Help re DD (4yrs) with tummy pain - what to do next?

[mabelbabel]

I took my daughter to the GP this morning, with tummy pain. She's been complaining of this pretty constantly for a few days now. Yesterday told me (twice) she thought she would be sick as well. Wants to go to bed early, but otherwise is more or less her usual lively self.

When I thought about it, actually she's complained many times of tummy pain over the last few weeks/months, particularly feeling tired and sorry for herself at bedtime, which is unusual - Hence the visit to the doctors. Her appetite is low at the moment, particularly in the evening. She has no other serious/on-going symptoms, other than a few patches of excema (which was much worse at times when she was a baby). She is not constipated.

Doctor was very friendly, did all the usual stuff, said there was nothing wrong. Possibly she's coming down with an infection of some sort, but that tummy ache is very common etc. All of which is fine, and I understand. I asked her under what circumstances I should consider bringing her back - eg if it is persists for a length of time, and whether we should keep a record. She said there were only three circumstances in which a repeat appointment would be required:
(1) if we notice DD is not growing properly in relation to her peers;
(2) if she has constant diarrhoea, or
(3) if she cries when she goes to the toilet.

I'm a bit sceptical of this (these sounds like extreme symptoms!). My plan was to keep a record. If the pain is constant for another week or two, then I think it deserves another look. Or if it goes but comes back frequently over the next month or two, then also it deserves another look.

Does this sound like a sensible approach? WWYD? Any other advice in the meantime?

(I know this is just an internet forum and I'm not after medical advice etc. Just wondering how best to manage this without over- or under- reacting. Of course if the pain suddenly got much worse, or other worrying symptoms appeared I'd be back at the doctors like a shot).

Before I'd do anything else I'd start a food diary and make notes when she's complaining to see if there's a link.

Is it stomach pain or belly pain or both?

It's possible that she could have an intolerance - although lactose intolerance does usually have bouts of diarrhoea as a symptom, it's not a given; and wheat/gluten intolerance (coeliac or not) can just cause pain, and no adverse bowel movements.

As you've said it's been going on for a long time, I would think that rules out most infections - DS1 had a horrible adenovirus thing that affected his abdominal lymphatic system, but it only lasted 5 days - so intolerance seems more likely.

Keep a diary of what she eats as well as her pain levels - see if you can see a correlation.

She points to around about her belly button, sometimes is quite specific but not always. I'll start a little diary and see what happens. If it was caused by something dietary, what sort of reaction times are we talking about?
She has had occasional short-lived bouts of diarrhoea, but nothing too serious (eg not desparately running for the loo). A few times over the last few weeks we've put her to bed thinking that she'd have a full-on stomach bug by the next day (because she's tired, a bit sad, and complaining about her tummy), but that has never materialised.

If she's sensitive it could be anything from between a few minutes and the next day.

www.nhs.uk/Conditions/lactose-intolerance/Pages/Symptoms.aspx

www.nhs.uk/Conditions/Coeliac-disease/Pages/Symptoms.aspx

NHS doesn't list symptoms of gluten intolerance other than for coeliac disease, but you can look on other websites for them if you think it might be appropriate.

They're the most likely offenders; but once you've done the food diary, you'll be able to see if there's anything else that crops up regularly.

Intolerances aren't like allergies, they don't create a dangerous situation like anaphylaxis but they can still be pretty damn uncomfortable, and coeliac disease, if severe, can be quite dangerous if not dealt with (malnutrition, growth retardation etc.)

My DD2 suffered for months with intense pain around her belly button. GP was rather super, tested for coeliac which was negative so referred straight to paediatrician.

Was tested for every stomach complaint under the sun, also had ultra sound. All negative.

Decided was abdominal migraine which normally does manifest around belly button. There is no test for this but if all other tests are negative they can assume it's migraine.

She was put on Pizotifen for a few months which seemed to work. Is now off medication and symptom free. Her triggers were very hot weather, very cold weather, dehydration and excitement.

OK, thanks for the info. I bet the minute I start the diary she's suddenly better and never mentions it again (Actually I really hope that does happen...).

wine that's interesting. Maybe if things not better in a couple of weeks I will pester the GP a bit more. Was your DD incapacitated by the abdominal migraine (in the same way that I would be with a 'normal' migraine)? I ask because my DD is generally able to get on with things apart from the fact she's not eating much, and is more sleepy than usual.

It never incapacitated her but she would double over in pain crying. She was nine at the time and not a child to make a fuss. They kept her awake at night and made her really pale and tired as she was in almost constant pain. The general thought on migraines is that they can last up to 72 hours but hers went on for days at a time.

Do you suffer from migraines yourself? My mum has migraines, my sister has ocular migraines. Paediatrician said that it can be hereditary and passes down the female line.

Are you certain she is not constipated?

Yes, I have migraines, which started when I was young, maybe 9 or 10. As a child, they always came with headaches, and I felt severely nauseous. DD is not in as much pain as you are describing, but I will keep a record of when and for how long in the future.

ItsAllGoingToBeFine I'm certain in as much as I know she is poo-ing with normal frequency! (she still needs help with bottom-wiping...). But could she still be constipated in this circumstance?

Really does sound like migraine to me although I am no expert.

DD had no nausea but it can happen, and if the abdominal pain was really bad she would get a headache with it too. Her pains worsened over time and they became more frequent and lasted longer as though her body was starting to give up fighting them.

This has some info on constipation ( link triggers PDF download)
www.eric.org.uk/assets/downloads/129/Toilet%20tool%20leaflet%20reduced%20size.pdf

Mabel - how long does it take her to produce a poo? The time it takes can indicate constipation, more than the frequency.

Thanks. I don't think she's constipated based on that, but I'll certainly bear it in mind, and note in the diary if it seems to be a problem.

Production time is usually fairly quick! She doesn't hang around too much. But to be honest I've never paid too much attention to that. (I will now).

DD was a bit useless again on Saturday evening and around Sunday lunch, but has been noticably more perky since then and no longer mentioning tummy ache.
She has, however, developed a fairly large round mouth ulcer just inside her lower lip. She says it doesn't hurt and that she didn't injur it (not a bite/bump). Any significance to this?

It is swollen and yellowish on the top. Doesn't look like a cut or open sore.

Frequent mouth ulcers can be a symptom of coeliac disease.

Have you checked for worms?

Sometimes comes with an itchy bum (but often not) and stomach aches. check when they're asleep with a torch, little white feckers like thin cotton strands - but they wriggle

My 10 yo DD saw 9 doctors over a few weeks recently for non specific abdominal pain, including 3 visits to A&E because she was grey,sweaty and screaming. Despite that we were pretty much ignored for several hours on each visit, and when we did see someone we were told that in 90%+ of these cases no organic cause was found or it was all in her head. She was palmed off with various (useless) painkillers and anti spasmodics. Eventually, as the medics were uninterested, I took her to an osteopath who listened to us and diagnosed spasming of the psoas muscles linked to her hypermobility. She's treating it with exercises and the pain is finally receding, she's eating again and has gone back to school. She us back to her old talkative, cheerful self. Now we just need to nail the sleeping!

Spoke to someone recently who had a similar experience with GPs and hospitals with her DD. Turned out her "no organic cause" was a severe dairy intolerance.

A friend of a friend recently had a similar experience with her son. His "no organic cause" was atypical presentation appendicitis. By the time they diagnosed it his appendix was gangrenous and there was pus in his peritoneum.

In all three cases the medics were too blinkered to look past their own preconceptions. No organic cause? Poor diagnostic skills IMHO.

Advice- treat your child holistically. If the GP can't or won't help, try an osteopath. Good luck.