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It ’ s A Gut Feeling: Abdominal Pain in Children

Learn about the causes, symptoms, and treatment of abdominal pain in children, including screening tests and red flags for serious issues. Discover common conditions like irritable bowel syndrome and stress triggers, alongside treatment options and prognosis.

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It ’ s A Gut Feeling: Abdominal Pain in Children

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  1. It’s A Gut Feeling: Abdominal Pain in Children David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians

  2. Introduction • Common Symptom • Affects 10-15% of school-aged children • Definition (Dr. John Apley) • 3 episodes of pain over 3 months • Interferes with normal daily activities • Any child that seeks medical attention

  3. Causes • Functional abdominal pain • 90% of children • Organic • 10% of children • How to tell if serious? • Parents want an answer • How much testing to do

  4. Functional Abdominal Pain • No treatable cause found • Irritable bowel syndrome • Hypersensitivity disorder • Visceral hyperalgia • Not wimpy kids

  5. Symptoms of Functional Pain • Age greater than 5 years-old • Pain-free periods • Periumbilical pain • No relationship to eating, stools, stress, etc • Headaches, dizziness, appear pale

  6. Symptoms of Functional Pain • Fatigue or weakness • Pains in arms and legs • School absence but good student • Pain interfering with activities out of proportion to evaluation • Often a history of colic or feeding problems • No red flags

  7. Red flags Suggesting Serious Problem • Age less than 5 years-old • Weight loss or poor growth • Pain away from the belly button • Vomiting • Night-time pain

  8. Red flags Suggesting Serious Problem • Diarrhea (night-time) • Blood in the stool • Fever • Rash or joint pain • Family history of ulcers, inflammatory bowel disease • No school absenteeism

  9. Screening Tests • Thorough history (without parents) • Physical exam including growth chart • Stool for blood • CBC • ESR • UA • Celiac screen • Missed disease rare

  10. Treatment • Avoid excessive tests • Explanation of RAP • Not faking it • Similar to headache • Encourage regular routine • School attendance • Adequate sleep

  11. Treatment • High fiber diet • Peppermint • Healthy diet • Fast food • Caffeine • Spicy foods • Identify any stressors

  12. Stressful Stimuli • Physical Stress • Recent physical illness • Milk intolerance • Constipation

  13. Stressful Stimuli, cont. • Emotional Stress • Illness in family member • School problems • Recent move

  14. Treatment • Counseling • Treat anxiety • Help family promote adaptive behaviors • Children very suggestible • Coping mechanisms • Medications • Antispasmodics • Amitriptyline

  15. Prognosis • One-third resolve within few months • One-third replace abdominal pain with new symptom • One-third continue with pain

  16. Common Causes • School avoidance • Constipation/Encopresis • Muscle pain • Urinary Tract Infection • Physical or sexual abuse • Food allergies • Parasites • Giardia, Blastocystis

  17. Common Causes, cont. • Lactose Intolerance • Onset 4-6 years-old • Bloating, diarrhea, gas • Breath test or dietary exclusion • Carbohydrate Intolerance • Fructose (fruit and juice, soft drinks) • Sorbitol (fruits, sugar-free candy and gum)

  18. Common Causes, cont. • Irritable bowel syndrome • Abnormal contractions or sensation of the intestine • Not a psychological illness • Non-ulcer dyspepsia • Diarrhea-predominant • Constipation-predominant

  19. Common Causes, cont. • Irritable bowel syndrome • Rome criteria • Pain relieved by stools • Altered stools at time of pain • Altered stool frequency at time of pain • Mucus in stools • Bloating

  20. Common Causes, cont. • Irritable bowel syndrome treatment • Probiotics • Chamomile or peppermint tea • Peppermint • Relaxation techniques • Medications • Antispasmodics • Amitriptyline

  21. Common Causes, cont. • Gastroesophageal reflux • History of spitting up as a baby • Heartburn or regurgitation • Epigastric or chest pain • Dysphagia • Treatment • Maalox or Mylanta • Acid suppression

  22. Common Causes, cont. • Eosinophilic Esophagitis • Reflux symptoms • Dysphagia • Related to food allergies • Treatment • Elimination diet • Inhaled steroids

  23. Ulcers • Somewhat rare • Night-time pain, vomiting • Etiology • Ibuprofen • Helicobacter pylori • 20% of children • Blood test, stool test, EGD

  24. Gallstones • Rare • Think if blood disorders, obesity, OCP’s • Symptoms • Upper abdominal pain after meals • Increasing pain lasting 1-4 hours • Associated with vomiting

  25. Inflammatory Bowel Disease • 25% of patients less than 18 years-old • Family history in 30% • Autoimmune disease • Ulcerative colitis • Diarrhea, urgency, blood or mucus • Crohn’s disease • Weight loss, pain, diarrhea

  26. Celiac disease • Common (1:100-200 people) • Gluten (wheat, rye, barley) • Variable symptoms • Screen with antibody tests • Diagnose with EGD • Gluten-free diet for life

  27. Cyclic Vomiting Syndrome • Migraine Equivalent • Recurrent episodes of pain and vomiting • Seasonal • Diagnosis of exclusion • Treatment • Abortive therapy (Zofran, NSAIDs) • Preventative

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