Child with chronic stomach ache

June 6, 2017 10:52 AM

Do you/did you have a child who constantly complains of a non-specific stomach ache? What helped?

My 6-year-old daughter seems to have a stomach ache almost every day now. This started way back in September (when she started at a new school and new daycare) with a frequency of once or twice a week, specifically in the morning. I suspected it was anxiety, but of course we took her to the doctor who prescribed an antacid and restoralax. The antacid did nothing. I felt like the laxative helped a little.

Fastforward to today. Over the last month she's complaining almost daily. Usually in the morning. These days I try giving her gas-x, which I thought was working but doesn't seem to anymore. If there's something she doesn't want to do (go to school, go to swimming lessons) - it's almost a guarantee she will complain about her stomach. So I still suspect a psychological component to this, but obviously I am not a doctor. We are taking her to a doctor again today, but I have little hope this is going to be (easily) diagnosed.

I'm looking for some help/ideas because this is getting really hard. I can't keep her at home every time her stomach hurts - she'd miss half of school and half of her extracurricular stuff.

Here are all of the characteristics of this problem I can think of:

- Sometimes, but not always, a bowel movement makes her feel better. This makes me wonder - could their be a structural issue or something that makes it uncomfortable when stools move through her bowels?
- She does not vomit as part of these episodes
- Her stools look normal
- No paleness or fever, no normal visible symptoms of malaise
- She can't specify where or how it hurts. It just hurts 'everywhere'
- I will insist on celiac testing this round, but I can't see any symptoms I would expect with celiac
- Usually happens in the morning or right before we are going to do something she doesn't want to do
- Her diet is neither awesome nor terrible
- When it happens, she prefers not to eat anything
- Her demeanor is more grumpy/sulky during these episodes, not distressed.
- She drinks very little milk (maybe with cereal 2x a week), so I can't see it being lactose intolerance

If you have/had a child with similar issues, did you figure out what the issue was? Or can you tell me some things that helped? Also, what tests should she have? I figure barium swallow, celiac, maybe h. pylori, I don't know what else.

posted by kitcat to Health & Fitness (38 answers total)

I am not a doctor, but, this sounds like me as a child. It was all anxiety driven; nothing wrong with me health-wise.

Have you spoken with her teachers at school? Maybe she's being bullied?

Good luck!
posted by Hanuman1960 at 10:59 AM on June 6, 2017 [16 favorites]

Are her bowel movements regular? Our niece has gone to the hospital for several episodes of stomach pain (urgent care thought it might be appendicitis) that wound up being constipation. (not a daily pain, but just wanted to check.)

I will also say that sometimes if I am very anxious or nervous about something, my stomach will hurt, which will actually lead to me having to use the bathroom - sometimes it helps, sometimes not. I say this because I learned that everyone isn't like this, so maybe you aren't, but she sometimes is?

Good luck in figuring this out - these kind of things can be very frustrating to work through with doctors, etc.
posted by needlegrrl at 11:02 AM on June 6, 2017 [3 favorites]

Could she be developing extreme shyness about her GI system? This happens a lot with kids who are learning to be in public places for the first time and are upset about public bathrooms. A child might be excited about school and activity in general, but too worried about mockery or danger to use an unfamiliar restroom. This can lead to unhealthy urinary retention and constipation -- paruresis and parcopresis -- which also manifests as a desire to avoid eating or drinking too much, along with a general apparent sulkiness and desire to stay close to home.
posted by Countess Elena at 11:03 AM on June 6, 2017 [2 favorites]

Was just going to ask what needlegrrl asked about if her bowel movements are regular. I am in my 30s, and also had a lot of stomach pain/issues as a child and irregular bowel movements. It wasn't until this year (!!) that my doctors diagnosed me with IBS after ruling everything else out with various tests. I now am very careful what I eat (I'm on the low FODMAP diet for the most part). It's an extreme pain in the ass, but it is helping a lot actually.

Also be careful to just label it anxiety. My sister had much worse stomach issues than me as a child and my parents basically got to an exasperated point where they made her feel like she wasn't taken seriously. Turned out she too has food allergies and other issues that were diagnosed later. It could be anxiety, but try not to make her feel like you don't care (not saying you are doing this, just something to be conscious of in the future maybe).

