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Talking About GI Disorders

Here are some common questions about GI disorders in children:

How do I know if my child really has an upset stomach, or is trying to avoid going to school?

Many school-age children never think about faking it; assume the bellyache is real. However, children and parents often forget that some bellyaches come from too much excitement or from worries.

For school morning bellyaches, use the "Rule of Ones." If there is only one symptom, the bellyache, then don't worry. Two or more symptoms, bellyache and fever, or bellyache and vomiting should be taken more seriously.

The "Rule of Ones" may be used for two other common symptoms; infant regurgitation and toddler's diarrhea. In the absence of a second symptom, these two problems are likely to be functional, meaning they are expected behaviors for that age group, and are not a cause for alarm.

Why do irritable bowel symptoms seem to be worse in the morning and at bedtime in children?

These are stressful times for a child. There are a number of children who have bedtime anxiety which will cause symptoms of irritable bowel syndrome (IBS) at night, and also in the morning children will be under a fair amount of stress and anxiety facing the day, especially during school days. At times, children will not have pain during holidays or on the weekends during the morning time.

Shall I send my child to school when he or she is in pain from IBS?

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Children often wake up in the morning complaining of severe symptoms and then by early afternoon or late morning will be symptom free. This is difficult to understand for the parents. As the child stays home from school, part of the stress and anxiety decreases and the symptoms dissipate. Unfortunately, they may get into a vicious cycle where they become more nervous about missing school and making school work up, which will then increase their stress and anxiety level, and may increase pain that evening, prior to bed, and again the following morning. Children need to go to school, under these circumstances. They need to break the cycle of stress and anxiety, which is made worse by missing school.

I am 13 years old and have had stomach pains for over one year that make it hard for me to do anything. I have recurring abdominal pain syndrome. My doctor said there is nothing wrong with me and nothing he can do to treat me. Do you have any suggestions?

We assume that you have been seen by a physician who gave you the diagnosis of "recurring abdominal pain syndrome," (functional recurrent abdominal pain).

Tests are done to look for the presence of disease as the cause of symptoms. If the tests find no evidence of disease, the symptoms are termed "functional." Diagnosis of this functional gastrointestinal disorder is based on the symptoms, after ruling out the presence of disease or tissue damage. These symptoms are defined as abdominal pain severe enough to disrupt routine activities three or more times during a three-month period. Studies show that it is pretty common, affecting 10%-15% of school-aged kids.

So if it is not a disease that is causing these symptoms (you are not sick and that is good news), what is causing it? The answer is not entirely clear. Ongoing research is looking for the explanation.

Recent studies point to an increased sensitivity of the sensory nerves in the intestines. Normal movements of your intestines may be perceived as cramps or other discomfort.

The intestines share nerve pathways with the brain. In many situations, when the brain reacts to something – like the sound of a dentist's drill – the intestines, or gut, pick up the same signals and react.

The majority of people will ultimately have some kind of gastrointestinal (GI) symptom when exposed to stressful situations. If your GI system is a bit too reactive, you will experience symptoms in more types of stressful situations than someone else will whose gut is not quite as reactive. What is stressful for one person may not be stressful to another, and lots of people don't even realize it when they get stressed – they just feel sick.

Finally, there is the "gate theory" of how pain is experienced. When pain originates at some point, nerve messages pass through something like a gate on their way to the brain. The wider open the gate is, the more pain that is experienced. By thinking about and focusing on the pain site, we open the gate. Plus, feelings of anger or worry or sadness can open the gate.

However, we can also help close the gate. Turning attention away from the site or feeling of pain, through relaxation or focusing on some other activity, can help close the gate and lessen or even eliminate pain.

A well-known phenomenon that demonstrates this is that of the athlete who plays a game while injured, oblivious to the pain. The athlete is completely focused on the game and does not feel pain. Then, after the game is over, the athlete turns attention to the injury and feels pain.

Whatever the cause, you can do something about it! It takes some effort but there a number of ways that you can help yourself.

First, think about this example. Have you ever experienced a muscle cramp or a side-ache during strenuous running or exercise? You feel real pain in muscles that are not diseased. But they have been stressed beyond some point that in you causes discomfort. What do you do to avoid it in the future? You might think about what you were doing that resulted in the muscle pain. Maybe next time you do more warm-up exercises, or start out slower, or don't run as far.

The first time you felt a side-ache, you might have felt concerned and stopped running. After you learned that it was nothing to be concerned about, you may have barely taken notice the next time it happened, perhaps slowed down a bit, but then kept right on going.

This is the same type of thing that happens with functional recurrent abdominal pain. Your intestinal muscles may be causing you to feel pain. To get it under control, try this:

  1. While the pain you feel is very real, do not worry that you are sick. You are not. Your body is reacting to events in a way that is causing you discomfort but is not cause for alarm.
  2. Try to figure out if your symptoms are connected with anything else that may be triggering them. Do symptoms flare at certain times, before certain events, on weekdays, on weekends, etc? If you can identify triggering factors (like certain foods or activities) you can try to avoid them, or if that is not possible, try to deal with them in different ways.
  3. Are you missing school because of this? Worry over missing school can make symptoms worse. Try to keep going.
  4. Are you doing too much-school plus lots of outside activities? If so, take some time off to relax. Too much of anything can be stressful.
  5. The next time you feel the pain, don't let it stop you. Keep on going. Practice focusing your thoughts on what it is you want to do next and then go ahead and do it. Don't let pain take your awareness hostage.
Last modified on August 21, 2013 at 01:41:01 PM