Aviana is seven years old and has always been telling her parents that her “tummy hurts”. This shy yet spunky girl is sitting next to her mother, fiddling with her fingers patiently in my office. Her mother, a patient of mine, smiles and says, “This is my little peanut!”. “Mom! I’m not little!” Aviana replies with an embarrassed look.
Jane then starts telling me about Aviana. She says that her daughter has had tummy aches ever since she was a toddler and that they’ve been getting more frequent in the last year. Jane had already taken Aviana to her pediatrician, who explained that Aviana didn’t have any constipation or diarrhea and that her tummy pains were not related to when she would go to the washroom. Jane also had Aviana checked for celiac disease and lactose intolerance, both of which Aviana didn’t have.
Jane continues, “I’ve tried taking dairy and wheat out of her diet… I know you said not to, but I kept reading about how it helps kids, and nope, still no change. She complains about it almost every day in the morning or after dinner. She’s seeing a child therapist which helped for the first three months, but these last three months her stomach aches are getting more frequent. Her doctor said everything’s fine and that she’ll grow out of it, but I don’t think this is normal.”
I smile at Aviana and she smiles back. “Jane, you’ve taken all the right steps and it never hurts to do a temporary dietary change. I’d like to talk to Aviana to better understand her tummy aches.”
I look at Aviana. “Aviana, could you please show me where you feel the tummy pain?”
“I feel it in my tummy!” Aviana responds with youthful spunk.
Chuckling, I ask, “Ah, I see — could you please point to where you feel it?”
She raises her hands and places them against her belly button.
“Does it ever move anywhere else?”
She shakes her head, no.
“Does it feel like you have butterflies in your tummy?”
With a smile, Aviana replies, “Yes!”
“Do you ever feel like your get sick?”
She looks at her mom, puzzled.
I smile and ask, “Like you’re going to puke?”
“Oh, yeah, I felt like that on Saturday,” Aviana replies.
Aviana’s mom quickly responds. “That was because she was sick with the stomach flu… she doesn’t usually have that.”
“Aviana, I’m going to ask you some questions about poop, would that be okay?”
Horrified, Aviana giggles. “Gross!”
“It’s not that gross. Have you seen Shrek?” I ask.
Aviana nods her head, “I’ve seen all his movies!”
“Well, then you know what Shrek says… better out than in!’”
She covers her face and laughs out loud.
“Do you ever have tummy pains before you poop?”
“Nooo…” she says, her face bright red.
After asking more questions she is like most kids who have chronic stomach pains. Aviana represents 25 percent of kids who have chronic stomach pains. It’s known as functional abdominal syndrome. I always found it a polite way of saying, yes your child has stomach pain, but it’s nothing to worry about because it’s not a disease.
However, the kids I treat and their parents would disagree about it being nothing to worry about. When your child misses school and you find yourself at multiple doctor’s appointments it can be frustrating to simply be told, don’t worry, it’s part of growing up!
In the recent decade researches have been studying chronic stomachaches and found the following trends:
1) Up to 25% of youths can suffer from chronic stomach pains.
2) It’s one of the most common reasons to visit a doctor’s office.
3) It’s one of the most common reasons to miss school.
Additionally, researchers also know that children who have chronic abdominal pain are:
1) More likely to develop anxiety disorders (mostly social anxiety) as they get older.
a. Adults who had abdominal pain as a child were 51% more likely to develop anxiety compared to just 20% of adults who never had abdominal pain growing up as a child.
2) Anxiety tends to start in early childhood and the stomachaches tend to occur at the same time.
3) If you intervene early enough and help a child’s tummy pains go away they are less likely to suffer from anxiety as an adult.
So why do children get chronic stomach pains? It first starts with the way our brain communicates to our body. With our busy lifestyles, it’s not uncommon to feel overwhelmed as adults. The difference is that adults often recognize these feelings and will express them verbally.
Children, on the other hand, most often do not have the ability to communicate how they feel. As result, the body turns these emotions into physical symptoms.
When our body and mind are exposed to perceived threats, physical symptoms develop to slow us down. But in children, it often follows with stomach aches, nausea or the sensation of needing to pass stool.
One of the most interesting aspects of chronic abdominal pain is that it often occurs around the belly button region where the small intestine resides. Interestingly, the small intestine contains the same nerves, nerve structure and function as the nerves in our brain.
Even more impressive is that the nerves in the small intestine have the second densest region of nerves found in the body, beating out even the spinal cord with the brain taking first place. It’s no wonder that our abdominal region is nick named the second brain.
However, the small intestine has more tricks up its sleeves when it comes to regulating our moods. The small intestine produces serotonin, a hormone that helps with anxiety and depression.
Perhaps this is why kids develop stomachaches. It’s a way for their bodies to express that they’re not coping well emotionally — their stopgap to let help them avoid more stress.
Fortunately, functional abdominal syndrome (aka ‘my tummy hurts’) can be helped. By removing the physical symptoms that your child is experiencing, it may free up more resources, helping with learning how to cope with future stressors.
The key is to intervene early so that your child can thrive. Below are the steps you can take to help your child.
Primary Intervention = Mind Body Therapy
Cognitive Behaviour Therapy (CBT). CBT is designed to help the patient to change their behaviour pattern and can often be helpful in reducing the severity and frequency of stomachaches.
Secondary Intervention = Medications
While most parents would like to avoid medications, there are various types of medical treatments that can be helpful. Sometimes treating chronic abdominal syndrome with medications may be necessary as it can help break the pattern of anxious behaviour. Getting rid of stomachaches can help disassociated anxiety with the physical presence.
One way to help is the use of homeopathic medicines. Homeopathic medicines are micro-doses of natural substances to help balance out the body’s response to stress and normalize the body’s function.
Over the last 12 years, I’ve treated children who suffer from chronic functional abdominal syndrome. They usually respond within the first two months of treatment with a reduction in their symptoms. After six months, most children don’t require further treatment or any medication afterwards.
How is Aviana?
Aviana is now eight years old and is still mom’s little peanut, but she’s coming into her own.
After nine months of treatment, she no longer has stomach aches. Aviana is active with her friends, not missing school, and more importantly she’s herself again — a ball of energy with a bright smile that elicits a smile from everyone she meets.