What could be causing my child's recurrent abdominal pain?
The list of possible causes of recurrent abdominal pain (RAP) is long BUT the list of probable causes in a child who is well between episodes is very much shorter.
Probable causes of RAP
- Functional bowel disorder: most children with RAP have no detectable physical cause and will be diagnosed with functional bowel disorder (or, if other parts of the body are also affected, functional bowel syndrome).
- Irritable bowel syndrome (IBS).
- Functional dyspepsia.
- Abdominal migraine: this is the cause in 1-2 in every 10 children with RAP.
- Mesenteric adenitis: this is inflammation or swelling of the lymph glands in the tummy, which become inflamed and tender. It is common in children aged less than 5 years, who have much larger lymph glands in their tummies than adults do, and is usually caused by viral infections. It usually settles down in 2-3 days but will return with other viral infections - of which young children get many.
- Bladder (urinary tract) infections.
- Coeliac disease: this results from an immune reaction to gluten. It affects around 1 in 100 people in Northern Europe and the USA. It can cause recurrent tummy ache made worse when food containing gluten has been eaten.
- Lactose intolerance: this is a common digestive problem where the body is unable to digest lactose, a sugar mainly found in milk and (to a lesser extent) other dairy products. Symptoms usually develop within a few hours of eating food that contains lactose. They include wind, diarrhoea, bloating, tummy pain and feeling sick (nausea). Lactose intolerance comes on with age and is more common in older children and adults, affecting around 10% of white Europeans and 90% of South Asian, African or South American people.
- Giardia infection: this is a digestive infection which doctors used to believe was mainly caught overseas - but which we now know is also found in the UK. Symptoms include wind, diarrhoea, bloating, tummy pain and feeling sick (nausea).
Possible causes of RAP
- Inflammatory bowel disorders: Crohn's disease and ulcerative colitis. These conditions usually lead to blood or mucus in the stools and to repeated diarrhoea. Children can be quite unwell during attacks. They can begin at any age and they often run in families.
- Kidney disorders such as kidney stones.
- Pains related to periods, including period pain and ovulation pain.
- Tumours in the abdomen: these are rare. Weight loss and night sweats are other common symptoms.
- Inflammation of the pancreas: pancreatitis is very uncommon in children but it can result from abdominal injury, some illnesses and some scorpion bites.
- Stomach ulcers: these can occur in children, particularly if they have used non-steroidal anti-inflammatory drugs. The pain is typically made worse by eating.
- Sickle cell disease.
- Bezoar (a ball of swallowed material that gets stuck in the intestines). This is fairly unusual now. In the nineteenth century, chewing gum was a culprit.
- Swallowing of air (aerophagy).
- Injury, particularly to the spleen: this can occur during contact sport.
- Lead poisoning: this is rare and causes many vague symptoms, including tummy pains, being sick (vomiting) and weight loss. Lead-based paint and paint dust in old buildings are the likely cause in children.
- Severe worm infestation: unusual in developed countries, this is particularly seen with roundworm infestation in Africa, Asia and Latin America.
- Tuberculosis: this is a rare cause in the developed world but common worldwide. In the UK it more usually presents with a cough.
Non-abdominal causes of RAP
Occasionally a physical problem outside the tummy can cause RAP. This explains why your doctor will need to examine, for instance, the testicles and groin of a boy with RAP. Recurrent pain in the tummy may be referred from:
- The testicles or ovaries.
- The joints of the back.
- A hernia in the groin.
RAP after gastroenteritis
Bacterial gastroenteritis can occasionally seem to trigger IBS. This may just mean that the bowel is sore and taking its time to settle down. Researchers do not know why gastroenteritis leads to IBS in some people and not in others. It is not clear whether IBS caused in this way is just as likely to persist as IBS which starts by itself.