You asked about what you could do - can you work with a doctor to rule out food allergies? My doctors had me do a gluten test, lactose test, etc. etc. where you basically remove the thing from your diet for 2-3 weeks, then indulge in a shitload of it all at once and see what happens.
posted by FireFountain at 11:08 AM on June 6, 2017 [2 favorites]

We have a family member who just had this with an elementary-age daughter, who had complained of stomachache for years and they'd written it off as psychological. It turns out to be a food allergy. Just to say, yeah, do keep testing and try elimination diets.
posted by LobsterMitten at 11:10 AM on June 6, 2017 [2 favorites]

This was me as a kid. Every morning before school, general discomfort and nausea. It was certainly partly anxiety; back then, a teacher openly mocked me for claiming I was "stressed"; "Children don't get STRESSED." Therapy helped. What also helped was a drink of hot beef tea in the morning before school; it may have been partly placebo, but it did seem to stop me feeling like I was going to puke any minute.
posted by The otter lady at 11:12 AM on June 6, 2017 [4 favorites]

At that age my nephew often had stomach pains which were eventually diagnosed as abdominal migraines. If I recall it took a long time to figure out what was wrong with him.
posted by bondcliff at 11:15 AM on June 6, 2017

This sounds like me as a child. I was being bullied. I would never in a million years have told my parents.
posted by FencingGal at 11:31 AM on June 6, 2017 [4 favorites]

My anxiety when I was a child definitely used to manifest as stomach aches, pains, nausea and general stomach issues.

Edited to add: it still does manifest this way now to a large degree, but at least I know what it is and why.
posted by Dressed to Kill at 11:32 AM on June 6, 2017 [5 favorites]

I had stomach pains when under stress as a child, especially when competing in things. I ended up talking about it with a good counselor; we ended up calling it "nervous stomach", and I had a "worry stone" to keep in my pocket to rub with my thumb when I felt that kind of distress. It helped, and eventually I didn't need it anymore, but I kept it around for a long time and felt fond of it.
posted by theatro at 11:34 AM on June 6, 2017 [2 favorites]

I can't keep her at home every time her stomach hurts - she'd miss half of school and half of her extracurricular stuff.

fair enough, but what happens if she does miss something, does it go away? say you cancel one swimming lesson when she feels sick (if you're willing to lie to your kid a little bit, the best test is to pretend it's for unrelated reasons - parent business - so it's not obvious she's being checked for what she might perceive as an accusation of "faking") and check in half an hour later to see if she feels surprisingly better.

also, when you don't cancel stuff, how long does the pain last? all day? just until the unwanted activity starts? or variable?
posted by queenofbithynia at 11:40 AM on June 6, 2017 [6 favorites]

My 6yo does this too on school days when he wants to stay home and spend more time with me (I am not a SAHP, and I make legit sick days the very least amount of fun as possible so that he doesn't think he's missing great things when he's at school). So I'm going to nth the psychological component.

I would be digging a lot about what happens at school and daycare. I'd be questioning other parents to see if they've heard anything from their kid about my kid. We read How Full Is Your Bucket from time to time and I use that phrase as a jumping off point sometimes to check in with my kiddo ("how's your bucket today?") Sometimes he brings up things that he wouldn't bring up if I just said "how was your day?".

Basically, keep communication open and keep pulling at that thread, eventually it will fall into place.
posted by vignettist at 11:45 AM on June 6, 2017 [1 favorite]

Response by poster: but what happens if she does miss something, does it go away
Yes, if not immediately then within a half hour.

when you don't cancel stuff, how long does the pain last? all day? just until the unwanted activity starts? or variable?

The next time I see her (whether at the end of the school day, or after the swimming lesson for instance) - all mentions of a stomach ache are gone and she's a happy girl. There are exceptions - for example, what prompted me to write this today is that she was sent home from school. She complained a lot about her stomach this morning, but still ate her breakfast.

