“My Tummy Hurts”
These words you’ve heard echoed many times. Too many to count in fact. At first it was the stomach flu. But then the issues started happening more regularly. At school, at home, with no particular rhyme or reason.
Your heart goes out to them. You wish you could just take away your child’s stomach pain. And you know just how it feels because you’ve also suffered with similar issues.
So what do you do?
Naturally, you take them to their doctor or paediatrician. You search on the internet. You talk to other parents. No answers seem to present themselves. The struggle for you and your child is real. Maybe you try a probiotic or a medication – partial relief at best.
As the school absences and missed activities pile up and their quality of life deteriorates, you finally say enough is enough. Something needs to be done. You pick up the phone. You call a naturopathic doctor…
In this article I’ll cover common digestive conditions kids may experience like stomach pain, constipation and diarrhea. I’ll discuss some of the causes and detail what a naturopathic approach may look like for your child.
Chronic Stomach Pain in Kids
As with adults, there is now an epidemic of children and adolescents suffering with chronic digestive disorders. The proportion of kids with stomach pain is becoming increasingly common. Most studies report that around 15% of children suffer with functional abdominal pain. Functional means that no causes have been discovered to explain why the child is experiencing the pain. That’s a lot of unanswered questions.
The symptoms may vary but could include any of the following:
- abdominal pain or cramping
- constipation or diarrhea
- nausea or vomiting
- gas & bloating
- food intolerance
- food impaction or trouble swallowing
- low appetite
- weight loss
- headaches or migraines
And these symptoms have been experienced for at least 3 days a week for the last 3 month with symptoms appearing at least 6 months ago.
So Why is Stomach Pain So Common in Kids?
There are more questions than answers in this field but here’s what we think might be contributing:
Diet, diet, diet!
Kids aren’t eating properly – straight up. Now this isn’t always the case but most of the time there is a dietary challenge keeping your child from feeling their best. Sometimes it’s the foods you would never expect – More on this below.
Kids should be eating real food, not processed, garbage. A good first step, if you haven’t already done so, is getting kids to this step – eating whole, unprocessed foods.
Consider that our gut bugs rely on the things we feed it. Now consider how gut bugs influence our brain, behavior, immune system and yes, our likelihood of a chronic digestive disorder. On so many levels, it makes sense to improve the quality of our diets first and foremost!
Next we’ll consider how specific foods may contribute to chronic digestive symptoms.
Malabsorption vs Intolerance
Fructose, sorbitol, and lactose are all carbohydrates that can be malabsorbed. What this means is that instead of being broken down and absorbed through the intestines, they are left intact to be fed on by intestinal bacteria. When this leads to digestive symptoms like gas, bloating or diarrhea it is considered an intolerance.
Carbohydrate intolerances are common in children. The prevalence of fructose intolerance in children with functional gastrointestinal disorders is 35-55% and may play a particularly large role in constipation.
Foods and beverages like pops, fruit juices, sauces and baked goods are generally loaded with fructose. But seemingly healthy foods like apples, honey, mangos, pears and grapes are also high in the fruit sugar. You’ll need to be careful of nearly all dried fruits if you have a fructose intolerance as these are notoriously concentrated with fructose. Most of the fruits on this list are also loaded with sorbitol. The fact that healthy fruits can be contributing to childhood digestive complaints is surprising to most.
Lactose from cheese, milk and most yogurts will be problematic for those with lactose intolerance.
Although controversial, it appears that eliminating IgG-based food intolerances can contribute to improvements in digestive symptoms. I wrote more about this in my article on Crohn’s and colitis.
It is therefore crucial to Investigate the role that food may be playing in your child’s digestive symptoms. Food sensitivities and carbohydrate intolerances can result because of an imbalance in gut bacteria, which we’ll discuss next.
Gut Bugs
The development of the immune system through the acquisition of intestinal bacteria during the first two years of life is a critical step towards solid digestive health. Children born via caesarian section for example often will have much different microbes in their guts than those born through vaginal delivery. Breastfeeding also plays a big role in this development. However, don’t fret if this wasn’t the case for you and your child.
