What is Functional Abdominal Pain in Children?
Functional abdominal pain is a common condition in children. This type of stomach pain is different from the pain caused by any underlying physical disease. It can exist in a variety of forms, including irritable bowel syndrome, functional dyspepsia, and abdominal migraine. Functional abdominal pain is a type of digestive system disorder that falls under a set of rules for diagnosis known as the Rome IV criteria. The Rome IV criteria also cover other types of digestive system disorders like nausea, vomiting, or difficulties with bowel movements.
These Rome IV criteria, released in 2016, provide guidelines for doctors to diagnose functional abdominal pain and related conditions. There was an important change in these guidelines from the previous version, the Rome III criteria. Now, physicians can diagnose functional abdominal pain based on unexplained symptoms after professional health evaluation, whereas earlier, the diagnosis required no proof of physical disease.
According to the Rome IV criteria, a diagnosis of functional abdominal pain requires certain conditions. These conditions must be met for at least two months before making a diagnosis and must occur a minimum of four times in a month. These include:
1. The stomach pain is intermittent or continuous and does not only happen during normal bodily processes like eating or having a menstrual period.
2. Other digestive disorders, like irritable bowel syndrome, functional dyspepsia, or abdominal migraine, do not fulfill their respective criteria.
3. After a careful health assessment, the stomach pain cannot be fully linked to any other known medical condition.
What Causes Functional Abdominal Pain in Children?
Functional abdominal pain is likely caused by a combination of several different factors. Essentially, it happens when the body becomes more sensitive to the normal sensations in the abdomen, resulting in an extreme sensitivity to pain. This is also known as visceral hyperalgesia. For instance, regular sensations like bloating or indigestion can cause more pain than what most people usually experience.
In some instances, an initial event like an infection, an allergic reaction, a change in gut bacteria, or a problem with how the gut moves food can make the body more sensitive to these pains. Mental and emotional factors like stress, anxiety, or depression are also linked to this heightened sensitivity to pain.
Research also shows that functional abdominal pain can develop in children who already have other painful disorders, like Crohn’s disease. In these cases, the abdomen can become extremely sensitive to pain, especially if the child is also dealing with anxiety.
Risk Factors and Frequency for Functional Abdominal Pain in Children
Functional abdominal pain, a condition often seen in children, affects approximately 13.5% of kids globally. This condition is more likely to affect females and children who also have mental health conditions.
Signs and Symptoms of Functional Abdominal Pain in Children
Functional abdominal pain can be suspected from a person’s medical history and physical examination, but it’s important to rule out other possible causes, too. This involves examining the duration and pattern of the pain, its relation to bowel movements, and other symptoms like heartburn and nausea. The goal is to identify any other possible origins of the abdominal pain, as well as to better understand the specific subtype of abdominal pain the person might be experiencing.
- Functional abdominal pain tends to linger over time. Some types, such as irritable bowel syndrome, occur almost daily. Others, like abdominal migraine, involve intense pain episodes separated by pain-free periods lasting weeks to months. Sudden, severe pain raises concerns for other medical conditions.
- The timing of pain in relation to meals, as well as the types of food consumed, can offer important clues. For example, lactose intolerance or other carbohydrate digestion problems, celiac disease, or discomfort related to the digestion of certain types of food constituents (FODMAPs) found in various foods, can cause bloating.
- Difficulties with bowel movements – constipation, diarrhea, or both – could suggest irritable bowel syndrome. If constipation relief alleviates the pain, it’s more likely to be functional constipation than irritable bowel syndrome. Other considerations, especially for children, include the time spent on bowel movements, reluctance to use the toilet at school, or evidence of encopresis (involuntary fecal soiling) or streaks on underwear. For young kids, the relation of symptoms to potty training, and whether they’ve been toilet-trained but then reverted to incontinence, is relevant.
- A thorough medical history should include any red flag signs such as bloody stools, persistent vomiting, difficulty swallowing, painful swallowing, nighttime diarrhea, unintended weight loss, stunted growth, unexplained fever, signs of abuse, referred pain, changes in skin color or texture and joint pain. A family history of inflammatory bowel disease, or any past surgeries, can make other inflammatory conditions or complications from scarring more likely.
- The location of pain can also provide information. Younger children often struggle to pinpoint and describe pain, and might say they have belly button pain or pain throughout their abdomen. Older kids and teenagers can often pinpoint the pain, though they might describe it as general or moving around. They might also describe the pain as cramping or bloating. Continual, sharp, severe pain in a specific area of the abdomen should make medical professionals suspicious of a condition related to that area.
- During a physical exam, a person might have tenderness throughout the abdomen, but those with functional disorders often let the doctor press deeply without much discomfort. If constipation is a main symptom, the doctor might feel a mass that suggests a build-up of stool. Other aspects of the physical exam work to reveal any signs pointing towards another cause. Often, though, the physical examination doesn’t reveal much, which can be comforting for both the person and the doctor.
Testing for Functional Abdominal Pain in Children
For identifying functional abdominal pain, which means stomach pain with no clear physical cause, there are no specific tests or studies required. Instead, what doctors do is rule out the possibility of other conditions. This is done by considering the details of the symptoms you present, and your results from the physical examination. In other words, the main goal of the diagnosis is to discard the possibility of other illnesses and to conduct any necessary tests as suggested by your symptoms and exam results.
Treatment Options for Functional Abdominal Pain in Children
If you suffer from functional abdominal pain, which is recurrent stomach ache without a clear cause like an ulcer or gallstones, several methods can help to manage this persistent discomfort.
One of the main strategies is to manage the triggers of the pain, like certain food intolerances or constipation. Experts believe that an excessively sensitive stomach or intestines might be the driving force behind this type of pain. Reducing these “pain signals” could decrease the amount of pain you experience.
