From Belly Pain to Diarrhea: When to Seek Help for Your Child’s GI Symptoms

When it comes to bladder and bowel issues, most kids are either super sharers or very private. There’s not much in between. As a parent, how can you know if your child has a gastrointestinal (GI) issue that you should discuss with your pediatrician? Ronen Stein, MD, an Attending Physician in the Division of Gastroenterology, Hepatology and Nutrition at Children’s Hospital of Philadelphia (CHOP) offers advice to parents.

Signs to watch for

While some children will let you know when they are experiencing belly pain, nausea or diarrhea, others won’t say a word. Parents need to be observant. If something seems unusual for your child, ask questions. Some examples of concerning behaviors may include self-limiting food intake, sudden diet changes, excessive or lengthy bathroom trips, and repeated soiled underwear in the laundry.

Starting the conversation about bowel issues can be challenging – and uncomfortable for you and your child. Sometimes parents may feel children are willfully ignoring potty ques or simply distracted by activities; while children may feel blamed or shamed that a bowel accident happening and don’t understand why. Acknowledge your own uneasy feelings surrounding the taboo topic; then push past it and talk to your child.

Share your observations and ask questions:

• I noticed you seem to be spending more time in the bathroom. Are you feeling OK? Do you have any stomach pain or discomfort? How often does that happen? Have you noticed the pain/discomfort returns after you eat certain foods or types of foods?
• Are they vomiting frequently? Experiencing explosive diarrhea or bowel accidents?
• How long have symptoms been going on? How often do they experience them?

While many children will experience these issues occasionally, if your child is complaining of GI pain or discomfort regularly, talk to your child’s pediatrician.

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Pediatrician: Your first line of defense

Your pediatrician is the best person to start any discussion about your child’s general health. In most cases, this physician has seen your child over multiple well child visits in the past, has access to your child’s medical history, and can offer the best overall insight about your child.

First, your pediatrician will want to learn about your child’s symptoms, how long they’ve been going on and how they are impacting your child’s day-to-day life. The pediatrician may order tests to determine blood counts, electrolyte levels, kidney function, liver enzymes and inflammation markers. A celiac disease screening test might be ordered. These tests can help diagnose some conditions, eliminate others, and indicate whether additional testing is needed before treatment can be determined.

Depending on results of your child’s physical exam and testing, they may be prescribed medication to treat certain conditions like reflux and constipation or to control certain symptoms including abdominal pain and diarrhea.

If initial testing does not identify a cause of your child’s symptoms – and symptoms are disrupting their quality of life – your pediatrician may recommend that your child see a pediatric gastroenterologist and possibly also a GI psychologist.

Diagnosing disorders of gut-brain interaction

If your child is experiencing significant weight loss, bloody diarrhea, belly/bowel pain that wakes them from sleep, or uncomfortable symptoms that seem to be controlling their life, make an appointment with a pediatric gastroenterologist as these symptoms may warrant further testing. Because family history commonly plays a role, if the child has a close relative – parents or sibling – with celiac disease or Crohn’s disease, for example, that information may help direct the specific testing needed. Although most children with gastrointestinal complaints will end up having a disorder of gut-brain interaction (DGBI), the most common of which is irritable bowel syndrome, there is no specific test for this condition. The diagnosis is made based on a characteristic pattern of symptoms once more serious underlying conditions have been ruled out.

“Stress is often a major contributor to DBGIs like irritable bowel syndrome, functional abdominal pain and functional nausea,” Dr. Stein says. “Although there may not necessarily be a specific food trigger, sensitivities or intolerances to lactose, fructose, gluten and fatty foods are common – and coupled with stress, can produce GI symptoms.”

‘Not all in their head’

For some children with GI pain, no specific physical cause can be identified – and therefore treatments are harder to plan.

“Our GI psychology team teaches patients stress reduction and distraction techniques to teach families how to help reduce their kids’ stress with music, drawing, crafts, etc.,” Dr. Stein says. “When stress contributes to belly pain, kids are not making it up, it’s not all in their head. There’s a complex mind-body connection that goes beyond the central nervous system and into the many, many nerve cells in the GI tract.”

To support these patients, CHOP offers cognitive behavioral therapy in the form of visualization, breathing techniques, music therapy and art therapy, among others. These therapies support patients by offering them another outlet for stress.