Chronic Stomach Pain in Children: Causes & Treatment Strategies

4 days ago

5 min read

One of the more common complaints that I see in my younger patients is chronic stomach pain. In this article I will discuss some of the most common causes, and some ways that we might consider addressing this symptom.

Chronic stomach pain in children is pretty common and can be caused by a variety of factors, both physical and emotional. My approach is to rule out any obvious physical concerns first, and once that has been achieved, we go deeper and look at emotional factors.

PHYSICAL CAUSES TO RULE OUT

Food introductions: When we are talking about children who are very young (6-18 months), the first thing I ask about is what foods were introduced, on what schedule, and at what specific age. I find that often parents are introducing foods way too early. A general rule of thumb is that if the child doesn't have any teeth (even if they're older than 6 months old), their digestive system is not yet developed enough for food. Once the first tooth has erupted, that's ideally when the first food should be introduced. I prefer to introduce one food at a time and wait at least 4-5 days before introducing anything new. This allows enough time to see how the child responds. If there is gas, bloating, increased fussiness, crying, sleep disturbances, or other notable changes in your baby then it could be the food they've just been introduced to. The timing of specific foods is also very important. Grains, other than organic, sprouted oats, I prefer to hold off on until closer to 18 months-2 years of age depending on dentition. The first foods should include a broad variety of vegetables and fruits primarily. Meat (except for organic chicken liver), and most grains should be introduced last, closer to 2 years old.
Food sensitivities and intolerances: If the child is over the age of 7, this is something that I take a closer look at. Until the age of 7, the gut isn't fully developed and although food sensitivities could be an issue, it's likely that the child will outgrow it over time. After the age of 7, this concern is on my radar more. There are a few methods for assessing food sensitivities, including elimination diets and blood work, which can be discussed on a case-by-case basis.
Antibiotic exposure: Antibiotics at any age can lead to many gastrointestinal and even mental health issues, but specifically before the age of 2 years old, antibiotics can really damage a young child's microbiome. If there has been any antibiotic exposure during the child's lifetime, addressing this and healing the gut becomes a top priority.

Other Medications: There are several medications that can cause stomach pain in children. These include: antibiotics, NSAIDs (ie. Advil), iron supplements, laxatives, etc. If these are currently being consumed, addressing and healing the cause in an effort to eliminate reliance on these medications becomes a top priority.
Infections: although this category generally results in more acute pains, it's still important to rule out anything infectious. Fevers, lethargy, diarrhea and vomiting can all be signs of an infection.
Structural Issues: I love it when my patients work with a skilled osteopath and/or chiropractor because they can help heal any structural issues that might be present. This is not my area of expertise so I refer out if I suspect that this may be a concern.
Constipation: I define constipation a little differently than most. I like to see a bowel movement every day, without exception. We consume food daily and as a result, we should be eliminating daily. If your child goes several days without a bowel movement, that may be common in the general population but it is not normal and needs to be assessed. Constipation can cause bloating, gas and stomach pain if it goes unaddressed for too long. It may also point us to deeper rooted health issues like food intolerances, thyroid disfunction, and mental/emotional causes.

EMOTIONAL CAUSES

Stress: I find that this is the underlying cause in a solid number of chronic stomach pain cases in kids. One thing I always like to ask is, "does the stomach pain change or go away over the weekend." If the answer is yes then it's quite likely that something during the work-week is part of the issue. This could be something that's happening at school, being over scheduled with extracurriculars, or a child simply feeling that they don't have enough time to do the things that matter to them.
Anxiety: this is similar to stress but is perhaps a little bit more concerning in that it can manifest in a variety of sometimes worrisome behaviours, for example, picking the skin or pulling hair out. Children can feel anxious for so many reasons. Many children that I treat don't like being away from mom and dad all day long while they're at school, for example. Separation anxiety is a very common cause of chronic stomach pain. Another one is things that are happening in the classroom that maybe your child hasn't spoken about at home. A noisy classroom, a sense of chaos, witnessing yelling, negative behaviour, or direct bullying can all leave children feeling anxious. I always advise parents to have a close, connected, ongoing relationship with their children, even if they don't see any signs of distress. You'd be surprised how often a child will disclose something during a visit that the parent says they've never heard the child mention before.

TREATMENT STRATEGIES

Depending on what the underlying cause is, and the nature of the child, treatment will vary. It usually involves some, or all of the following:

Addressing healthy dietary habits and ensuring adequate mineral nutrition, adequate hydration and adequate physical movement
Ensuring healthy, daily bowel movements and removing any pharmaceutical or over the counter medications as appropriate and sometimes with the cooperation of a paediatrician. Sometimes we need certain supplements for a specific period of time to help with this.
Sometimes I will ask patients to do a cellular detox, particularly if there has been antibiotic or medication use at any point in the child's life. This helps the body to re-establish a healthier baseline.
Addressing nervous system health and stress management. This can include things like giving the child a break from activities for a little while; it can mean gentle massage or physical techniques that parents can do at bed time; it can involve specific nervous system tonic herbs.
In the case of anxiety or stress, I like to use Flower Essences and Homeopathic remedies. I've found that these therapies work beautifully and children are so responsive to them.

WHEN TO SEEK EMERGENCY CARE

If any of the following signs and symptoms are present, it's advisable to seek emergency medical care: