In Conversation with Doctors

 

“Mummy, My Tummy Hurts!”

by Professor Dato’ Dr Christopher Boey Chiong Meng,Consultant Paediatric Gastroenterologist & Hepatologist

What is recurrent abdominal pain?

Pain in the stomach or intestinal area is called abdominal pain. Your child has recurrent abdominal pain if he or she experiences at least 3 episodes of abdominal pain that are severe enough to affect his or her daily activities, over a period of at least 3 months. It is a common complaint among children. Local studies have shown that about 10% of Malaysian school children aged 11-16 years suffer from recurrent abdominal pain.

Recurrent abdominal pain is not itself a disease, but a term used to describe a symptom. It can sometimes be organic, which means that there is an underlying disorder/disease such as urinary tract infection, lactose intolerance, inflammatory bowel disease, pancreatitis, gastritis, oesophagitis, peptic ulceration or stool retention.

Although there are a large number of possible organic causes, they only account for less than 10% of the causes of recurrent abdominal pain in children. It is the important role of the doctor to make sure that these organic causes are not missed

Is it my child’s recurrent complaints of abdominal pain due to a serious organic disease?

Features that suggest an organic cause are:

  • Site of pain.The further the pain is from the center (periumbilical), the more likely the pain is to be organic.
  • Sleep disturbance.If the pain is severe enough to wake your child up at night, there is a higher chance that there is an underlying organic disorder.
  • Age of child.In general, the younger the child, the higher the chance that there is an organic disease.
  • The presence of featuressuch as fever, blood in stools, inflammation (of joints, skin or eyes), weight loss, poor growth, anaemia, jaundice, high blood pressure, abscesses around the anus, recurrent and indolent mouth ulcers.
  • Family history.There may be a family history of diseases such as inflammatory bowel disease, peptic ulcer disease or renal disorders.

The pain can affect your child’s growth and development as well as overall well-being. It can interrupt his or her school attendance, affect appetite, interfere with sleep, aggravate mood and emotions. So, if your child suffers from it, it is important to consult a doctor.

What could be the cause of abdominal pain if no organic disease is detected?

Studies of recurrent abdominal pain in childhood showed that in over 90% of cases, there are no underlying diseases. This does not mean that the pain is not real, or made up. In cases where organic causes for the pain are not found, the symptom could be largely caused by stress, anxiety or depression. In other words, the pain could be psychosocial in origin.

Studies conducted at University of Malaya show that children aged 9-15 years who experience recent significant life-events such as death in the family, change of address, failure in a major school examination or bullying at school, have a higher chance of developing recurrent abdominal pain.

It is important to emphasize the need to get your child assessed thoroughly by a doctor to ensure that any treatable organic cause is identified before concluding that the pain is due to psychosocial causes

Remember also not to give your child over-the-counter medications for the pain before the cause of the pain has been properly assessed by the doctor.

What general advice is there for looking after my child?

You need to look at your child as a whole, your family, your home environment and your child’s school dynamics. Maintain regular heart-to-heart dialogue with your child. Listen attentively and be sensitive to his or her worries.

As a parent, it is your responsibility to ensure that your child settles in a warm, supportive and understanding environment at home and at school. Help your child stay happy and joyful by taking action immediately as soon as you detect an issue that is bothering him excessively and is causing abdominal pains.