They must have been seriously concerned because once her teacher actually let her throw up in class and didn't send her home (I was like, wtf? when I found out).
posted by kitcat at 11:48 AM on June 6, 2017

Response by poster: Oh and unfortunately she is very reluctant to communicate anything that might be bothering her (I was the same way as a child). She can get irritated if I simply ask something innocuous like "Did you tell your friends all about your vacation? What did they say?" Occasionally I get reports of bad behavior from her teacher and daycare teacher - unfortunately she is more likely to hurt other kids' feelings than be bullied herself. And I know she doesn't love her teacher or her daycare, but next year we are moving to a better area with a better school and better daycare. Through all this, though, she gets lots of love, attention and support.
posted by kitcat at 11:54 AM on June 6, 2017

It could totally be psychological but I've known at least one kid whose parent (a pediatrician!) dismissed their belly pain as psychological; and it turned out to be some sort of peristaltic abnormality that was tying the kid's guts up. I'd ask a pediatric gastroenterologist before assuming it's psychological.
posted by fingersandtoes at 12:02 PM on June 6, 2017 [1 favorite]

I have to agree with most folks here- you kinda have to make sure it's not a physical issue before treating for a psychological cause. My son has SIBO which causes diffuse stomach pain and (for him) constipation. It's an unusual diagnosis which took us a while because symptoms were definitely worse when he felt stressed. If your pediatrician is out of ideas, maybe a pediatric GI can help rule out physical causes.
posted by PorcineWithMe at 12:11 PM on June 6, 2017 [1 favorite]

My son, also 6, went through something similar this winter, and it turned out he was super anxious about something very specific but didn't know how to tell us. He's also not forthcoming about things, gets annoyed and refuses to answer totally innocuous questions, etc. His aches didn't affect his appetite, and cutting out dairy/wheat/whatever made no difference.

We had his annual well visit during that period and our pediatrician suggested a daily probiotic, but was pretty confident that it might be anxiety. She framed it for him as worries that he was holding in, and told him that some kids who don't like to talk about worries can write them down instead. So we put up a "worry tree" in his room (just a sketch of a tree on a big piece of paper) where he could tape up notes about something that was making him worried. He did it only once, but it gave us a platform to talk about what specifically was bothering him. Took another few weeks, but it eventually got better.

Good luck. Hope your kiddo feels better soon!
posted by that's candlepin at 12:15 PM on June 6, 2017 [11 favorites]

Appreciate people pointing out that you shouldn't discount physical issues, and keep pursuing answers on that front as well.
posted by that's candlepin at 12:16 PM on June 6, 2017 [1 favorite]

Sounds somewhat similar to my daughter, who complained of intermittent stomach pain, often at inopportune moments, schedule-wise. We weren't sure what was going on. Turns out it was extreme constipation. Have you had an abdominal x-ray? That should be able to rule out the constipation issue, possibly.
posted by dellsolace at 12:44 PM on June 6, 2017 [2 favorites]

Sounds similar to our daughter when she was 6-9 years old (she's currently almost 13). In our daughter's case, her doctor ordered some some followups with the local children's hospital, which is quite good. After a few interviews and some tests, they determined the root cause was mild-to-moderate constipation, caused by dehydration. This plus a little anxiety was all it took to bring her from "mildly uncomfortable" to "moderately debilitating stomach pain".

In our daughter's case, the primary solution was to simply make sure she drank more throughout the day. We also got her a fidget toy so that she can distract herself when she becomes mildly anxious. Together, these two changes have dramatically cut down the number of times she experiences these incidents. They still happen occasionally, but water usually solves the physical pain, and the fidget toy seems to keep her mind from dwelling on things unnecessarily. YMMV, obviously.

On preview, exactly what dellsolace said above.
posted by mosk at 1:04 PM on June 6, 2017 [2 favorites]

On the anxiety front, I've heard good things about What to Do When You Worry Too Much. You should definitely investigate physical causes as everyone above has written, but this might help you communicate about feelings, which she seems reluctant to discuss.

