Tummy troubles, it turns out, are common in school-aged kids, for reasons that vary as much as their choice of favourite colour. “In addition to all the different illnesses that can give kids tummy pain, a lot of their general anxiety and stress seems to gravitate toward the stomach,” says Jeremy Friedman, associate paediatrician-in-chief at The Hospital for Sick Children in Toronto. As many as one in three children visit a doctor because of abdominal pain by the time they’re 15. (Fortunately, only a small number of these children have a serious problem.)
The challenge for parents is to figure out what’s causing it, a difficult task during the busy back-to-school season. This transition exposes kids to new germs, sometimes to new foods, and to potential stressors such as unfamiliar teachers, book reports and changing friendships. Parents also have to remember kids aren’t skilled at putting their discomfort into words.
When Kiyomi Theberge’s six-year-old daughter, Kiera, started getting regular stomach aches last year before school in the mornings, Theberge suspected it had to do with separation anxiety. But then the pain began happening at home, and finally, one night in May, Kiera woke up in anguish. “It hurt when I touched her stomach. I thought. ‘What if it’s appendicitis?’” says the Calgary mom. Theberge drove her daughter to Alberta Children’s Hospital, where an X-ray revealed that she was severely constipated. “Our doctor said that in 98 percent of kids who come in with stomach aches, their bowels are full of feces,” she says. Kiera was given laxatives, and the doctor told Theberge to increase her daughter’s dietary fibre. Theberge says the reason for this often goes back to toilet training and children learning to “hold it” away from home. When they head off to school, where bathrooms aren’t as accessible, that practice “can lead to a cycle of avoidance,” he says.
Two years ago this September marked the start of tummy troubles for Brenda Fougere’s then six-year-old daughter, Avery. Still adjusting to life after her parents’ separation, Avery began belching and burping after eating, and developed a nervous feeling she described as “butterflies” in her stomach that made her feel like she was going to throw up. “I think it was anxiety related to the divorce,” says Fougere. Now eight, Avery still has abdominal pain. Fougere has had her tested for celiac disease, tried her on a gluten-and-dairy elimination diet and is waiting for her to see an allergist. Deep down though, Fougere thinks it’s stress-related. The answer isn’t to remove the stressors, but to build a child’s repertoire of ways to manage anxiety, and thus help themselves feel better. They can cuddle a lovey, play it out with toys or kick a ball around to blow off steam. “Children need to learn how to self-soothe,” says Mamen.
Cole Montgomery* was three when he began verbalizing his stomach pain every morning at breakfast. “He starts to complain about it while he’s eating, and then it goes away. And then the next morning, he’s complaining again. Sometimes he’s lying on the floor doubled over,” says his mom, Dayna. She suspected a food allergy—Cole also has asthma, which increases his risk for developing allergies—but a skin-prick allergy test, and a subsequent allergy blood test at age five, came back negative. When specialists provided no answers, Montgomery talked to a psychologist at her doctor’s office because she wondered if the pain was anxiety-related, but later dismissed this theory. Then she took Cole to see a naturopath, who determined he is highly sensitive to grains like wheat, barley, oats and rye. Montgomery hopes the pain will resolve after some tweaks to his diet. “Stomach pain is a very common feature of allergic food reactions,” says Joel Doctor, a specialist in allergy and clinical immunology at the University of Calgary. While it’s possible for stomach pain to be the only allergy symptom, it’s typically accompanied by such others as a runny nose, sneezing, hives, swelling of the lips or difficulty breathing. “Symptoms usually occur within two hours of exposure,” he says. Food allergies also tend to follow a pattern: The child will have the same reaction after each exposure (although subsequent reactions may worsen).
*Name has been changed.
A version of this article appeared in our September 2012 issue with the headline “Tummy troubles,” p. 38.