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Friday, July 25, 2014
Stomach pains after eating
A mother asked Dr. Gottesman a question about her 9 year old daughter that had stomach pains after she ate. My 6 year daughter is having the same problem-for 2 years also. What was the outcome of this little 9 year old girl? We have been seeing our pediatric doctor for this problem-we`ve had chest and abdominal xrays and nothing shows up. The dr. is baffled and can`t explain why she`s having so much pain. No dirrehea, no vomiting. She just holds her stomach, sometimes doubled over and cries for about 10-15 minutes. We have an appointment with a pediatric gastro at the end of Sept. What type of test, xrays do I need to ask for? I`m planning on carrying xrays and files on my daughter. The symptoms the other mother was talking about describes my daughters pains as well. I just wanted to know if you found out the outcome.
No, I never did learn the outcome for the other child. Your doctor is being careful and thoughtful in working with you and your daughter. You have a great plan in bringing X-rays and medical records with you that I am certain the gastroenterologist will appreciate having and that will likely speed up the diagnostic process by avoiding repeating tests already completed.
The absence of vomiting and diarrhea is certainly a positive thing, especially if your child is growing well. Good growth, about 5- pounds per year in weight and 2.5 inches growth in height per year, is very reassuring that despite the pain, her body is able to take in and use food for good growth.
There are many tests that could be done depending on where the specialist senses the root of the problem lies. For example a 24-hour pH probe study may be ordered if the problem is suspected to be acid reflux disease. Endoscopy may also be ordered where the child is asleep and the specialist examines the esophagus, empty stomach and first section of the small bowel for ulcers or evidence of erosions from reflux, bulges or narrowings that may cause painful symptoms. Ultrasound can be used to examine the gall bladder, which may cause pain from spasms or gall stones or inflammation. Blood tests can check for anemia due to blood loss, liver and pancreas problems. MRI can also identify any structural problems in the intestines. I think it is important to know your family history thoroughly for migraines, ulcers, ulcerative colitis, Crohn's disease, irritable bowel disease, chronic abdominal pain, constipation, food allergies and sensitivities, irritable bowel syndrome, diverticulosis, and gall bladder disease from at least the grandparents, aunts, and uncles, through parents, siblings and cousins. It would also be helpful to keep a 3-day record of everything your daughter eats and drinks to take with you as well as a list of all medications used, whether prescribed or over-the-counter or herbal remedies. It would also be helpful to track a week's worth of bowel movements and voidings, if at all possible, describing the color and consistency of the bowel movements and any discomfort with urinating.
Last, but not least, it is important to know that tracking down the cause of chronic abdominal pain is often a lengthy process. It may end with the non-specific diagnosis of chronic functional abdominal pain. There is nothing wrong with digestion and absorption of food, or structure and function of the child's GI tract, however, the child's nervous system feels pain from normal functioning.
During the diagnostic process, and really always, it is helpful to children to have a regular schedule for eating, play, and sleep. They need a regular good night's sleep of at least 8 hours per night. Their diet should be healthful foods, nonfat milk, and plenty of water. Every child needs at least 60 minutes of active play every day. It aids digestive tract functioning, decreases stress, and helps the child learn and sleep better. Try not to be anxious and tense yourself. Children pick up on our worries and anxieties and imagine all types of scary things they never tell us about, but that disturb their rest and worsen their symptoms.
I hope this is helpful information and that all is well soon.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University