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Abdominal pain in children – chronic

Key points about chronic tummy pain in children

Chronic tummy pain is common and often due to increased pain sensitivity to the movement of food and by-products through the digestive tract. This is called functional abdominal pain.
Common functional causes are irritable bowel syndrome and functional dyspepsia.
Less often there may be an underlying condition, eg, coeliac disease or inflammatory bowel disease.
If not treated, chronic tummy pain can affect your child's wellbeing.
If there is an underlying cause, treatment will focus on it. Functional pain can be managed by reassurance and explanation of the source of the pain.
For 30–50% of children it will settle within 6 weeks.

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Chronic abdominal pain in children is common. It refers to tummy pain that is constant or comes and goes for more than 2 months, and is bad enough to interrupt normal activities.

Image credit: 123rf

The most common causes of chronic tummy pain in children are due to the body's functioning – this is referred to as functional abdominal pain. This means your child may have an increased pain sensitivity in response to the movement of food through the gastrointestinal tract. In most cases, there is no serious underlying disease.

Functional causes include:

irritable bowel syndrome
functional dyspepsia
abdominal migraine
abdominal wall pain.

Organic causes can be found in some cases but these are less common. These include:

coeliac disease
inflammatory bowel disease, Crohn's disease or ulcerative colitis
peptic ulcer disease
recurrent UTI
pancreatitis
enteric infection
gallstones or kidney stones
ovarian cysts
constipation.

Chronic tummy pain is vague and is usually located around the belly button. Other symptoms that can accompany chronic tummy pain in children include:

nausea (feeling sick)
headache
dizziness
indigestion
altered bowel habits
excessive gas.

If your child has the following symptoms, it usually suggests an organic cause (physical abnormality). Tell your doctor about these symptoms:
poor growth weight loss chronic severe diarrhoea (runny poos) constipation (not pooing enough) blood in stools (poos) unexplained fevers or joint aches persistent vomiting (being sick) waking up at night due to the pain family history of peptic ulcers or inflammatory bowel disease.

Your doctor will take a history including asking about what the pain is like, any other symptoms and family history. Your doctor will also want to know about how your child has been at school and at home, including your child's behaviour and mental health.

Your doctor will examine your child's stomach and measure your child's growth. In some cases, a rectal examination may be needed. Your doctor will also do some tests, such as blood tests, taking a stool sample, urine (pee) test or an abdominal ultrasound. These tests are to rule out other diseases and to confirm any diagnoses depending on what your doctor thinks is causing the pain.

If there is a physical or organic cause, treatment will focus on the underlying condition. If it is due to a functional cause, it can be managed by reassurance and explanation of the source of the pain.

Medicines are usually not needed, unless the pain is caused by an organic or a physical cause. In some cases, cognitive behavioural therapy from a psychologist can be helpful.

There are some tips that to help manage chronic abdominal pain in children:

Keep a diary and record the intensity, triggers, timing, duration and relieving factors of your child's pain. It can be useful to bring this to your doctor’s appointment.
Encourage healthy behaviours such as a balanced diet and physical activity.
Avoid reinforcing pain or pain behaviours. Reassure your child the pain will ease and encourage them to continue their normal activities.
Chronic abdominal pain usually happens in the morning and lasts less than an hour, so bring your child to school when the pain starts to settle.
Encourage school attendance.
Gain support from school teachers and discuss a plan to manage abdominal pain in school.

Your doctor will also ask for regular follow-up appointments to make sure that your child's pain is settling. If your child's pain gets worse or new symptoms arise, tell your doctor as this may suggest an underlying physical or organic cause.