Chronic Abdominal Pain

Q. My daughter is 4 1/2 years old. She has been complaining about stomachache on and off for at least the last 7-8 months. However, she has never had any other symptoms - no nausea, diarrhea, vomiting or fever. Back in July we had a stool culture done and nothing was found. However, lately, her complaints have become more frequent and she has even missed some school. Her complaints are generally first thing in the morning, but are now extending into the evenings as well. Sometimes it is simply a matter of having to use the bathroom. Other times it is gas. But other times it is simply a mystery. She has complained too of her vagina hurting and there does sometimes appear to be some redness and a kind of chapping around the outer areas. She sometimes complains about her anus hurting as well. My husband and I really are at a loss as to what the problem could be. I'm having images of a huge worm in my daughters body! We've taken her to two separate doctors who could not find anything wrong. Linda, Rome, Italy

A. Recurrent or chronic abdominal pain is common in kids. These children are usually gaining weight well and have no other symptoms, like diarrhea or constipation. The pain may occur everyday, and unfortunately, often no clear explanation is found.

And since it is so common, it often gets quickly dismissed by some doctors, especially when the child otherwise seems well.

Common causes of abdominal pain which you might look into include:

• constipation - Is she having bowel movements each day? Are her BMs like hard little balls or very large and firm?
• lactose intolerance - Is her pain worse after drinking milk or eating other dairy products? Have you tried eliminating all dairy products from her diet for a week or two to see if it makes a difference?
• infections - which may include infections caused by parasites or bacteria. When they did the stool culture, do you know if they tested her for parasites, like Giardia?
• irritable bowel syndrome - with alternating constipation and diarrhea, bloating, and passage of stools with mucus
• celiac disease - an intolerance to gluten,which is found in wheat, rye, and barley, and can cause cramping abdominal pain, oily stools, anemia, and many other symptoms
• gastritis or heartburn - which can cause a burning pain in a child's lower chest or upper abdomen
• inflammatory bowel disease - like Crohn's disease or Ulcerative Colitis

Without any other symptoms and normal testing, especially if the child's pain is around their belly button, they often get diagnosed with functional abdominal pain. Having functional abdominal pain basically means that your doctor can't find a real cause for your child's pain. That doesn't mean that they are faking though. Some experts think that these children simply feel things in their intestines that the average person doesn't feel and they associate it with pain. A high fiber diet sometimes helps these children.

Since she has complained of both her vagina and bottom hurting, another common condition that could be causing her problems are pinworms. These look like thin white threads and can cause itchiness on a child's rectum and sometimes their vagina.

Getting a Second Opinion

Since your child's pain has lasted so long and is getting worse, she would likely benefit from seeing a specialist. A Pediatric Gastroenterologist would likely be able to further evaluate and treat your child and figure out what is causing her pain.

It may help to keep a symptom diarrhea of when she gets pain and what seems to make it better or worse.

Warning signs to look for that would prompt a quick evaluation include:

• abdominal pain that wakes your child up at night
• persistent vomiting
• fever
• weight loss
• having bloody stools or vomiting blood (hematemesis)