Functional abdominal pain in children

Does your child complain of stomachaches a lot? It may be what's called functional abdominal pain.

It's a tricky condition in kids. Most often, the discomfort isn't found to be the symptom of a specific condition for which there's a clear course of treatment, and so initially its origin is something of a mystery. But it is very much a real, painful condition in otherwise seemingly healthy children that should be addressed.

"For a very long time, this has been a wastebasket diagnosis," says Sana Mansoor, M.D., a board-certified LifeBridge Health pediatric gastroenterologist. "In the past, children were sometimes told it was all in their head. But studies have shown that the symptoms are very real. The pain is very real but without an underlying physical abnormality. It's almost like a nerve pain. There's no blood test or imaging that can be done to find the source of it, but it happens because different biopsychosocial factors cause lowering of the body's pain threshold."

What can trigger it

About four episodes of random, unexplainable pain in a month, for at least two months, should raise suspicion of functional abdominal pain. Pain is commonly experienced around the belly button area, though the pattern, severity or location of the pain can vary.

"It's extremely common. We see it in young kids. We see it very commonly in teenagers," Mansoor says.

To get to root of the problem, doctors usually apply the biopsychosocial model, which takes into consideration biological, psychological and social factors the child may be dealing with. Sensitivity of the digestive organs is at the core of functional abdominal pain. Nerve signals or chemicals secreted by the gut or brain may cause the gut to be more sensitive to triggers that normally do not cause significant pain such as stretching or gas bloating, according to the American College of Gastroenterology. Digestive tract sensitivity can be triggered by any number of things, including a viral or bacterial infection, stress or constipation. Children suffering from psychiatric disorders such as anxiety and depression, or physically or emotionally traumatic experiences, may have an exaggerated response to pain.

Possible symptoms

Symptoms associated with functional abdominal pain may include:

• Dyspepsia (upper abdominal pain associated with nausea)
• Vomiting
• Feeling of fullness after just a few bites
• Abdominal pain with bowel movements

Pain can be so severe it can make a child cry or break into a sweat, or cause his or her face to turn pale or red. "Functional abdominal pain is a very common reason for kids missing school and, consequently, parents missing work," Mansoor says.

The good news is that despite the recurring pain, normal growth and general good health persist.

How it's treated

Mansoor says doctors try not to go overboard with examinations for functional abdominal pain because of the added negative effects frequent testing can have on the child's psychological state. "We know that excessive testing adds to the anxiety, especially when we don't find anything and it causes the kid to think, "˜There's something wrong with me and nobody can find what's wrong with me,'" she says.

For treatment, doctors typically recommend dietary changes that may include avoidance of greasy and spicy foods, caffeine, juices, and carbonated drinks, as well as gas-forming foods such as cabbage and beans. "There are certain sugars which are not digested well, and if you do eat a lot of them, they produce a lot of gas leading to indigestion," Mansoor says.

Avoiding lactose might also be helpful for children who suffer from lactose intolerance in addition to functional abdominal pain. In addition, patients may benefit from avoiding sugar-free sweets containing sorbitol, which cannot be properly digested and, when large amounts of it are consumed, can cause cramping, bloating and diarrhea.

Certain antibiotics and antispasmodic medications may be prescribed in some cases. Low-dose antidepressants, particularly for teenagers, are also a possible treatment because of the stress and anxiety associated with functional abdominal pain. Sometimes families are encouraged to take the child to see a behavioral therapist or psychologist to talk about what may be bothering them (perhaps bullying) and/or learn coping mechanisms. "Things that are proving to be really helpful are cognitive behavioral therapy, relaxation exercises like yoga, stress reduction and hypnotherapy," Mansoor says.

Functional abdominal pain is a condition treated by LifeBridge Health pediatricians. Call 410-601-WELL to learn more about services offered at LifeBridge Health or to schedule an appointment with a physician.