Transcription:
When to Be Concerned About Your Child’s Stomach Pain

Melanie Cole (Host): Little children will sometimes have tummy aches, but when do they signal a potentially serious problem? My guest is Dr. Barrett Barnes. He’s a board certified pediatrician who specializes in caring for children with gastrointestinal conditions. Welcome to the show, Dr. Barnes. What are the most common causes of stomach pains in children because they get tummy aches all the time?

Dr. Barret Barnes (Guest): Right. I agree. Thanks for having me, Melanie. This is certainly a very common condition. We see it a lot. Ask your colleagues out in the community. It’s a huge list that if we try to rock and roll through that very quickly, it can be difficult, but I’ll try to do my best. In general, we look at the timing. Is it pain that’s been going on for more or less than two months? What is the age of the child? Are they verbal? Can they express why and where and how? Where do they localize the pain? If we then take that and divide that into things that are more common, and often, while the symptoms are real, not as necessarily harmful, we would say those are usually what we call functional disorders. They interfere with daily function. Irritable bowel syndrome is a classic example of that. In younger children, in school-age children, the most common probably functional disorder is constipation. It’s about a third of the children that we see, and it causes a lot of complaints—nausea, reflex symptoms, especially abdominal pain. And then, functional abdominal pain of childhood or what parents used to call school belly, kids that get belly pain kind of during the school year, typically gets better on holidays or on weekends. And then, even more rare conditions that are still in the functional spectrum, abdominal migraine. These children are having migraines. They’re just having more gastrointestinal symptoms than headaches. And then there is the most serious, which are thankfully less common, and those we typically think about in terms of broad categories. Could this be infectious—chronic infections like GRD or H. pylori? Could this be an anatomic issue? Could this be an acute appendicitis? Is this a chronic inflammatory condition, like inflammatory bowel disease? Is this immune-mediated—say, celiac disease? Or is this actually a manifestation of an allergic disorder, like eosinophilic esophagitis? And then finally, the last thing we have to think about is is this truly gastrointestinal or not? Many children will complain about abdominal pain, and it may have nothing to do with the gastrointestinal tract. And so, thinking about other organ systems like the renal system, et cetera.

Melanie: Well, Dr. Barnes, you did rock and roll through all of those. So, no, that was great. When kids complain about stomachaches and, as you say, the school belly and constipation, so common, and of course, it causes all kinds of pain, when should parents be concerned that it is something more? How do we know if it’s just constipation? As a parent who keeps track of their children’s poop, I know if they’re constipated, but not all parents do. How do we know to bring them in to you?

Dr. Barnes: Exactly, that’s a great question and one we see. First and foremost, I think any pediatrician and family doc out there in a community would always want to see your child if you have concerns. That’s if nothing else for reassurance. In general, we talk about, what we call “red flag signs” or symptoms. These are concerning signs or symptoms that the pediatrician or family doc may recognize anything that would get our attention quickly. So if you notice your child is not gaining weight, or growing well, that’s not normal. Children are supposed to gain weight and grow. If the child is having belly pain and lots of vomiting that can’t be explained, just having one too many “viral infections.” Blood from either end is never normal and needs to be seen right away. Children with recurrent trouble swallowing and children with recurrent urinary tract symptoms, any of those things would get our attention. And sometimes they can subtle. You’re exactly right. Trying to find out what your child is doing in the bathroom, for some families, it’s easier than others. There’s some families where it’s totally, developmentally normal that once the child is potty trained, they may not discuss or describe with their parents in detail what they’re doing in the bathroom. That’s normal, but that means that there are times when what they’re saying they’re doing in the bathroom, they’re not, especially with regards to go and poop. So sometimes, having that somewhat embarrassing conversation with your preteen needs to happen to make sure that they’re actually going to the bathroom every day.

Melanie: So if parents come to see the pediatrician and it’s determined that it isn’t something more serious, then what can parents do at home? You started by saying have that discussion, learn to kind of find out what your kids are doing in the bathroom. Maybe occasionally take a look, see if there’s blood or anything so that you know. What else can we do at home? Are there over-the-counter things? What can we do?

