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Tummy Troubles?

Mommy, my tummy hurts," says your child. And so the mystery begins. Is it temporary discomfort, a chronic problem, a serious illness, or a bout of anxiety? To help you figure it out, here's what to know about kids' most common stomach ailments:

Constipation
Infrequent bowel movements  -- or difficulty having them  -- can affect children from infancy on up. When stool builds up in the large intestine, it can cause discomfort or pain around the belly.

This tummy pain may in turn cause your child to withhold stools, which can worsen the problem. It also makes toilet-training a toddler very challenging; in fact, pediatricians advise treating constipation, if there is any, before introducing the potty.

For infants under 6 months who haven't started solids, try more frequent feedings. For older babies and toddlers, offer more fruits, vegetables, and diluted juices such as prune, pear, or dark (not white) grape. (For toddlers on up, if these measures don't help after a day or two, your pediatrician may suggest a stool softener.) "Before my three-year-old daughter, Elsa, gets constipated, I can see it coming on  -- she gets tired and cranky," says Karen Sue of Princeton, New Jersey. "We remind her that if she doesn't want an ouchy tummy, she has to eat an apple or a pear, drink more water, and get enough exercise."

For preschoolers and up, you can also add a fiber supplement such as psyllium for a day or two, but call the doctor if it's not working by then. And use a stronger laxative only on a doctor's advice for short-term relief; pick one that's not habit-forming, such as MiraLax or milk of magnesia.

Stacey Colino, a mom of two, wrote "Lights Out!" for our November issue.

Food Intolerances/ Allergies

If your child often experiences belly bloating, cramping, gas, or diarrhea within two hours of eating a particular kind of food, she may have a food intolerance, the inability to digest specific food components. A common one is lactose intolerance  -- trouble digesting the sugar in milk  -- but some babies have other problems digesting certain formulas.

When your child has a food allergy, though, she may have those symptoms but also get a rash or hives or start wheezing. Kids can develop allergies to nuts, eggs, fish, soy products, and other foods.

If you suspect either condition, your pediatrician can help you identify the culprit. You'll then need to make sure your child avoids it at home, and alert his school not to give it to him. Sometimes being proactive pays off: To help her daughter Emily, 4, who's allergic to milk, Leighann Krenz of Akron donated frozen nondairy sweet muffins to the preschool. That way, when there are birthday cupcakes, Emily can be part of the party, too.

Gastroesophageal Reflux Disease (GERD)
In this condition, some contents of the stomach wash up into the esophagus and mouth, usually because the valve between the esophagus and the stomach opens and closes at the wrong times. Symptoms are most obvious in infants. All babies spit up, but you should suspect reflux if there's also obvious discomfort during or right after eating (i.e., crying, arching the head back or sideways, or turning away from the breast or bottle).

Preschool and older kids are much less likely to spit up, but may have abdominal pain, experience an acidy taste in the mouth, throw up easily or often, or throw up and swallow it again, says Sari Acra, M.D., a pediatric gastroenterologist at Vanderbilt Children's Hospital in Nashville.

Once it's diagnosed, the treatment goal is to reduce the pressure and acid in the stomach. For babies, give smaller, more frequent feedings, and keep them upright for 15 minutes afterward. For older kids, try avoiding spicy, fried, acidic, or fatty foods, large meals, and late-night snacks.

It's okay to try antacids in a child over 3 (ask your pediatrician to prescribe a dosage based on weight). But frequent or long-term use of them in babies may interfere with bone fusion. For persistent or severe bouts of GERD, a child-safe medication (such as Prevacid) may be prescribed.

Irritable Bowel Syndrome (IBS)

If your child experiences abdominal pain, bloating, changes in stool appearance, and alternating bouts of diarrhea and constipation, he may have IBS. It's difficult to diagnose this in kids under age 5, since they're not yet able to clearly describe their discomfort, says pediatric gastroenterologist Michael Hart, M.D., at Carilion Medical Center for Children in Roanoke, Virginia. The exact cause of the syndrome isn't known, but there may be a genetic susceptibility to triggers such as illness, emotional stress, disrupted routines, and specific foods. Medications aren't very effective, so a treatment plan often focuses on avoiding trigger foods (fatty foods, chocolate, caffeinated beverages), getting enough sleep, and eating meals on a regular schedule.

Stress
Anxiety alone can cause stomach-aches. "This is not imagined pain," says Joseph Levy, M.D., author of My Tummy Hurts. The gastrointestinal tract contains most of the body's serotonin, a neurotransmitter linked with mood, which can send the brain pain signals. So when your family's stressed, your child may feel it in the gut. Especially susceptible are kids undergoing a change such as a new home, daycare, school, caregiver. Missing meals or regular bedtimes can also play a role.

Take my son Nate, for instance. Last winter, when he was 6, he caught a stomach bug and missed a couple days of school. The next week, he was well enough to play in the snow when school was canceled for two days. But when he went back to class, the nurse called to say his stomach still hurt. He was fine at home, but the following day at school, the nurse called again. My theory: After six days off, he just wasn't ready to go back to school.

I took him to the doctor anyway. After finding nothing worrisome, she told Nate that she thought his stomach still hurt because he was missing his mommy and daddy. "That can happen?" he asked. She told him it could, but that his tummy would get better when he got used to being back in school again. There were no more calls from the nurse. The doctor said I'd done the right thing by acknowledging and "treating" Nate's pain  -- without going overboard. Had I pampered him, or kept him home from school again, I might have rewarded and reinforced the very pain I wanted to help relieve.

Whatever's behind your child's tummy troubles, you need to treat the complaint with respect. It helps to remember that young kids may not understand how their body works. "When one of my nieces was four, she often said she had a stomachache when I visited her," says Ingrid Sanden, mom of a 7-year-old, from Alexandria, Virginia. "I finally realized that it was hunger pains  -- after she ate, she always felt better!"

If only it were always that simple.

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