Is her current teacher the same one that let her throw up and didn't send her home? That's inexcusable behavior imo. Does your daughter know you have her back about that?
posted by purple_bird at 1:30 PM on June 6, 2017

I grew up with on-and-off bloating and abdominal pain as part of my normal experience. Just recently I've been trying a low-FODMAP diet and it has helped SO MUCH! The elimination diet is a huge nuisance (no wheat, legumes, or alliums, limited dairy, fruits, and vegetables), but the improvement is absolutely worth the trouble if it works.

There's also a stress-related component to my own GI problems (which I've read is not uncommon) so I think it's plausible that your daughter's pain is triggered by a combination of psychological stress and food issues.
posted by sibilatorix at 1:49 PM on June 6, 2017

Response by poster: Re: throwing up - that happened a loooong time ago, before x-mas I think. Yes, she knows I have her back.
posted by kitcat at 1:51 PM on June 6, 2017

My son had this - same time every day. Then he started throwing up and...it was a parasite. I'd see if they will do a stool test.
posted by warriorqueen at 2:07 PM on June 6, 2017 [1 favorite]

My best friend's son did this periodically throughout childhood. He was a somewhat nervous, anxious, and shy kid, and although they thought it was probably anxiety, they did take him to the pediatrician. He thought it was anxiety, too. Belly pain/diarrhea wasn't everyday, but occurred periodically over several years. Finally my friend took her son in frustration to a pediatric gastroenterologist, who diagnosed him with celiac disease. It took years - at least 5- for the diagnosis, what with the incorrect reassurance of the pediatrician, their feeling that it really could be anxiety, and so forth.

It seems that his daily level of discomfort was probably related to how much gluten he'd consumed at dinner the night before and what his breakfast contained. They were totally shocked and the entire family was tested. Turns out the kid has celiac, but his sister and my friend's husband also have antibodies, basically a less symptomatic variant which DID NOT have GI symptoms. Only my friend is unaffected. The son was the only one with symptoms.

I'd ask about at least having a blood test for antibodies. The gold standard for diagnosis used to be an endoscopy, but I believe testing has improved and is now much less invasive, including the test for antibodies. If your child does have celiac, there are certain GI cancers that are a risk, so it's not all about GI discomfort.
posted by citygirl at 2:41 PM on June 6, 2017

This sounds absurd, but my boy's similar symptoms were cured when I bought him bigger underwear. He outgrew his old stuff and I didn't even think to check.
posted by Uncle Jimmy at 2:49 PM on June 6, 2017 [3 favorites]

What is she like during school holidays?
posted by Jubey at 4:17 PM on June 6, 2017 [1 favorite]

I can personally recommend the strategy of keeping some special 'placebo medicine' on hand. It's worth a try.
posted by bq at 5:02 PM on June 6, 2017 [1 favorite]

If I was your kid and I threw up in class, I would have anxious anticipatory nausea about throwing up in class for a long time after.

If things got way worse after the throwing up in class incident, then the fear of that event recurring could account for a lot of the anxiety.
posted by delight at 5:21 PM on June 6, 2017 [2 favorites]

I was like this as a child. In my case, it was diagnosed as anxiety but turned out to be lactose intolerance. It went undiagnosed for a long time because i lied to my doctor about how often I drank milk. For some reason, i thought I was in trouble. So take what she says with a grain of salt.
My son had this last year, we cut out dairy, added probiotics... he missed about 35 days of kindergarten! then i got sick too, and when i was diagnosed with a parasite, we figured out he must have given it to me. So, ask for a stool test. Or 3, they're very prone to false negatives. This year he's been so much healthier, and back on dairy. (i on the other hand am still in recovery). Good luck!
posted by Valancy Rachel at 6:45 PM on June 6, 2017

My son had this - the GI doctor we had suggested using an antacid for what seemed like an unnecessarily long time. We'd tried it already and it hadn't worked. However, using a big enough dose for a long enough time actually did make a big improvement. I think he had a small ulcer and those just take a long time to heal. So from personal experience, I wouldn't discount the antacid just because it appears not to work after taking it for a few days or even a few weeks. (Taking a big dose for a long time really should be done under a doctor's supervision because if you are wiping out an ulcer you will need to take more than it says on the box. So if you think that might be it, ask the doctor about it).

