From the Guidelines
Chronic stomach aches in children are most commonly caused by functional abdominal pain, which includes conditions like irritable bowel syndrome, functional dyspepsia, and abdominal migraines, and are often influenced by psychological factors such as anxiety, depression, and stress. The management of these conditions should prioritize a multidisciplinary approach, incorporating patient-friendly language about the pathogenesis of pain, and understanding the psychological contexts in which pain is perpetuated, as suggested by the AGA clinical practice update on management of chronic gastrointestinal pain in disorders of gut-brain interaction 1.
Causes of Pediatric Chronic Stomach Ache
- Functional abdominal pain, including irritable bowel syndrome, functional dyspepsia, and abdominal migraines, accounts for about 90% of cases where no structural or biochemical abnormality is found.
- Organic causes include gastroesophageal reflux disease (GERD) 1, constipation, lactose intolerance, celiac disease, inflammatory bowel disease 1, peptic ulcer disease, and urinary tract infections.
- Psychological factors like anxiety, depression, and stress often contribute significantly to chronic abdominal pain in children.
- Less common but serious causes include appendicitis, pancreatitis, gallbladder disease, and rarely, tumors.
Approach to Management
- For functional pain, a combination approach including reassurance, stress management techniques, and sometimes low-dose antidepressants may be effective, as supported by the understanding of chronic gastrointestinal pain in disorders of gut-brain interaction 1.
- Treatment depends on the underlying cause, ranging from dietary modifications for food intolerances to medications for specific conditions like GERD (using proton pump inhibitors) or constipation (using polyethylene glycol).
- Parents should seek medical attention if pain is severe, wakes the child from sleep, is accompanied by weight loss, persistent vomiting, blood in stool, or fever, as these may indicate more serious conditions requiring immediate evaluation.
Key Considerations
- Providers should master patient-friendly language about the pathogenesis of pain, leveraging advances in neuroscience and behavioral science, to help patients understand that chronic pain is real, perceived from sensory signals processed and modulated in the brain, and is modifiable 1.
- Avoiding pain catastrophizing and addressing psychological inflexibility, overfocusing on a cause or solution, and pain solicitation from the patient’s support system are crucial in managing chronic pain.
From the Research
Causes of Pediatric Chronic Stomach Ache
- Chronic abdominal pain in children is usually functional, meaning it is without objective evidence of an underlying organic disorder 2, 3.
- The presence of alarm symptoms or signs, such as weight loss, gastrointestinal bleeding, persistent fever, chronic severe diarrhea, and significant vomiting, is associated with a higher prevalence of organic disease 2, 3.
- The nature of the abdominal pain or the presence of associated symptoms, such as anorexia, nausea, headache, and joint pain, cannot discriminate between functional and organic disorders 2, 3.
- Anxiety, depression, behavior problems, or recent negative life events are more common in children with chronic abdominal pain and their parents, but do not distinguish between functional and organic abdominal pain 2, 3.
- Functional dyspepsia, a common disorder, can impose significant diagnostic and treatment challenges due to coexisting gastroesophageal reflux disease and irritable bowel syndrome 4.
- Primary care pediatricians' practices in assessing and treating chronic abdominal pain vary widely, and there is no single standard of care 5.
- Children and adolescents with chronic abdominal pain experience distress and anxiety that can interfere with their daily activities, and effective management is often lacking due to misconceptions and insufficient knowledge among healthcare professionals 6.