Here are answers to some common questions about bellyaches
How can I tell if my child is faking a bellyache?
Assume the bellyache is real.
How is a functional gastrointestinal (GI) disorder different from a disease?
In this context, pain associated with disease is caused by anatomic abnormalities, inflammation, and/or tissue destruction.
Functional pains are caused by an altered way in which the body is working.
If my child has symptoms, but the tests are negative, does it mean it is all in my child’s head?
No. Functional pains are influenced by a combination of mental (mind) and medical (physical) factors – a brain-gut interaction. The gastrointestinal tract is connected to the brain by millions of nerves, and each system influences the other.
If symptoms persist, does my child need more tests?
Asking this question means you either do not accept the concept of functional disorders, have not accepted your child’s diagnosis, or have fears related to the child’s health that have not yet been addressed.
If you've taken the child to other physicians who may not have come to a symptom-based diagnosis, trust in a functional diagnosis might not come easily.
A knowledgeable physician can diagnose a functional GI disorder by careful review of the child’s symptoms and a physical examination. If any selected diagnostic procedures are performed, they are often limited to a few basic tests.
Functional GI disorders are not dangerous, and we know how to manage them. Talk to your physician if you have questions or if you observe a change in symptoms.
How can you be sure there is no disease?
Worries about the child’s health are normal. Repeated explanations may be necessary because the concept of functional symptoms may be new.
There are no tests for diagnosis of a functional gastrointestinal disorder, but there are symptom-based diagnostic criteria. Functional GI disorders are common; diseases are unusual. If your child’s symptoms meet the diagnostic criteria for a functional GI disorder, there's no need to worry that it is something else.
Ask your physician to reevaluate the child promptly if the symptoms change.
How do you treat the pain in functional disorders?
Conceptually, functional abdominal pain may be treated:
- with education
- from the top down (learning)
- from the bottom up (medicines), or
- with any combination of these.
Sometimes getting a diagnosis and learning about a functional disorder is enough to reduce the worries a family has about the health of their child. All parents ask the same four questions when they see a clinician:
- What is wrong?
- Is it dangerous?
- Will it go away?
- What can we do about it?
In the case of a functional bellyache the answers are:
- It’s a functional bellyache.
- It's not dangerous.
- It comes and goes.
- There are several ways to treat it.
If the answers satisfy and the child is not disabled by pain in any way, further treatment may be unnecessary. The goal is to help the child cope with symptoms so that they don’t miss daily obligations and activities.
Top down treatment – Children can learn to use the thinking parts of their brains to reduce pain.
Research has proven that cognitive behavioral therapy (CBT) and hypnosis can be just as good as medicine in relieving functional GI symptoms.
CBT is a series of lessons that teach a child (or adult) how to use the thinking part of their brain to reduce pain from functional disorders. Usually a psychologist teaches these lessons for an hour each week for about ten weeks. It is the child’s responsibility to practice the techniques at home every day, so CBT requires active participation in the treatment.
A second top-down treatment is hypnosis. In carefully designed research, hypnosis was as good as medicine in treating irritable bowel syndrome after a few weeks.
If these top-down methods are available, they have several advantages:
- They teach the child the skills needed to reduce pain without medication.
- They add to the child’s skills at coping with other kinds of adversity and stress, like taking tests at school or hiking up a mountain.
- If practiced regularly, the skills are a permanent improvement in coping with life’s stress.
Bottom up treatment – Children may benefit from small doses of chronic pain medicines, or medicine to take away acid or intestinal muscle spasm. These medications are safe and effective in most, but not all, children.
Choice of treatments depends on how disabling the pain is to daily activities, and the availability of the treatments.
- If the pain does not disrupt daily activities, then education and reassurance may be all that is needed.
- If pain is changing the child’s behavior or disrupting the family, then CBT, hypnosis, or medicine may be advisable.
- If a functional bellyache prevents school attendance or normal eating, than a combination of top down, bottom up treatments may work best.
Is dietary fiber important?
In large population-based studies, fiber seems to have some long-term advantages.
In the short term, increasing fiber in your child’s diet may not be worth the fuss. In toddlers, getting them to eat anything regularly becomes a struggle, because it is developmentally appropriate for them to be testing their ability to control their environment. The same thing goes for adolescents.
In addition, fiber is often associated with an increase in intestinal gas production, and may increase abdominal cramps and flatulence. Flatulence is especially embarrassing to the school-age child.
Soft stools and painless defecation are most often achieved with daily oral polyethelene glycol, as directed by your child's physician.
Is diet an important factor?
Diet is very important, but each child is different. It is important to eat a well-balanced diet. If it is possible to identify foods that trigger symptoms, those foods can be reduced or eliminated from the diet. Many people with IBS - working with a knowledgeable dietitian - improve on a low FODMAP diet. FODMAP stands for "Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides, And Polyols." Present in many foods, FODMAPs are smll molecules that are converted to gas by bacteria in the intestines.
How do you know when a non-verbal child has a bellyache?
Chronic pain makes a child change behavior. Infants and toddlers will not eat when it hurts to eat or they fear it will hurt to eat. Infants and toddlers will stop pooping if they experience pain when they poop. Refusal to eat and refusal to poop are two symptoms that indicate it is time for a visit to the doctor. Crying or fussiness alone is not always a symptom of pain.
Should I keep my child home because of an early morning bellyache?
Not if there are no warning signs of disease. As a parent you can help your child learn to cope with a functional disorder. Remind the child that the functional bellyache is not dangerous, and that the pain will not differ at home or in school, so the child may as well go to school and learn.
A few children and adolescents have diarrhea and pain from irritable bowel that comes every morning and lasts several hours. A few more children and adolescents experience intense upper abdominal nausea and vomiting for several hours each morning. These early morning functional symptoms may be treated successfully with bedtime low-dose amitriptyline.
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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.
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Adapted from IFFGD Publication #809 by Paul Hyman, MD, Professor of Pediatrics; Chief, Division of Pediatric Gastroenterology, Children’s Hospital and Louisiana State University Center for Health Sciences, New Orleans, LA.