Your Children's Health

By Roy Benaroch, MD

Last week we talked about the first steps to take when your child has a belly ache: how to look for the very rare (but serious) causes and how to understand what’s going on and help your child feel better. Now it’s time to review some of the most common causes of recurring belly aches in children.

Constipation happens at every age. Our guts are just not developed to digest and handle the kind of diets that we consume in the developed world—even the healthiest 21^st century meals are completely unlike anything humans have had to digest for thousands of years. Don’t worry if your child is constipated—but do take steps to help. The best hints for constipation as a cause of pain: it gets worse during or after meals, and it’s relieved by a trip to the bathroom. If your child has hard, large, infrequent stools, talk with your own pediatrician about steps you can take to relieve this. It will include something to help keep stools soft, plus setting aside relaxed, unhurried time to sit in the bathroom for a set period of time each day.

Many older children develop lactose intolerance. This is never present from birth—human milk is loaded with lactose—but instead starts in children and young adults, building gradually as people lose the ability to digest this natural milk sugar. Symptoms include abdominal pain, bloating, and foul-smelling diarrhea after dairy products. Tests for this aren’t widely available, but you can do your own test by restricting dairy, then deliberately giving your child a big glass of milk. You’ll know quickly if it’s the dairy causing the pain.

Another common cause of recurrent abdominal pain is irritable bowel syndrome. In this condition, the gut seems to be overly sensitive to ordinary sensations. The diagnosis doesn’t require invasive testing, and treatment usually relies mostly on improving the diet and other lifestyle factors.

Many children seem to have most or all of their abdominal pain on school days, especially in the mornings. This doesn’t mean the pain is fake, but it does mean that stress and psychological factors might be contributing (as well as rushed meals, school lunches, and some children’s refusal to use the bathrooms at school!). Keeping a log of when pain occurs can help parents and pediatricians spot the patterns that reveal the diagnosis.

There are other, more rare causes of belly pain, some of which need more specific evaluation and management. Hints that something like this could be going on include weight loss, unexplained fevers, pain accompanied by vomiting or reflux, blood in the stools, exposures to farm animals, or a family history of conditions like Crohn’s Disease or ulcerative colitis. If your child’s abdominal pain is frequent, severe, or just won’t go away with simple steps, you need to take him to the doctor for an evaluation.