, ulcer, appendix). The goal is to get the child to return to normal function rather than complete disappearance of their pain.

In most cases the child is relieved by the findings and often the pain will diminish as their anxiety does too. Funny thing, I rarely seen recurrent stomach aches in the summer. That too is reassuring for both family and child.

That’s your daily dose, we’ll chat again tomorrow.

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