Disorders of Gut-Brain Interaction: Functional Abdominal Pain Disorders
Unexplained abdominal pain stomachache; tummy ache; belly ache GI; IBS; IBD; irritable bowel; Crohns disease; ulcerative colitis; gut-brain connection; gut microbiome; probiotics; peppermint oil; constipation; diarrhea
One in four kids are affected by abdominal pain with no clear cause, a condition called gut-brain interaction or functional abdominal pain disorders. These can be chronic, with ongoing abdominal pain, or cause stomachaches that come and go. Learn more.
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HealthyChildren.org
By: Price T. Edwards, MD & Patrick Reeves, MD, FAAP

Functional abdominal pain disorders (FAPDs) are the most common condition seen by pediatric gastroenterologists (digestive system doctors). FAPDs affect one in four children across the world. The disorders may be chronic, with ongoing abdominal pain, or cause stomachaches that come and go.

FAPDs in children typically have no clear cause. They fall under a type of diagnosis called disorders of gut-brain interaction (DGBIs). Constant communication exists between our brain and the nerves, which may cause pain in our gastrointestinal tract (GI) and the rest of our body.

FAPDs do not develop over the course of one day. It can take months or even years for a disorder to develop. Continue reading to learn about the symptoms, diagnosis, and treatment for FAPDs in children.

Symptoms of functional abdominal pain disorders

Most children with FAPDs will have pain at or around the belly button. Other more concerning symptoms can occur with FAPDs may include:

Nausea/vomiting

Headaches

Dizziness

Tiredness

Dysphagia (difficulty swallowing) or odynophagia (painful swallowing)

gastrointestinal bleeding

Nighttime diarrhea

Skin changes around the bottom

Involuntary weight loss

Deceleration of linear growth, a slowing down of gain in a child's height or length

Delayed puberty

Unexplained/recurrent fever

Arthritis or inflamed joints

If your child has abdominal pain accompanied by any of these symptoms, or if you have a family history of inflammatory bowel disease (IBD) such as ulcerative colitis or Crohns disease, celiac disease or peptic ulcer disease, contact their doctor. These signs will need further testing and you may be referred to a pediatric gastroenterologist.

What causes gut-brain interaction & functional abdominal pain disorders in children?

The cause of pain from FAPDs and DGBIs is unknown, but research suggests it can be associated with:

Stressful events, like a move or family separation

Changes to the bacteria that live in the gut (gut microbiome)

Dysregulated autonomic nervous system, which controls digestion and and other automatic body functions such as heart rate

Family history of DGBIs, which suggests that genetics could play a role.

Disordered movement of the GI tract, when normal rhythmic contractions that move food and waste through your digestive system become irregular

How are DGBIs & FAPDs diagnosed & treated?

Typically, FAPDs require diagnosis and treatment from a doctor, and many children may feel better within a few days to a few weeks.

DGBIs are diagnosed through the evaluation of your child's symptoms by their doctor. There are different conditions that share symptoms, and a diagnosis will vary between children. One child may benefit from further testing while another child may not. Each child is different, so evaluating your child's symptoms may be the best way for their doctor to reach a diagnosis. Talk to your pediatrician to better understand your child's health.

Treatments typically depend on your child's symptoms and the type of DGBI they have. DGBIs can add stress and negatively impact quality of life for patients. The goal of many treatments is to reduce and manage symptoms so patients can stay involved in life activities.

Treatments for DGBIs and FAPDs include:

Child psychology or cognitive behavioral therapy (CBT). Studies suggest that both in-person and virtual use of CBT can be effective in treating FAPDs. Hypnosis and biofeedback training can also be effective treatments.

Finding dietary triggers. It may be helpful to keep a journal to track foods that cause pain and symptoms of FAPDs. Some patients with IBS may respond well to less FODMAPs, or foods with high levels of poorly digested sugars. Consult your pediatrician about the low-FODMAP diet for your child.

Medications. Medication use will vary depending on which DGBI has been diagnosed. For functional abdominal pain related to intestinal spasm, antispasmodic medicines are frequently used. Peppermint oil has also been shown to have an antispasmodic effect. Some medication may be prescribed to prevent episodes of FAPDs. One study found probiotics helpful for FAPDs and irritable bowel disease. There is ongoing research into additional medication to treat and prevent DGBIs.

Acupunture & medical devices for FAPDs. Some treatments use auricular (ear/hearing) acupuncture with small needles. There are also devices being developed that use electrical stimulation that can treat FAPDs. Here are what the devices look like:

Remember

Reach out to your child's pediatrician if you have concerns about your child's gastrointestinal pain.

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