• Tuesday Q & A: Stomach pain common in children, but exact source not always easy to identify

DEAR MAYO CLINIC: Is it possible for children to have irritable bowel syndrome? My 9-year-old son often complains of stomach pain, but we can’t seem to find a cause or pattern.Woman holding young child with stomach ache while physician examines her

ANSWER: Although irritable bowel syndrome is possible in a 9-year-old, it is very rare. Stomach pain, on the other hand, is quite common in children that age. When stomach pain persists, it should be evaluated. If you have not already done so, make an appointment for your son to see his primary care provider. If necessary, that individual may recommend that he see a gastroenterologist who specializes in caring for children. Even if the exact source of stomach pain cannot be identified, there often are ways it can be effectively managed.

Many children have stomach pain. Usually it is not a symptom of a larger medical problem, and the pain often goes away on its own. But when stomach pain in children lasts, it does become a concern, particularly when it continues to be a problem for three months or more.

Other red flags associated with stomach pain that should be evaluated include chronic diarrhea, fever, frequent vomiting, bloody or black tarry stools, sudden or severe pain, and bowel movements in the middle of the night. If a child who has stomach pain is not growing at a typical rate, or if a child is losing weight, that also could signal an underlying medical issue that needs assessment.

The first step in evaluating chronic stomach pain in a child typically is a detailed discussion about the child’s medical history, including a review of family history. It is important for your son’s doctor to know the specifics of his condition, including when the pain started, how long it usually lasts and any other symptoms he may have.

In particular, symptoms such as swollen joints, red or painful eyes, headaches and skin rashes may help point to an underlying cause. A physical exam usually comes next. X-rays and blood tests can be useful, too. Endoscopy (a test that involves passing a lighted tube or scope into the colon or the stomach and upper small bowel) may be used in some cases as well. If a doctor notices a suspicious area of tissue during endoscopy, a sample of the tissue may be removed and analyzed to see if it could be part of and help diagnose the problem.

If no other specific medical condition can be found, irritable bowel syndrome, or IBS, could be considered. IBS affects the intestine and often causes stomach pain, along with cramps, bloating, gas, and diarrhea or constipation. It is important to note, however, that although IBS is rarely diagnosed in the teenage years, true cases of IBS are small in children under 10.

In many younger children with chronic stomach pain, a specific cause of the pain cannot be identified. That can be very frustrating for the children and their families. Even when stomach pain cannot be explained, though, there are steps that can be helpful. For example, making diet changes, lowering stress, using relaxation techniques and getting regular physical activity all can be useful in managing stomach pain.

After a thorough evaluation, if the source of your son’s stomach pain still cannot be identified, talk to his doctor about steps you can take to help ease your son’s symptoms. With time and behavior changes, chronic stomach pain in children frequently improves. William Faubion, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.

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