Joel Rosh, MD, Director of Pediatric Gastroenterology at Goryeb Children’s Hospital answers common questions about children and upset stomachs.
What should I do if my child complains of a stomach ache?
First, stay calm. If you become anxious about the pain or go overboard constantly assessing for symptoms you may make your child more anxious, potentially worsening the pain.
Depending on the age of the child, complaints of stomach aches or pains can be hard to interpret. Rather than asking them to rate their pain on a pain scale, which many children may not understand, you can try asking them specific questions – are they hungry? Angry? Do they have to use the bathroom? Are they worried or anxious?
The most important things to watch for are fever which accompanies the belly pain, vomiting, or the location of the pain on the belly. When there is pain in a very specific place, it may be more significant than pain located diffusely in the general “tummy area.”
What if my child wants to stay home from school because of a stomach ache? How do you gauge when it's okay to send him or her to school?
Most pain (more than 80 percent) has to deal with how the gastrointestinal (GI) process works, which is often influenced by physical, psychological, and emotional states, leaving only 20 percent of pain related to a more serious problem – an anatomic problem, inflammation, etc.
Research has shown that 1 out of 4 school-aged children have belly pain on a recurrent basis. I like to say, if they have stomach pain, send them to school and reassure them their pain will get better, but if there is pain with a fever or other symptoms (vomiting, localized pain), it should be investigated more.
I also like to encourage parents to ask their children what would happen if mommy or daddy didn’t go work every time they had an ache or pain? Often, this makes them reconsider skipping school.
What types of procedures can I expect my child to undergo if she's having chronic stomach pains?
Interestingly, there are solid clinical studies that show doctors can make an accurate diagnosis 80 percent of time based upon a complete medical history and physical exam alone. When you add a blood or stool sample, there is more than 95 percent accuracy in diagnosis. More than 25 years later, these results haven’t changed!
Based on this, only about 5 to 10 percent of children referred to our program undergo a GI or endoscopic procedure. The most important test even in 2019 is a good history and physical exam.
Is there a way to determine stomach pains caused by gas or acid reflux vs something more serious such as appendicitis or celiac disease?
Everyone has gas. One of the most common causes of gas is air swallowing, which can be exacerbated by mouth breathing, stuffy noses and snoring, eating quickly and gum chewing. It can make you bloated or uncomfortable, but gas is not a medical emergency.
Acid reflux is much less common in children than adults. Because a few years ago there were many medications for reflux, we assumed cases of infant or pediatric acid reflux were common, but numerous studies showed that is not the case and we have wisely moved away from routine use of acid-lowering medications in pediatrics.
Appendicitis causes pain around the belly button or on the lower right side of the belly. Parental radar is really great here, because children who have appendicitis are very sick and parents can recognize that. And remember the localized pain. Because the pain is centralized to one location (belly button or right side), this should be taken more seriously.
The fact is only about one percent of the population has celiac disease, and the majority of people on a gluten-free diet in this country do not have celiac. For a number of reasons, gluten has become the “demon molecule,” and everyone is afraid of it and it has become very in vogue to avoid it. This is a current food fad and not based in scientific evidence. A gluten-free diet is not recommended for kids who do not have celiac because it can make the child deficient in key macronutrients and can be easily tied to weight gain.
A simple blood test can screen to see whether a diagnostic endoscopy is warranted to test for celiac disease, and then if it is a confirmed diagnosis, a gluten-free diet should be started only with the guidance of a pediatric dietitian.
If my child has gas, how should I treat those symptoms?
A lot of people who think they have too much gas don’t. They make the same amount of gas as everyone else, but they just be much more sensitive to it. When you talk about or think about your stomach – or gas – you actually cause contractions in your gastrointestinal system. The more you think about it, the more your stomach contracts, and people who are sensitive to this will feel it more. When you talk to your kids about this, many of them admit they think about their gas or stomach more often and understand it’s happening more because they’re actually in this cycle and causing it to happen more.
How do I know when it's time to see a specialist about my child's stomach issues?
Most of the time, primary care providers can take care of abdominal pain because it is so common in children. When the primary care doctor needs additional support from a specialist or if the stomach problems persist and additional symptoms appear, they often refer to a gastroenterologist.
If my child complains of intense stomach pains, how do I know whether to go to urgent care vs the emergency department?
Fortunately, there is a lot access to quality medical care in New Jersey. The most important thing is to get them into the medical system somehow (urgent care or primary care), and then be directed to the emergency department when it is determined that a higher level of care is needed.
Again, using that parental sense, if your child is very sick or complains of intense pain and has a fever or severe vomiting, head to the emergency department.
Children with chronic stomach pain are sometimes suffering from anxiety or depression. How can you tell when it's a stress-induced stomach ache vs something more?
It’s a notable clinical marker when the child does not want to go to school. If a child tries to push through pain and wants to be in school with friends and participate in life, this is often an illness, or organic pain as children are resilient and do not want to let their illness get in the way of their life. If a child has anxiety, it is issue in their life that is their current focus and they want to avoid the world and school and withdraw. This is a sign that parents should talk to the child about what’s happening emotionally.
We – parents and medical professionals – get in diagnostic trouble when we artificially separate anxiety and pain. When determining a “cause,” we need to take a holistic view of biologic, psychologic, and sociologic factors.