How can I tell if my child is faking it or not when he complains of a "stomach cramps?" These ailments have a suspicious way of arising when it's time to do chores or get ready for school. Is this pain real, or is it just a ploy? Should we take him to the doctor, send him to bed, or just tell him to tough it out?
As a matter of fact, recurrent abdominal pain is a common and vexing problem among school-age children. While you should not assume that these discomforts are imaginary or manufactured to escape responsibility, judgment will be required to gauge your child's tolerance to pain in general and the severity of these pains in particular.
The good news is that the vast majority of these episodes are not caused by diseases such as infection, cancer, inflammation or structural abnormalities that need to be repaired.
The bad news is that the most common form of recurring discomfort, known as functional abdominal pain, is very real and can be quite disruptive to a child. Research suggests that functional abdominal pain arises from abnormalities in the communication between the central nervous system and the enteric nervous system, a complex network of nerves that supplies the entire digestive tract. One explanation is that children with this problem may have an increased sensitivity to pain within the bowel. So sensitive, in fact, that normal changes in pressure within the bowel may be perceived as uncomfortable. Whether this arises from a malfunction within the enteric nervous system, the central nervous system or both – or even a complex interaction between the two – is uncertain.
Functional abdominal pain may be sharp or dull, high or low in the abdomen, widely spread or somewhat localized. After one to three hours, the pain typically disappears. While these episodes may interfere with a variety of daytime activities, they rarely awaken the child from sleep. Very often there appears to be no obvious relationship to food or time of day, and there are no other signs of illness such as fever, weight loss, persistent diarrhea, or blood in the stool. In fact, if any of these symptoms are present, the problem cannot be assumed to be functional abdominal pain.
In many cases, the pains seem to be related to stress. This might be of the everyday variety or from more significant events such as harassment by a schoolyard bully, uncertainty generated by a stormy parental relationship or more serious forms of emotional, physical or sexual abuse. If you have reason to suspect some such cause, a medical evaluation may need to be accompanied by some sensitive questions.
If diagnosing functional abdominal pain is a challenge, treatment is an art. Reassurance, passage of time, mild pain relievers, stool softeners and some troubleshooting of the issues of life should be on the agenda. If recurring episodes of abdominal pain are particularly disruptive, and especially if there is uncertainty about the diagnosis, your pediatrician might recommend an evaluation by a specialist. Remember that your child will need more immediate medical attention if an episode of abdominal pain:
- is severe and sudden;
- doesn't let up after a few hours;
- is accompanied by repeated episodes of vomiting and/or diarrhea;
- is associated with a fever over 100.4 degrees F;
- includes other symptoms such as headache or listlessness;
- begins in or shifts to the upper or lower right side of the abdomen; or
- is associated with blood in the stool.
If you have questions about the potential psychological dimension of this problem, call us. Focus on the Family's staff counselors would be happy to talk with you over the phone for a free consultation.