For example, if you can’t digest lactose or fructose properly, it’s essential to manage this issue correctly to avoid setting off pain. If bloating is a consistent problem for you, it might help to follow a low-FODMAP diet. This diet excludes specific types of carbohydrates found in foods like wheat, some fruits, lactose, fructose, and certain artificial sweeteners that can cause digestive problems in some people. If constipation is an issue, you might find relief from adding fiber-rich foods to your diet or using laxatives that don’t stimulate the bowel, like PEG-3350.
Sometimes, medication is an effective way to manage functional abdominal pain. Doctors might prescribe certain types of antidepressants like SSRIs or TCAs, which can sometimes help decrease pain by affecting how your body’s nerves communicate with each other and in modulating the sensations in your stomach or intestines. But, their exact role in treating abdominal pain isn’t fully understood. In cases where you also have mental health conditions like depression or anxiety, these medications might have additional benefits by helping to manage these conditions, which could be contributing to your symptoms. However, studies haven’t definitively proven the usefulness of these medications for functional abdominal pain in children.
Some patients might find pain relief from antispasmodics (medications that prevent or alleviate muscle spasms). This medication, which include hyoscyamine or dicyclomine, can be used daily to avoid pain episodes or as needed for sudden flare-ups. You might also find relief from natural supplements like peppermint oil or menthol, which are believed to relieve pain by relaxing your stomach and intestine muscles.
Alternative strategies that don’t involve medicines or diet can also be effective at managing functional abdominal pain. These include cognitive-behavioral therapy (a type of talk therapy that helps you manage negative thought patterns), hypnotherapy (a form of therapy that uses hypnosis), biofeedback (a technique to learn to control your body’s functions), and lifestyle changes like reducing stress. Other options include yoga, meditation, and osteopathic manipulation, which is a hands-on treatment approach performed by osteopathic doctors, among many other therapies.
What else can Functional Abdominal Pain in Children be?
Functional abdominal pain is a common and valid cause of discomfort. Doctors should start thinking about it as a possible explanation early in their diagnosis, not just when other checks haven’t found a cause.
Even though functional abdominal pain is a legitimate cause, anyone who comes to the doctor with stomach pain still needs to go through tests to find out what’s causing their pain. The causes considered by the doctor will depend on how the pain feels, where it’s located, how old the patient is, and what makes the pain worse. Doctors will also look out for alarming symptoms like fever, sudden pain increase, very young age, pain that wakes you up from sleep, blood in the stool, anemia, and weight loss or not growing (in kids). Signs that the patient might need surgery (like sudden pain, silence in the stomach area, tensing up, worsened pain when the doctor presses and lets go, and a person in evident distress who’s not moving) also need an immediate checkup.
Based on the patient’s symptoms, doctors might think about inflammation-related diseases like Crohn’s disease or ulcerative colitis. Common conditions causing stomach pain could also include intolerance to lactose or celiac disease.
Sorting functional abdominal pain into categories can be useful for figuring out treatment. Categories include irritable bowel syndrome, abdominal migraine, or functional dyspepsia. If the pain comes and goes and happens along with headache or other migraine symptoms (like sensitivity to light or sound, or feeling sick), it might be an abdominal migraine. If the pain is connected to when you eat and it’s located in the upper stomach, it could be functional dyspepsia. Irritable bowel syndrome is connected to issues with the stool, whether it’s constipation, diarrhea, or both. Sometimes the pain doesn’t fit into any of these categories and remains unspecified.
What to expect with Functional Abdominal Pain in Children
Functional abdominal pain refers to long-term, chronic stomach pain that doesn’t have a clear physical cause. Despite no detectable abnormalities, this continuing discomfort may affect children’s schoolwork and social interaction, potentially causing distress and disability. Research shows many kids could still experience this lasting pain years after they’ve been initially diagnosed.
Past studies suggest adults suffering from irritable bowel syndrome, a common disorder that affects the large intestine, are more likely to have had symptoms similar to a digestive disorder during their childhood.
Research also indicates that other problems occurring along with the stomach pain, such as anxiety or depression, or other body symptoms like headaches, play a larger role in the long-term health outcome than the diagnosis of the stomach pain itself.
Possible Complications When Diagnosed with Functional Abdominal Pain in Children
Functional abdominal pain isn’t caused by an underlying disease or condition, therefore, no complications arise from the disease itself. The complications that could arise are, instead, related to the chronic pain’s impact on the person’s ability to engage socially or perform well at school. This constant pain can also lead to other serious problems like depression or anxiety, especially if the symptoms persist over a long period of time. This means that while the pain often doesn’t have a physical cause, it can still have serious impacts on the person’s daily life and mental health.
Impact of Functional Abdominal Pain:
- Effects on social interactions
- Impact on school or work performance
- Potential for depression
- Risk of developing anxiety especially if symptoms persist over time
Preventing Functional Abdominal Pain in Children
When a patient first experiences abdominal pain, it’s crucial that the doctor discusses the possibility of functional abdominal pain. This type of pain comes from the body’s nervous system and is not due to any physical disease in the abdomen. Understanding the physical symptoms and personal medical history can help the doctor determine the best course of action. In many cases, further tests may not be necessary.
It’s important to understand that while these symptoms are common, they should be taken seriously. Giving undue attention to the symptoms could lead to increased worry, which can actually make the symptoms worse. It’s necessary that parents or caregivers respond consistently to the patient’s symptoms, helping to minimize anxiety and distress.
Moreover, stress, anxiety, and depression, if recognized, can affect the body and cause physical symptoms like abdominal pain. So, understanding and managing these emotional challenges can be an important part of the treatment. Lastly, it’s critical that the child continues to attend school as maintaining a usual routine can also help in managing the symptoms.