A child's tummy ache - we've got mail - Brief Article

Better Nutrition, Jan, 2002

"I enjoy reading Better Nutrition so much that even when I am out of town I look on your web site for my closest health food store--just to snag a fresh copy of your magazine. Throughout the past few months, I've noticed you've included a lot of information in feature articles and what-not about upset stomachs. Sometimes the focus is candida, sometimes it is food intolerance ... etc. While I don't doubt that these issues should be taken seriously, I have noticed that in all, the symptoms seem quite similar but the remedies are all different. My 8-year-old son experiences upset stomach, irregularity and loss of appetite quite frequently. I am afraid to put him on restrictive diets as a remedy because he is a growing child. Your articles have been very helpful as far as information regarding what's out there, but now what do I do? I would like to visit my pediatrician regarding this, but can you tell me how a doctor would distinguish what it is that he has? Is there anything special I should tell my pediatrician when I bring my son in for a check up?"

BETTY ESTEFAN
Anaheim, CA

Reply by Allison Messina, MD

Chronic recurrent abdominal pain is a very common pediatric problem. About 10 to 15 percent of school-age children experience abdominal symptoms at some time during childhood. Fortunately, about 90 to 95 percent of the time it is not serious and resolves on its own without any complications. A specific cause is usually never found. It can sometimes be an incredibly frustrating condition though, not only for the child, but for the child's caretakers as well. When a child has recurrent abdominal symptoms (pain, upset stomach, etc.) the most important tools for the physician are a good medical and dietary history and a physical exam, including your child's growth parameters. Also, a good doctor will ask you and your child about stresses in the child's life. Since emotional stress is often linked to real abdominal symptoms, identifying stress is key. While in an overwhelming majority of cases a specific organic cause is not found, there are certain signs and symptoms your doctor will be looking for. Chronic fever, growth failure, weight loss, anemia, blood in the stools, anal disease and chronic pain from the midline of the body are symptoms which are more concerning for organic disease and usually require a more directed work-up.

Your instincts about taking your child to the pediatrician before starting him on a restrictive diet are correct. It is important that your doctor first gets a good history and examines your child. If your current pediatrician does not already have them, a copy of your child's growth charts would be a good thing to take with you to the doctor. A dietary history is also important. Because a balanced diet is especially important in a growing child, changing your child's diet should only be done after your child has had a complete medical evaluation. Also, if a special diet is deemed necessary for your child, the plan should be made in conjunction with a pediatric dietician.