Recurrent Abdominal Pain Syndrome of Childhood
Your child complains of belly ache over and over again. This pain has been coming and going for about three months now. The pain is severe enough to affect her going to school or playing in the park. She has been carefully tested in the hospital. All the blood tests, urine test, X-rays, and scan have come back with normal results.
What a dilemma.
This experience is well too familiar to millions of parents worldwide. Their kids are suffering from what doctors now call recurrent abdominal pain syndrome (raps).
Recurrent abdominal pain syndrome is a not well defined pain found in about 1 in every 8 children. It occurs between the ages of 5 – 12 years. This syndrome has been extensively studied. It is thought to be due to the interaction of biological, physical and psychological factors with the child’s evolving personality.
The timing of the onset of the pain of recurrent abdominal pain syndrome coincides with school term. It must be said that many children who suffer from this distressing syndrome are not “just not wanting to go to school”. The situation is totally out of their control.
Many kids suffering from recurrent abdominal pain syndrome are caught between parental discord or outright separation. Their pain could be the only coping mechanism these children can come up with. Other related complains are constant headache and or pain in the limbs. Nausea, vomiting, pallor, dizzy attacks and anxiety in older children are common. The pain is usually not associated with meals neither is the child woken up once asleep by this pain. When asked to point to the site of pain, they often point vaguely around the belly button. Interestingly, the further away from the belly button a child points, the more likely it is believed, the pain is due to as specific organ disease.
Before concluding that a child’s recurrent abdominal pain is due to RAPS, other conditions like peptic ulcer, abdominal migraine, constipation, or inflammatory bowel diseases should have been eliminated from careful history.
It is not uncommon for children with recurrent abdominal pain syndrome to have strong family history of irritable bowel syndrome.
The key to successful management of this condition begins with a careful and detailed history taking from the child and parent. Once organic causes of abdominal pain have been eliminated, the child’s family and school environment should be looked into, to unveil any possible psychosocial stressors that may be lurking there.
Examinations and laboratory investigations will be unremarkable.
A sympathetic but clear and careful approach to management yields result. Many have found success by following this approach:
The pain of RAPS is real. Letting the child and the parents know this is important. They should also be made to understand that the child will not be physically harmed and that the condition will resolve with support. While reassurance is provided, continuous re-evaluation of the child’s physical and psychological status is important.
The child should be encouraged to keep a pain diary. This help the suffer to feel involved in the management of this disease. The diary should reflect what time of the day the pain occurs, the severity, scoring this from 1 being least severe to 10 being most severe, how long the pain lasts, and what help in relieving it. The numbers of days in a week pain is experienced is recorded. While this may seem to make the child dwell his or her attention on the pain pattern, it also help to at a stage desensitize him from the effect of pain. The pain diry should be seen by both the parents and doctor.
Resolving Psychologic Problems Were Possible
Once the child’s family and school environment is screened for any possible psychosocial stressor, steps should be taken to resolve these in the most sympathetic and amicable way.
Marital breakdown when handled with the children having access to both parents if appropriate, and helping the child discuss his concerns openly can be quite helpful
Bullying at school, pressure to excel in academic work, or trying to settle in a new school are issues that can stir up stress in the school environment.
The school teacher and parents if both work together, can help to ease tension here.
The child should be encouraged to go to school even during episodes of pain, but with full parental and school support.
Most children with recurrent abdominal pain when properly managed usually get better within two months.
If despite all these steps no improvement, a visit to a child psychiatrist may be wise, once physical ailments are certainly ruled out.
Children with recurrent abdominal pain syndrome sometimes grow up to develop irritable bowel syndrome.
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