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Tummy Troubles

Mommy, my tummy hurts." What parent hasn't heard these plaintive words  -- then wondered what, exactly, they mean? Stomach flu? Too many gingerbread men? A ploy to miss a day of school?

And no wonder. Bellyaches can result from a wide variety of causes, some having nothing to do with the stomach  -- like, say, strep throat or a urinary tract infection. Fortunately, most are easily diagnosed and treated.

Bryan S. Vartabedian, M.D, a pediatric gastroenterologist in Houston, writes frequently on children's health.

Overindulgence

Candy canes, marshmallow-topped sweet potatoes...'tis the season for overstuffing, and little tummies can suffer. Rich foods that are high in sugar and/or fat tend to empty from the stomach very slowly, resulting in a full, bloated feeling that can progress to pain. The best treatment: rest and abstinence. Within a few hours of going easy on activity and eating, your child should start feeling better as the food is digested.

Constipation

The vague, crampy discomfort that a child experiences with constipation can occur after meals when the intestines are stimulated to squeeze. Constipation is sometimes called "the silent epidemic" by pediatricians, since kids tend to become secretive with their bowel habits once they achieve independence on the potty. Parents should be suspicious when kids spend a long time on the toilet or make frequent trips to the bathroom with little or no result. In toddlers or preschool children, unusual squatting or stiffening of the legs may also indicate efforts to suppress the urge to have a bowel movement. "Hiding" during potty time may mean the child is associating pain or discomfort with bowel movements.

In most cases, constipation is related to diet or low levels of activity: Kids who spend more time catching cartoons than catching baseballs are likely to be irregular. An older child may experience anxiety provoked by a less-than-private school bathroom stall, and so "hold back" the urge to move her bowels.

Once it's identified, constipation usually isn't difficult to deal with. When diet's the problem, it may be the result of getting too much of a good thing. Excessive milk is a frequent culprit; temporarily keeping your child's intake to two glasses a day may get her back on track. This should be fine for any youngster who's 2 years or older. As long as her diet is reasonably well-balanced otherwise, she'll get ample calcium and protein. Make sure she drinks plenty of water and limit the amount of "low residue" foods, such as cheese, pasta, and some types of bread; substitute with high-fiber fruits, fresh vegetables, and whole-grain breads and cereals. For the child with discriminating tastes, natural fiber supplements, such as Metamucil, are a safe alternative.

Most children with constipation can be helped in a matter of days simply through the addition of extra fluid and fiber to the diet. (A little less time in front of the TV, and more time playing, won't hurt.) If your child doesn't respond within two weeks, consult your pediatrician. Chronic constipation can make toilet training difficult. In school-age kids, it may lead to soiling their underwear. Although in general laxatives should be avoided for children, stool softeners, such as milk of magnesia, are safe for long-term use under the supervision of your pediatrician.

Lactose Intolerance

When a child's body is unable to digest lactose (the sugar in milk), he may experience symptoms ranging from a mild bellyache to crampy, diffuse abdominal pain with gas and diarrhea. To diagnose lactose intolerance, your pediatrician most likely will have you eliminate all lactose-containing foods from your child's diet. This may include avoiding everything from milk to frozen waffles. If this tactic relieves the stomach pain, your doctor will then work with you to figure out a diet that your child can tolerate. Some youngsters are fine as long as they only drink milk with food; others may have to avoid foods with lactose entirely, and get calcium and protein from other sources.

Diet Products

While some parents encourage kids to eat sugar-free treats for healthy teeth, certain sugar alternatives, especially sorbitol, can be hard to digest and absorb. I often find that kids who complain of crampy abdominal pain, bloating, and gas chew two packs of sugar-free gum a day! Even small quantities of sorbitol  -- in two or three hard candies  -- can cause symptoms in some children. The solution: If bellyaches are frequent, go back to sugar-sweetened gums and candies in moderation (and make sure kids brush their teeth well).

Reflux

Heartburn, or gastroesophageal reflux, is surprisingly common in infants. It occurs because the valve that separates the stomach and the esophagus is immature and allows stomach acid to flow into the esophagus. This usually doesn't present many problems beyond spitting up and fussiness (although these babies may need to sleep on their tummies to avoid choking). And most children grow out of it  -- typically by toddlerhood.

For some kids, however, reflux continues into the school-age years. These youngsters may suffer from burning pain in the upper abdomen, or even chest, after eating. Other symptoms may include smelly breath, frequent burping, nighttime coughing, or a "bad taste" in the mouth. Although it's unusual (fewer than 5 percent of kids with reflux continue to have it past infancy), reflux in the school-age child nearly always requires treatment with prescription medications  -- typically, an antacid like Zantac. When these don't help, and symptoms expand to include difficulty swallowing, for instance, corrective surgery on the esophagus may be warranted.

Gastritis and Ulcers

Many stomachaches in children result from gastritis (inflammation of the stomach lining) or an ulcer (an open sore or lesion on the stomach lining). The pain produced by either is sharp and concentrated between the bellybutton and rib cage; there's sometimes nausea and vomiting. Frequently these symptoms appear during or after eating  -- especially if the food is acidic or spicy. (Orange juice or salsa-spiked tacos alone are rarely the cause of gastritis or ulcers, however.) For school-age children, an oral antacid like Mylanta can provide temporary relief, but if your child reaches the point where he's frequently asking for it, you should probably take a trip to the pediatrician.

Some ulcers and bouts of gastritis are associated with bacteria called Helicobacter pylori. Both are usually cured with a two-week course of a special combination of antibiotics, plus, for ulcers, antacid therapy.

Appendicitis

The appendix is a small finger-like appendage that's attached to the far end of the colon. Generally, for unknown reasons, it can become infected or its opening obstructed. Usually the pain of appendicitis begins around the bellybutton and migrates to the right lower abdomen, and is accompanied by a low fever (100 to 101 degrees), poor appetite, mild diarrhea, and sometimes vomiting. The abdomen is often so tender to the touch even a gentle shaking of the bed a child is lying on can hurt.

If your child shows these symptoms, see your pediatrician or head for the emergency room. Once appendicitis is diagnosed  -- typically through a combination of X ray, ultrasound and blood tests  -- the inflamed organ is surgically removed. Otherwise there's a risk it will rupture, and the contents of the colon will spill out into the abdominal region.

Chronic Recurrent Abdominal Pain (RAP)

When there seems to be no other explanation for a child's discomfort, pediatricians often label repeat tummy troubles as RAP. As many as 10 to 30 percent of children and teens are believed to suffer from this condition, which is usually defined as several episodes of stomach pain per week severe enough to interfere with what a child is doing, that occur for a period of more than three months. Children with RAP will usually complain of pain around the bellybutton and may experience associated symptoms of nausea, flushing, light-headedness, or headaches. These can occur at any time, but are usually fleeting: A kid with RAP may suddenly get a tummyache in the middle of playing a game or doing homework and have to lie down for a few minutes until it subsides.

Although the exact cause of such chronic discomfort isn't known, there's some evidence to suggest that it's due to a child's heightened sensitivity to the squeezing of the bowels. It may also be that children with RAP don't empty their stomachs in a normal way or have abnormalities in the way the intestines push food along. RAP tends to show up when a child reaches 5 or 6, and usually disappears by the time she's 11 or so. Until then, there's little more that can be done, although some children may benefit from learning methods to cope with the pain.

And when it comes to any kind of stomach discomfort, never imply to your child that the ache is "all in her head." Such remarks will only create anxiety about whatever it is that's troubling her tummy.

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