"Mum,
my tummy hurts," is a common phrase in the Lister household.
Twelve-year-old Heidi has always had a sensitive stomach.
She's complained of tummy aches for as far back as Mrs
Lister can remember. Her parents believed it was her way
of getting out of activities like figure skating, ballet
and gymnastics � not to mention school. "In my mind,"
says her mother, "she would automatically get 'sick' when
she had something important to do. As a parent, I couldn't
help but be suspicious." But when Heidi turned 10 the
problem seemed to get worse. She was missing two or three
days of school per week and was on the verge of failing
the fifth grade. Heidi's mother decided it was time to
see the family doctor.
Cases like this are common. An
estimated 10 to 20% of school-aged children suffer from
some sort of recurrent abdominal pain and many go untreated.
The majority of cases are caused by functional gastrointestinal
disorders � primarily irritable bowel syndrome (IBS).
Once parents do decide to bring their kids in to see
the doctor, diagnosing the root of the pain is a little
tricky. Diagnostic imaging and blood tests for IBS always
come up negative, leading some parents to believe that
the pain is "all in their head" or that their child
is faking it. Others may believe that their kid is seriously
ill, regardless of the negative test results, and will
demand more testing and a referral to a specialist.
But long waiting lists � in some cases up to eight months
� for pediatric gastroenterologists might force these
concerned parents to come back and see you, their GP.
With that in mind, here are some tips on what to tell
your patients � and their parents � about IBS.
BYE-BYE
TO BELLYACHE
• Just the specifics A good place
to start is by asking your young patient how they're
feeling. "There's a pattern to the story that I hear,"
says Dr Alvin Newman, a Toronto gastroenterologist and
professor at the U of T. "Frightful symptoms without
obvious detriment to health; pain relieved by bowel
movement; and funny looking bowel movement. Once you
hear that, you're on the road to diagnosing IBS," he
says. Specific symptoms include abdominal pain and cramping,
and one of the following: bloating and gas; constipation;
diarrhea; pain relieved by having a bowel movement;
and having a strong urge to have a bowel movement.
• Rule out Crohn's
"Because of the epidemic of Crohn's, some doctors are
afraid to diagnose abdominal pain as IBS," says Dr Newman.
One way to tell the difference between Crohn's and IBS,
he explains, is that patients with Crohn's become sicker
and their condition deteriorates. Their general sense
of vigour and well-being suffers and they may lose weight.
If the patient is showing signs of other symptoms like
anemia or inflammation you should refer the patient
to a gastroenterologist.
• Get rid of those
butterflies Dr Newman suggests explaining to parents
that their kids' complaints about tummy trouble should
be taken seriously. He adds that parents and children
need to know that the syndrome won't lead to any real
deterioration of health. IBS will probably recur throughout
their child's life but they should rest assured that
it won't get worse. Also, it doesn't cause cancer and
doesn't require surgery.
• Food, fibre and
fun Unfortunately, there's no cure for IBS. But
treatment is available. One of the best ways to control
symptoms is through diet. "Try to identify foods that
may be causing the symptomatology," suggests Dr Newman,
"like fructose sweeteners in fruit drinks." Advise your
patients to try eating six small meals a day, reduce
the amount of fat they consume and increase their dietary
fibre. Antispasmodic drugs (like hyoscyamine and dicyclomine)
can be prescribed to help control pain. Laxatives aren't
recommended for children because they're more susceptible
to addiction problems. Dr Newman also suggests that
you tell your patients to get active. "Kids need to
stay as fit as possible," he says.
• Tender loving
Tx Children might benefit from stress management
techniques, relaxation therapy and cognitive behavioural
therapy. These treatments are already widely used to
treat adult IBS and could be useful for younger sufferers
as well. Kids also need the support of their family.
"They need vast amounts of reassurance that they aren't
suffering from a chronic illness," says Dr Newman.
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