Also, when your kid has stomach problems everybody will suggest it's psychological. This happened to us constantly. I questioned myself a lot even though this is not a kid with any kind of anxiety issues. So if you don't think it's psychological stick to your guns and look for a physical reason. In retrospect, I wish I had not discounted what he was telling me.
posted by selfmedicating at 7:22 PM on June 6, 2017 [1 favorite]

I was like this too. My mother convinced me that eating carrots would calm a nauseous stomach - not because of anything in carrots, but because chewing them generated excess saliva and coated the stomach lining. I have no earthly idea if this is true, but it sounds plausible enough? Anyway, her solution was to always keep carrots at the house and allow me free & unquestioned access to carrots as I wanted. I also had the option to bring carrots to school. It worked. I ate a lot of carrots as a kid, but they did calm me down and help my stomach. I'm sure it was 99% mental, and it worked.

I do suffer from anxiety as an adult but have learned non-carrot soothing techniques.
posted by samthemander at 9:32 PM on June 6, 2017 [3 favorites]

Can you add a fiber supplement to rule out issues relate to that? Metamucil or similar seems fairly harmless?
posted by man down under at 9:33 PM on June 6, 2017 [1 favorite]

UPDATE: I just googled "carrot nauseous stomach" for the first time in my 31 years, and there appears to be no scientific basis to my mother's con job. KUDOS, MOM!
posted by samthemander at 9:34 PM on June 6, 2017 [9 favorites]

My 9 year old is so similar. We've done a pediatric GI workup including endoscopy and a pH probe test, she did have mild reflux but PPIs did not halt the stomach pain. MiraLax is necessary daily and still she has times where she is still constipated. He recommended trying gabapentin (Neurontin) to help with the functional abdominal pain but unfortunately she became extremely irritable on it; it did seem to lessen the abdominal pain. I'm also suspicious of food allergies or SIBO and that is next on my list to investigate. Otherwise we have gotten an IEP based on the anxiety and are implementing supports in school to help with her specific anxieties (test taking / performance; social issues; sensory breaks when overwhelmed, etc). I hope that helps, memail me if you want to talk more as I understand how insidious it is to treat. It's hard to watch your child in pain.
posted by sealee at 9:43 PM on June 6, 2017

Wanted to chime in and second what others have said about not dismissing it as anxiety. I was a few years older than your daughter when I first started having terrible stomach aches. My mother was insistent that it was psychological and I spent my childhood in and out of therapy. Now in my late 20s I finally have a doctor who wanted to figure out what was wrong with me and discovered I'm allergic to milk and have non-celiac gluten sensitivity - my whole body's been inflamed for 20+ years because my family was sure it wasn't real. Do exhaustive food allergy tests (I recommend the ones Genova does) and take the results seriously. Good luck to your daughter!
posted by iguana in a leather jacket at 11:22 PM on June 6, 2017

I think keeping a food and symptom diary would help here. It can highlight patterns that you may not be seeing. Depending on your daughter's temperament, you could make it into a fun little project re figuring out the mystery of her stomach problems. When I was little, I had pretty significant tummy issues as well, and I remember doing an elimination diet. I helped my mom pick out fun recipes and then we cooked them together. I still have good memories of that time, decades later (I'm allergic to tree nuts, as it turns out.).
posted by backwards compatible at 4:47 AM on June 7, 2017

I agree with what's been said about not dismissing this as anxiety -- however, don't dismiss anxiety as a Serious Thing, either, just in case your kiddo's tummy troubles ARE anxiety-related. I was an extremely anxious kid, and my experience was pretty much exactly what you've described. Anxiety can cause all kinds of physical symptoms -- mine gives me stomachaches, it messes with my digestion, it makes me dizzy, it interrupts my menstrual cycle, it makes me tense up which causes body pain, etc..

The fact that your daughter's stomach only acts up before something she doesn't want to do suggests that it might be a good idea to consult a psychologist/therapist (along with following up with her pediatrician to check for physical causes, of course). My parents never did that for me -- if they had, I'd probably be struggling less with anxiety as an adult.
posted by QuickedWeen at 9:44 AM on June 7, 2017 [2 favorites]