The famous hygiene hypothesis states that we negatively impact our health by over-sanitizing and by minimizing our children’s contact with rich microbial environments like dirt. This impacts gut bacterial richness and diversity which we need in order for our health to thrive! This has become one of the leading theories behind why allergies and autoimmune diseases are skyrocketing in North America. It has no doubt contributed to the rise in digestive disorders in children as well. Let the kids play in dirt!
Infections like a bad stomach flu or food poisoning can predispose kids to more chronic digestive symptoms like pain, gas and bloating. They can also damage surfaces in the gut where absorption occurs leading to carbohydrate and lactose intolerances, often key features found in children with abdominal pain disorders. This is likely what happens if your child, all of a sudden, stops tolerating lactose-containing foods after a gut infection.
Finally, the overuse of antibiotics in childhood has become a real threat to kids developing a robust digestive system. This was certainly the case for me as a child. It can take years for your natural gut bacteria to get back in balance after antibiotic use.
Stressed Out Kids
At home, at school, on social media – it seems kids are always being bombarded with external pressures. There’s a solid link between mental health challenges and digestive disorders. In fact, anxiety and depression are much more common in children with chronic digestive disorders. Sadly, there’s also a strong link between physical and sexual abuse in childhood amongst chronic pain sufferers.
Stress rewires the gut. This occurs through visceral hypersensitivity and it can make children feel pain when they shouldn’t. It can also cause them to experience pain out of proportion to the stimulus. Read Wired Brain, Wired Gut? for more information on this phenomenon.
Treatments that focus on the gut-brain axis such as gut-directed hypnotherapy and cognitive behavioral therapy can be very helpful treatments for children with chronic abdominal pain.
Family Matters
For better, but often for worse, we tend to share certain features of digestive structure and function with our immediate family members. For example, first-degree relatives of those with both Celiac and Crohn’s disease have increased intestinal permeability or “leaky gut” compared to families who don’t these digestive diseases. Leaky gut is a major determinant of many chronic digestive disorders like chronic stomach pain in kids.
Does this mean you or your child are destined to a life full of digestive woes?
Certainly not. But it may mean you have to work a little harder on things like diet and optimizing your environment (stress) in order to keep digestive disorders at a distance.
Common Digestive Disorders in Children
Functional digestive disorders in children can be broken down into the following:
Functional abdominal pain syndromes:
These consist of:
Irritable bowel syndrome (IBS) – Chronic digestive pain that is related to a change in bowel movement form (hard vs soft/watery) and frequency. I have written extensively about IBS here
Functional Dyspepsia – Characterized by bloating after meals, feeling full earlier than normal and/or stomach pain or burning after eating. This condition affects children in their stomach and small intestine. Read my previous article on functional dyspepsia.
Abdominal migraine – Stomach pain in kids that can last up to hours and days, with periods of complete absence of pain for weeks to months with seemingly no relation to food intake. Generally these kids will also suffer with migraine headaches.
Research suggests a connection between the health of the mitochondria, which are the major energy producing cells in the body, and susceptibility to migraines. The same appears to be true in abdominal migraine.
Functional Constipation (FC) – Straining, ineffectual urges or infrequent, hard bowel movements are the hallmarks of constipation. Pain is not a prominent feature with FC.
One more condition to keep your eye on…
Eosinophilic esophagitis (EoE) – an inflammation of the esophagus caused by a reaction of immune cells to food allergies or sensitivities. This condition is often seen in childhood and is becoming increasingly common alongside the steep rise of food allergies and asthma. We’ll see a lot more of this condition in the coming years. The symptoms usually consists of food impaction, trouble swallowing and is often mistaken for acid reflux or GERD.
Not surprisingly, diet is the number one treatment strategy for EoE and involves eliminating the offending foods by performing an elimination diet.
Now let’s look at what tools naturopathic doctors have to determine and treat your child’s digestive complaints.
Digestion Through a Naturopathic Lens
The first step to solving a problem is by first identifying it.
