Belly Up

Dear Mamas,

My almost nine-year-old has started complaining of tummy pain.  We took her to the ER concerned about appendicitis, but they couldn’t find anything wrong with her.  We took dairy out of her diet and the vomiting has stopped but still, every night for a week now, she starts complaining about her tummy hurting, even bent over in pain.  At the same time, we found out a boy in her class likes to talk about murder and ninjas and burglars.  So now, she’s afraid to sleep in her room at night.  It’s become an ongoing saga…fine (but tired from lack of sleep) during the day but at bedtime  the fear and tummy pain starts.

Tonight she was literally buckled over in pain and willing to go back to the ER and get another IV.  Can bedtime fears cause that much pain?  Can this be purely psychological? And if so, how do we help her cope with her fears?  I’ve asked the teacher to move her desk away from this boy’s desk and we are going over the facts with her that she is indeed safe, that mom and dad are here to protect her, that God is here to protect.  But nothing seems to be working.  I am taking her back to the doctor tomorrow just to rule out any illness.  I just don’t know what else to do. Can you help?

Thanks,

Sheila

Hi Sheila,

Belly pain is one of the most complicated and confusing symptoms we see in pediatrics. It can be caused by so many things, some represent a physical problem, and some don’t. Having said that, a bellyache that’s bad enough to send you to the ER demands attention. Let’s follow some of the clues.

You say that altering your daughter’s diet did change her symptoms. She was vomiting with her pain before, and now she’s not. This may mean that she’s reacting to some kind of sensitivity and her symptoms may continue to improve as the offending item works its way out of her system. You should have a good idea about that within a week or two.

Certain kinds of infection can also cause episodic abdominal pain like what you describe. You may want to check with her pediatrician and see if a stool culture is called for. It will test for several organisms that could be the culprit.

My approach in general is to rule out medical causes of belly pain that need treatment before jumping to a more emotional explanation. That’s not to say that children’s mental and emotional states don’t affect their physical well-being, but it makes sense to consider the physical first. Did IV hydration at the emergency room improve her pain? Were pain meds required? Did they do any other diagnostic tests, like an ultrasound or CAT scan? Is the pain keeping her out of school?

It is unlikely, though not unheard of, that her fears and upset about this boy in school are the sole cause of this degree of pain.

Bottom line, if the pain continues to be as severe as you describe, your daughter will probably need a few tests to rule out some not-so-common conditions. A barium enema will check for any unusual twists and turns in her lower intestine that may be causing her pain. There is also an unusual condition called abdominal migraine that can cause the symptoms you describe. Consider mentioning it to her doctor.

This is really hard on you. There’s nothing worse than seeing your child in pain when you’re helpless to fix it. Be there and hold her and look for clues as to what small things may help. A heating pad or warm bath may relax cramping. Small, frequent sips of water will keep her from becoming dehydrated, which can make the pain worse. Continue to reassure her and try to explore her fears.

This stuff requires detective work as much as anything. It’s not easy to be patient, but the answer will come.

Count on your pediatrician to be your partner in finding the cause.

We wish you and your daughter the best,

The Mamas

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?


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2 responses to “Belly Up”

  1. Dawn

    My son had abdominal pain almost every night for over a year, and none of the tests showed anything wrong. We couldn’t figure out a dietary link, either. Then, I was diagnosed with celiac’s, and the house went gluten free. He hasn’t had any abdominal pain since. There is a blood test (not always conclusive), but talk to your doctor about it.

  2. Pamela Rosenberg

    My son had stomache pains since he was one, and eventually he would vomit after almost every meal. He was followed by a gastroenterologist, and an eating disorder clinic for FTT..failure to thrive. Gasto kept sending us to the FTT clinic, and they would sent us back to gastro saying that he was complying, trying to eat, but would vomit. After 6 years of going back and forth, my son was diagnosed with celiac disease.. What a horrible process for both my son and I. He is now 15 yrs old and on a strict Gluten free diet. Gastro dept failed us for 5 years. My son had many of the classic signs and they had blinders on. All is well now. Good luck to everyone out there.

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