Sarah Noble
There are dozens of possible causes for children's sometimes ceaseless stomachaches. Anything from stress to the flu could cause pain. It is not uncommon for children to have sensitive stomachs and, most of the time, there is no need to be concerned. However, when your child's sensitive stomach becomes persistent and worsening, it never hurts to contact your pediatrician.
According to Dr. Michael Kappelman, MD, MPH, assistant professor of pediatrics at the University of North Carolina School of Medicine at Chapel Hill, "Inflammatory bowel disease (IBD) affects about 50,000 to 75,000 kids in the United States." IBD is a chronic autoimmune disease that results in inflammation of the gastrointestinal tract.
Dr. Kappelman says that physicians believe, "Most people with IBD have an overactive immune system, in which their intestine mounts an inflammatory response as if it were fighting an infection, even though no infectious organism can be identified. This inflammatory response results in damage to the gastrointestinal tract." The body is seemingly attacking itself.
"Another possibility is that some cases of IBD may be the result of an immune deficiency. Indeed, there are a number of immunodeficiencies that have symptoms that mimic those of IBD, and some new research suggests that therapies that stimulate the immune system might be helpful in treating patients with Crohn's disease," Dr. Kappelman says.
Dr. Kappelman believes IBD involves, "a complex interplay of genetics and environmental exposure. Possible contributing environmental factors may include the presence of disease-causing bacteria, the absence of protective bacteria, and lifestyle." However, a definite cause remains unknown. Although parents may attribute children's stomachaches to food, Dr. Kappelman says "There is no good research to suggest a dietary cause for IBD."
There are two main types of IBD, Crohn's disease and ulcerative colitis. According to Dr. Kappelman, "Crohn's disease is more prevalent in pediatrics." Crohn's disease can affect anywhere in the gastrointestinal tract and consists of deep inflammation through numerous levels of intestinal tissue. "Crohn's disease can also cause fistulas, or internal connections of the intestines to the skin or other organs, as well as strictures, or narrowing of the intestines." Ulcerative colitis, on the other hand, only affects the colon and consists of inflammation of the more superficial, or external, layers of the intestine.
Although there is no cure for IBD, patients may experience periodic remissions. In general, they experience a continuous cycle of flares and remissions. A flare occurs when there is active disease and symptoms are prevalent. When symptoms are lessened and the patient is healthier, they are said to be in remission. "There is no telling how long a remission period will last, but things, such as adhering to medications prescribed by your doctor can prolong the length of remission, and factors including infections, smoking and overuse of antibiotics, can contribute to flares," Dr. Kappelman says.
Since parents may find it hard to distinguish when IBD may be a possibility, there are a number of red flags to look out for in these situations. Dr. Marsha Kay, a staff pediatric gastroenterologist at Children's Hospital Cleveland Clinic, says "The visibility of these symptoms may vary according to the child's age because older children are more likely to be able to communicate more efficiently to their parents. Common symptoms of IBD include an increased amount of bowel movements for an extended amount of time, fecal urgency, blood in stool, diarrhea, unexplained fevers, stunted growth, swelling of joints, abdominal pain, and skin rashes."
It is important for parents to remain calm and remember that there can be many other reasons for symptoms like diarrhea. According to Dr. Kay, "The key is to look for a significant change in the child, such as waking up at night because of stomach pain or diarrhea."
Growth problems are also common in children with IBD. "This disease often requires children to increase their caloric intake to help fight off the disease because the body is robbing them of calories to fight off inflammation," explains Dr. Kay. However, IBD patients also often experience loss of appetite and nausea, which may make children less likely to eat. These two factors fight against each other, which can result in stunted growth and absorption problems. According to Dr. Kay, "Girls with IBD may also experience a delay in their first period, or, if they have already started menstruating, they may stop."
If a parent suspects there may be a possibility of IBD, Dr. Kay says there are a number of tests they can expect. "The pediatrician may run basic blood tests, a rectal exam, and stool samples. If there is reason to continue testing, the child will most likely be sent to a pediatric gastroenterologist to proceed with the testing. There the child may undergo an upper endoscopy and or colonoscopy including endoscopic biopsies, CT scans, and a variety of other tests that may also aid in the diagnosis of IBD."
If the child is diagnosed with IBD, the next step is to treat the disease. Since there is no cure for IBD, Dr. Kappelman says, "There are two main goals of treatment: to induce remission and to maintain remission by blocking pathways of inflammation." There are a variety of medications available to help alleviate pain for IBD patients. Dr. Kappelman also says, "Nutritional therapies, which treat the disease activity and promote and health development, are also effective, and becoming more popular in the Unites States."
Dr. Kay agrees and says, "These treatments involve an elemental, or polymeric, diet, which consists of foods that are very broken down."
There are circumstances in which surgery does become necessary for IBD patients. Dr. Kappelman says, "Surgery is most likely necessary when the patient does not respond to medications or experiences complications from the disease."
According to Dr. Kay, however, "Surgery, especially emergency surgery, has recently become very limited." She believes this is because of new medications such as Remicade and Humira. She says that "Remicade is the biggest advancement in the last ten years of IBD." Dr. Kay adds that "It is a miracle drug that allows patients to do the things they want to do."
Sarah Noble is currently studying journalism at The University of Dayton and actively pursuing a career in freelance writing. She was diagnosed with Crohn's Disease in 2006 and has been fighting it ever since. She has developed a passion for educating others about this familiar, yet serious disease and has joined the fight against chronic illness.
Enjoyed this article?
Want to help us continue to provide you with the best in children's health information?
Then make a donation to Pediatrics for Parents.
It's easy - just click on a button and donate via PayPal.
May not be reproduced in any format without written permission.