Dr. Barnes: Great. That’s a great question. Typically, in addition to doing what we just described, making certain that their diet is healthy, that they’re not having overt indiscretions with things that can upset the stomach. Certainly, simple sugar is a big player there, kids that drink a lot of soda, or from the Midwest pop, sweet tea, those kinds of things. They can upset the stomach, especially if you overdo it. Kids are getting way too much caffeine. Caffeine’s a great bowel stimulate. They can cause diarrhea and belly pain. So, really trying to look and see that the ingredients are. Making certain they’re having normal bowel habits. And then, is the pain distractible or not? Can you somehow get them to distract will also help. Focusing on it a lot can actually make it worse. And then, in terms of over-the-counter, there’s really not one great remedy out there. Otherwise, there would be one bottle that we’d all get in the counter instead of lots of choices. And it’s really hard to know which one to use in younger children. Toddler, infant age, we wouldn’t recommend any of those things. There are some supplements that have been shown in the literature to offer some benefit. Probiotics in particular, these are good bacterial species. We’re all supposed to be colonized with them, and taking them on a regular basis can reduce many gastrointestinal complaints. The kids that are having belly pains with some reflux complaints or heartburn, trying a topical antacid like calcium carbonate—the brand name there would be something like Tums, or something similar like Maalox—can offer relief. And if they’re having headache at the same time and they’re old enough to take medications like nsaids or acetaminophen, that’s a reasonable choice. It’s just, again, you don’t want to overdo it. You may cause more problems. Those are the simple things we usually tell families to do at home. And if those aren’t working, then it may be time to consider seeing a pediatrician again or, more importantly, a pediatric gastroenterologist.

Melanie: Dr. Barnes, I’d like to jump back to probiotics for a minute because this is a great suggestion. Do you have any specific way? I mean, can kids get it by eating a good quality Greek yogurt? Can they get it in a chewable tablet? How do you like them to get their probiotics?

Dr. Barnes: Yeah, it’s a great question. There are lots of different ones available on the market. There are a few that have actually been studied in the literature, a few species and multiple species. Typically, that part of the market is -- there are lots of varieties now: powders, capsules, and chewable forms. And then, obviously, yogurt manufacturers have started to add those products back in. In general, there’s not one we think that is better than the others yet. They’re probably will at some point be a combination that is really proven to be the best. And so, in general, we just say a standard probiotic once a day is probably beneficial. Yogurt is an easy and great way to get it into your child. However, you need to make certain that the yogurt actually have not just live cultures but the added probiotic. And they only work if you take them every day. If you stop taking them or use them intermittently, you will revert invariably almost back to your native species, which may or may not be what you’re born with. It may have changed over time depending upon where you’ve lived, what you’ve eaten, antibiotics, et cetera.

Melanie: This is such great information. And what about preventing the stomachaches? We’ve talked about probiotics and good diet. Is there something psychologically we can do with our children, Dr. Barnes, to kind of ward off before they have, maybe, school belly? We don’t have a lot of time, but is there a way that parents can kind of just pass it off?

Dr. Barnes: Sure. It’s common sense things. Hand hygiene. In school, you’re washing your hands to reduce the risk of infection with soap and water. Asking your pediatrician, “Why is my child going on antibiotics? Is this truly a bacterial protection?” So avoiding overuse of antibiotics, making certain they have a healthy diet with a variety of food sources, trying to eliminate stress and finding healthy outlets for stress, physical activity, exercise, family time together, doing things; working together to try to reduce stress; increasing physical activity; and then, obviously, paying attention without going overboard to bowel habits—how often they’re pooping, what does it look like, any concerns.

Melanie: And why should families come to UVA Children’s Hospital to receive care for stomach problems?

Dr. Barnes: I can give you multiple reasons, but I’m going to give you two quick ones. One is that we have four outstanding pediatric, board-certified gastroenterologists, three outstanding nurses, one nutritionist, and two administrative assistants that all practice state-of-the-art medicine. A more specific example is you really want to go to a place where you’re at the cutting edge, and a good example of that is our eosinophilic esophagitis clinic that’s a multidisciplinary clinic within PGI, where you’re going to see a gastroenterologist, two allergists, a nutritionist, and it’s all put together by an outstanding nurse coordinator that allows Dr. Commins or Tropathy, our two allergists and myself to think at our highest level. And then, we work very closely. We’re taking medical nutritionists to make certain that the families are getting the whole picture. So, for a relatively rare disorder, a food allergy problem, you’re going to see three different doctors, a nutritionist, and then have a nurse put it all together. You’re not going to get that in most communities. So, whether you have a general GI issue and you just need to see a gastroenterologist that’s going to be able to kind of piece that out, whether it’s simple constipation, or maybe something more worrisome, like inflammatory bowel disease, or you truly have a relatively rare disorder, eosinophilic esophagitis, a food allergy condition that leads to troubled swallowing. We’re going to offer that all here at UVA in a way that’s family-centered and family-friendly.

Melanie: Thank you so much, Dr. Barrett Barnes. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening. Have a great day.