Abdominal Pain
By Dr. Brown
Chronic recurrent abdominal pain is a common problem in pediatrics. Although pain can be caused by familial inherited diseases like Crohn’s disease or Ulcerative Colitis or something severe like appendicitis, more commonly the cause is usually attributed to constipation, poor diet, emotionally based pain, or lactose intolerance. Statistically, lactose intolerance and constipation are the most common causes in children.
In just about all cases for recurring abdominal pain, proper diet and plenty of fluids is the best treatment. Increasing fiber can help prevent non-specific "tummy aches". Another wonderful adjunct treatment is the use of "probiotics". These are the good bacteria that help with proper digestion and overall good bowel health. Probiotics can be purchased at the pharmacy without a prescription. Although there are specific children's versions, any probiotic will work. The various probiotics contain many different strains of healthy bacteria. So, if one brand doesn't work, you can try another brand.
Lactose Intolerance is a very common problem in our office. Many times there is a family history of intolerance to cow’s milk and milk products like ice cream, yogurt, cheese, butter, or even milk chocolate. If one or both parents have problems digesting milk it is very common for the child to also have problems. This may begin in infancy with breast milk or formula but most commonly this intolerance begins to appear in the early childhood years. It may first show up after a bad illness with diarrhea and then get better only to return later.
The problem stems from the patient's inability or decreased ability to make an enzyme in the intestine called "lactase". Lactase normally helps to digest the carbohydrate in milk called lactose. When a patient lacks the lactase enzyme, the bloating and discomfort comes from the gas produced by the bacteria that are normally present in the colon that digest the lactose further.
Treatment is simple. Lactase enzyme is available and does not require a prescription. You can often find it in the grocery store next to the milk section or at a pharmacy. It comes as a capsule. This capsule can be directly swallowed or can be opened into milk or sprinkled on cheese, pudding, pizza, ice cream, etc., at the time your child has the food or drink. This enzyme helps to replace the naturally occurring enzyme that the body is deficient in. Lactaid Milk is also available in grocery stores and is right next to the regular milk. By the way, Lactaid Milk is very sweet so your child is not likely to complain about the taste.
Constipation may seem easy to diagnose based on your child's habits, and most times it is, but the condition can also be "sneaky". Sometimes children may be passing stool on a regular basis, but instead of completely emptying their bowels, the child may be leaving portions of bowel movement inside. When the stool stays inside longer, the bacteria in the colon further ferment the stool causing more gas, distention of the bowel, and discomfort. In another variation called overflow constipation or encopresis: soft or liquid stool leak from the rectum around a mass of stool that is stuck in the lower bowel. So, it appears that your child is having bowel movements but not really getting all of the stool out. In fact, since it's only the loose material that can get around the mass of stool, you may be fooled that your child has diarrhea! There is a great video that discusses this concept on YouTube called "The Poo In You" - GI Kids, Colorado– the video is about 5:45 and helps parents understand this perplexing problem.
The remedy for chronic constipation is of course good diet, plenty of fluids, and good voiding habits. For the overflow type, you may have to spend a few days "cleaning" your child out to get the stuck mass removed, and then restart your child with good eating and voiding habits. To clean your child out well, you can use something like Miralax (also known as PEG-3350) which is non-prescription. The powder is generally given as one tablespoon mixed into 8 ounces of water, juice, etc. It's pretty tasteless, so you may be able to sneak it into your child's drink if necessary. Depending how much you need to clean out, will determine how many glasses your child needs.
Miralax can also be used to keep your child loose. Of course, it would always be best to have your child eat healthy foods - fruits and vegetables, but sometimes he or she will need extra help. Giving a small daily dose of Miralax may be just the answer. You will have to titrate your child's individual dose - it may be one tablespoon or one teaspoon per day; or it may be a dose every other day.
Once your child is better and regular, don't abruptly stop the Miralax. Slowly (over weeks and months) lower the dose of Miralax. Even consider giving a small dose every 2nd or 3rd day. This will allow you to see if your child begins to get constipated again before things get out of hand!
Crohn’s Disease usually begins with bloody stools, cramps, weight loss. Often there can be a family history of inflammatory bowel disease (IBD). Anemia (low hemoglobin in the blood) is usually due to blood loss in the bowel movements. Less energy is usually due to anemia and corrects when the blood counts return to normal. Age of onset is teenage years most often but can begin as a young child.
Ulcerative Colitis usually begins with bloody stools, abdominal pain, weight loss, and anemia as in Crohn’s disease. Similarly, there is often a family history. With both of these conditions, a gastroenterologist is usually consulted for diagnostic and therapeutic courses.
Appendicitis requires surgery. Appendicitis begins with abdominal pain often around the belly button and soon, within a few hours goes to the lower right part of the abdomen. We have seen it in all parts of the abdomen. Call us if your youngster has fever, loss of appetite, vomiting, and pain that is particularly bad when your child is moving around or jumping (you can try the jump test at home).