Through a thoughtful careful process a naturopathic doctor can determine what’s causing your child’s digestive issues, often within the first 1-2 visits.
A thorough discussion of your child’s’ diet, environment and past medical history is key.
One thing you and your child can start doing today is getting familiarized with something called the Bristol Stool Chart. Yes that means talking about poop. And specifically looking at your poop. Don’t shy away from this important topic.
Let me explain.
The Bristol stool chart is a validated visual reference that helps differentiate between “healthy” and irregular pooping patterns (constipation vs diarrhea). I say healthy because there are many factors to healthy poop beyond its form.
Other things you should be looking at are things like stool color. Is it brown, lighter or darker? Does it float or sink? Does it stick to the toilet bowel or break apart on impact?
Enter The Doo-Doo Diary (patent-pending)
I often recommend keeping a poop journal. That’s right, a poop journal! This helps children build an awareness of their bowel habits while learning how things like diet, stress, and water intake can affect their pooping habits on a day to day basis. It’s simple: every day they mark down if they had a bowel movement and what number it best corresponds to on the bristol stool chart above. You can even turn this into a fun, reward-based system. Parents, feel free to go nuts with this.
Herbs: A kids best friend
Herbal medicine is a fantastic tool for addressing multiple digestive complaints in children. In my clinical experience, children respond especially well to herbs in the form of both teas and tinctures (alcohol or glycerine-based herbal extractions).
Depending on the digestive concern, there is generally an herbal medicine that can safely help your child!
Peppermint oil, for example, is an effective treatment for IBS and functional dyspepsia in children. Now before you run off to the store please know that every child’s digestive plan should be unique and supervised for safety and effectiveness.
Note: essential oils should never be administered to children without first consulting a professional
A multi-herb formula that I use regularly has been studied for abdominal pain syndromes in children. It can improve pain and bloating within 10-20 minutes of consuming and has an excellent safety profile.
Does your child also suffer from anxiety? No problem! The great thing about herbal medicine is that your naturopathic doctor can compound a specific tincture (or tea) for your child that has multiple synergistic herbs that treat both the digestive system and the nervous system. Here’s the secret: some of our best digestive herbs also have calming/soothing effects on children’s brains as well.
And What About Probiotics?
One of the reasons probiotics can be so hit or miss for kids and adults alike is that most people don’t end up using the right probiotic strains. With intense consumer pressure in the health food industry these days it’s easy to leave the store with your head-spinning over which probiotic to take.
I go into much more detail on this important topic here.
When it comes to probiotics you want to know three things:
What strain at what dose and for what condition?
Only few probiotic strains make the cut when it comes to improving stomach issues in children like pain, diarrhea and constipation. Here are two:
- Lactobacillus rhamnosus GG (aka LGG)
- Lactobacillus reuteri DSM 17938.
Is It Time?
A naturopathic doctor can help you determine what’s holding your child back and determine an appropriate treatment plan to improve your kids stomach pain and more. If you are tired of watching your child suffer with chronic digestive issues, it’s time to book an appointment.
References:
Korterink, Judith J., et al. “Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis.” PloS one 10.5 (2015): e0126982.
Berni Canani, Roberto, et al. “Diagnosing and treating intolerance to carbohydrates in children.” Nutrients 8.3 (2016): 157.
Hutson, J. M., et al. “‘Rapid transit’constipation in children: a possible genesis for irritable bowel syndrome.” Pediatric surgery international (2019): 1-9.
Urbańska, Magdalena, and Hania Szajewska. “The efficacy of Lactobacillus reuteri DSM 17938 in infants and children: a review of the current evidence.” European journal of pediatrics 173.10 (2014): 1327-1337.
Rutten, Juliette MTM, et al. “Nonpharmacologic treatment of functional abdominal pain disorders: a systematic review.” Pediatrics 135.3 (2015): 522-535.
Martin, Alice E., et al. “Dietary interventions for recurrent abdominal pain in childhood.” The Cochrane Database of Systematic Reviews 2017.3 (2017).