How is recurrent abdominal pain in children treated?
If your child has an underlying physical cause for their recurrent abdominal pain (RAP), such as constipation or coeliac disease, treatments will be directed at that cause, and are not described here.
Most children with RAP without physical cause get better with reassurance that there is nothing physically wrong and with an explanation of the source of the pain.
Various other things may be helpful, including:
If children are stressed by RAP, and if they continue to miss school and other activities, a type of counselling called cognitive behavioural therapy (CBT) may be helpful. CBT helps people to change the way that they think about stressful things.
Family therapy, in which other members of the child's family are involved in the therapy, can be useful, particularly if other members of the family are experiencing anxiety. Other forms of talking therapy such as hypnotherapy are also sometimes used. Hypnotherapy probably affects the way the brain deals with pain.
Medicines are not usually recommended for children with RAP, unless they have severe symptoms which have not responded to simple management. Medicines are often not very effective for pain originating in the brain, and the side-effects of many medicines can make tummy pain worse. The following treatments are sometimes used, with varying success:
- Peppermint oil for IBS.
- Pizotifen (a migraine prevention medicine) for abdominal migraine.
- Indigestion medication called H2-receptor antagonists for children with severe symptoms of 'heartburn' or dyspepsia.
It has been suggested that children are less likely to experience RAP if they have a good proportion of fruit in their diet. It is not, however, clear that modifying the diet once you have RAP is helpful.
There is no evidence that fibre supplements or lactose-free diets are helpful for most children. Some children with IBS (see below) may benefit from fibre - but this must be of the soluble type. Insoluble fibre makes things worse.
It is always the case that a balanced, healthy diet containing sufficient fibre, fruit and vegetables is generally better for your child's health.
Children who have proven food intolerances, such as lactose intolerance, will benefit from excluding those items from their diet. In the case of lactose intolerance, this condition is not an allergy but an inability to process lactose in the bowel. It therefore does not usually need to be absolutely excluded from the diet, just reduced.
True food intolerance can only be diagnosed by stopping and they trialling the relevant food. Allergy tests offered by alternative practitioners, such as hair tests or tests involving placing food on the skin, are not supported by evidence, which means that they do not produce medically accepted results. If following such advice and applying exclusion diets as a result, be very aware of your child's need for a balanced diet with sufficient calories and nutrients to support growth and development, energy, learning and exercise. Restrictive diets are potentially harmful, so please consider talking to a health professional before making this choice for or with your child.
Hot water bottle
The power of the hot water bottle to make children feel better should not be underestimated. A hot water bottle, or a microwave-warmed grain bag, can be very helpful. This isn't just a 'placebo' - adding warmth to the sensations on the tummy can 'override' the pain nerves and reduce the sensation of pain.
Exercise and distraction
As explained under the section which explains the pain, boosting the levels of the body's natural painkillers such as adrenaline (epinephrine), cortisol and endorphins will reduce the sensation of pain. The best ways to increase levels of these natural body chemicals include exercise and fun or exciting activities. This may not always be easy (or even possible) for your child whilst they have pain. However, there is evidence that increasing these activities when your child does not have pain will then benefit them when they do.
Distraction can also be helpful during episodes of pain. Focusing the mind away from the pain will reduce its impact. Most parents are very experienced in distracting their child from pain - reading, films and TV, music and conversation are all likely to help your child feel better during attacks. Helping them keep up with school work if absent from school may also help them feel better, as they may be less worried.
Management of IBS in children
The symptoms of IBS can often be treated with a combination of the following:
- Adjustments to diet, including eating smaller meals more often, or eating smaller portions, and eating meals that are low in fat and high in carbohydrates.
- Medications (see below).
- Probiotics are helpful for some children.
- Increased exercise.
Certain foods and drinks are thought to cause IBS symptoms in some children, such as milk products, caffeine drinks, artificial sweeteners and gas-producers such as cabbage and onions. It is not a good idea to exclude everything at once: keeping a food diary can help work out whether any foods are triggers.
Dietary fibre can lessen constipation in children with IBS but it may not help with lowering pain.
Medications for IBS
Medications are sometimes used in childhood IBS. They include:
- Fibre supplements and/or laxatives when there is constipation.
- Antidiarrhoeal medicines to reduce diarrhoea in IBS (this can make pain worse).
- Antispasmodic drugs to try to reduce bowel activity and, therefore, pain (which is often worse after eating, so they are taken at mealtimes).
- Probiotics: live micro-organisms such as bifidobacteria improve symptoms of IBS in some children.
- Rarely, antidepressants are used to modify the pain but these medicines can have powerful side-effects so are only used in children by specialists.
What is the outlook for children with recurrent abdominal pain?
Recurrent abdominal pain (RAP) usually settles down over time. However, it can persist for a while. It is more likely to persist if it has been going on for a long time - more than six months - before seeking medical advice. It also seems as though it is more likely to continue if parents are very stressed, or families experience lots of stressful life events.
Many children who experience RAP will go on to experience IBS in adulthood. This is particularly the case where others in the family are affected by IBS.
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