Chronic recurrent abdominal pain is a common problem in pediatrics. Although pain can be caused by familial inherited diseases like Crohn’s disease or Ulcerative Colitis or something severe like appendicitis, more commonly the cause is usually attributed to constipation, poor diet, emotionally based pain, or lactose intolerance. Statistically, lactose intolerance and constipation are the most common causes in children.
In just about all cases for recurring abdominal pain, proper diet and plenty of fluids is the best treatment. Increasing fiber can help prevent non-specific "tummy aches". Another wonderful adjunct treatment is the use of "probiotics". These are the good bacteria that help with proper digestion and overall good bowel health. Probiotics can be purchased at the pharmacy without a prescription. Although there are specific children's versions, any probiotic will work. The various probiotics contain many different strains of healthy bacteria. So, if one brand doesn't work, you can try another brand.
Lactose Intolerance is a very common problem in our office. Many times there is a family history of intolerance to cow’s milk and milk products like ice cream, yogurt, cheese, butter, or even milk chocolate. If one or both parents have problems digesting milk it is very common for the child to also have problems. This may begin in infancy with breast milk or formula but most commonly this intolerance begins to appear in the early childhood years. It may first show up after a bad illness with diarrhea and then get better only to return later.
The problem stems from the patient's inability or decreased ability to make an enzyme in the intestine called "lactase". Lactase normally helps to digest the carbohydrate in milk called lactose. When a patient lacks the lactase enzyme, the bloating and discomfort comes from the gas produced by the bacteria that are normally present in the colon that digest the lactose further.
Treatment is simple. Lactase enzyme is available and does not require a prescription. You can often find it in the grocery store next to the milk section or at a pharmacy. It comes as a capsule. This capsule can be directly swallowed or can be opened into milk or sprinkled on cheese, pudding, pizza, ice cream, etc., at the time your child has the food or drink. This enzyme helps to replace the naturally occurring enzyme that the body is deficient in. Lactaid Milk is also available in grocery stores and is right next to the regular milk. By the way, Lactaid Milk is very sweet so your child is not likely to complain about the taste.
Constipation may seem easy to diagnose based on your child's habits, and most times it is, but the condition can also be "sneaky". Sometimes children may be passing stool on a regular basis, but instead of completely emptying their bowels, the child may be leaving portions of bowel movement inside. When the stool stays inside longer, the bacteria in the colon further ferment the stool causing more gas, distention of the bowel, and discomfort. In another variation called overflow constipation or encopresis: soft or liquid stool leak from the rectum around a mass of stool that is stuck in the lower bowel. So, it appears that your child is having bowel movements but not really getting all of the stool out. In fact, since it's only the loose material that can get around the mass of stool, you may be fooled that your child has diarrhea! There is a great video that discusses this concept on YouTube called "The Poo In You" - GI Kids, Colorado– the video is about 5:45 and helps parents understand this perplexing problem.
The remedy for chronic constipation is of course good diet, plenty of fluids, and good voiding habits. For the overflow type, you may have to spend a few days "cleaning" your child out to get the stuck mass removed, and then restart your child with good eating and voiding habits. To clean your child out well, you can use something like Miralax (also known as PEG-3350) which is non-prescription. The powder is generally given as one tablespoon mixed into 8 ounces of water, juice, etc. It's pretty tasteless, so you may be able to sneak it into your child's drink if necessary. Depending how much you need to clean out, will determine how many glasses your child needs.
Miralax can also be used to keep your child loose. Of course, it would always be best to have your child eat healthy foods - fruits and vegetables, but sometimes he or she will need extra help. Giving a small daily dose of Miralax may be just the answer. You will have to titrate your child's individual dose - it may be one tablespoon or one teaspoon per day; or it may be a dose every other day.
Once your child is better and regular, don't abruptly stop the Miralax. Slowly (over weeks and months) lower the dose of Miralax. Even consider giving a small dose every 2nd or 3rd day. This will allow you to see if your child begins to get constipated again before things get out of hand!
Crohn’s Disease usually begins with bloody stools, cramps, weight loss. Often there can be a family history of inflammatory bowel disease (IBD). Anemia (low hemoglobin in the blood) is usually due to blood loss in the bowel movements. Less energy is usually due to anemia and corrects when the blood counts return to normal. Age of onset is teenage years most often but can begin as a young child.
Ulcerative Colitis usually begins with bloody stools, abdominal pain, weight loss, and anemia as in Crohn’s disease. Similarly, there is often a family history. With both of these conditions, a gastroenterologist is usually consulted for diagnostic and therapeutic courses.
Appendicitis requires surgery. Appendicitis begins with abdominal pain often around the belly button and soon, within a few hours goes to the lower right part of the abdomen. We have seen it in all parts of the abdomen. Call us if your youngster has fever, loss of appetite, vomiting, and pain that is particularly bad when your child is moving around or jumping (you can try the jump test at home).