Why Does My Child Always Have a Sore Tummy?

By Lotta Johansson

IF YOUR CHILD OFTEN COMPLAINS OF STOMACH PAIN, BUT MEDICAL TESTS AND GP VISITS FIND NOTHING WRONG, YOU’RE NOT ALONE, AND YOU’RE NOT IMAGINING IT. OTHERWISE KNOWN AS 'FUNCTIONAL ABDOMINAL PAIN' (FAP), RECURRING TUMMY PAIN WITH NO CLEAR MEDICAL CAUSE AFFECTS UP TO 1 IN 5 CHILDREN, DISRUPTING SCHOOL ATTENDANCE, SLEEP, SOCIAL ACTIVITIES, AND GENERAL WELLBEING.

What is FAP and how is it different from other gut issues?

Functional Abdominal Pain is characterised by when a child has ongoing or recurrent abdominal pain, but tests fail to reveal an underlying cause.

Unlike conditions such as coeliac disease, lactose intolerance, or inflammatory bowel disease, FAP can’t be detected by a scan or blood test because it isn’t triggered by a visible issue in the gut.

FAP is linked to dysfunction in how the gut and brain communicate rather than a physical issue in the gut. Contributing factors can include gut sensitivity, family history, gastrointestinal movements that are too fast or too slow, anxiety and depression, immune system functioning, and central nervous system processing.

This type of recurring stomach pain in children is fuelled by complex signalling in the network between the digestive system and nervous system which amplifies painful sensations in response to stress, anxiety, or food.

According to the ROME IV, the standardised diagnostic used to classify functional gastrointestinal disorders, FAP is considered to be abdominal pain that is “distinct from any underlying organic pathology”. The disorder is characterised by four main criteria:

1. Episodic or continuous abdominal pain that lasts for at least four days a month for at least two months.

2. Pain that does NOT occur solely during eating or menstruation.

3. Insufficient criteria for other functional gastrointestinal disorders.

4. Abdominal pain that CAN NOT be fully explained by another medical condition.

How does FAP affect children?

Children with FAP often experience pain that is very real, even if doctors can’t “see” a reason for it. The pain may flare up in the morning before school or during times of stress, and can range from mild discomfort to intense cramps.

OTHER SYMPTOMS MAY INCLUDE:

• Nausea or headaches

• Fatigue or trouble sleeping

• Sensitivity to noise or certain foods

• Anxiety or low mood

• Disruption to daily routines like school, sport, or family time

Because there is no obvious medical explanation, parents may fret about overlooking a potentially serious medical condition while kids struggle with feeling misunderstood and anxious about their pain not being taken seriously.

This in turn creates a cycle where pain can lead to anxiety, which then worsens the pain and perpetuates ongoing symptoms. While FAP does not have a visible underlying cause, it does have an impact on health from heightened sensitivity to light, sound, or diet to fatigue or sleep disorders, anxiety, depression, headaches, nausea, and joint pain.

Treatment options for FAP

While there’s no quick fix for FAP, taking a holistic approach is the best way to soothe little tummies.

TOP TIPS FOR PARENTS:

• Stick to a routine particularly around meals, sleep, and school to help children and teenagers regulate their body and reduce anxietydriven symptoms.

• Provide healthy meals. While there is no specific FAP diet, some children may benefit from tracking food triggers or reducing highFODMAP foods under the supervision of a qualified medical professional.

• There is strong evidence that psychological support in the form of cognitive behavioral therapy (CBT) and relaxation techniques help kids cope better with FAP.

• Simply validating your child’s experience can alleviate anxiety and reduce symptoms. Explain that their pain is real, even if there is no disease causing it, is a way to show support.

In contrast to growing evidence on probiotics as a promising treatment option for FAP, 40% of children have been found to be symptomatic despite pharmacological interventions.

The expert consensus is that probiotics should be considered along with primary measures, such as dietary modifications and physical activity to treat FAP. It’s specifically recommended that probiotics should be used to treat FAP ideally for at least six to eight weeks.

When to see a doctor for FAP

When dealing with FAP it is important for your child to see their GP or paediatrician to rule out more serious causes of tummy pain, like infections, allergies, or gastrointestinal conditions.

IF FAP IS DIAGNOSED, ASK YOUR DOCTOR:

• Should we see a psychologist, dietitian or paediatric GI specialist?

• What strategies should we try first?

• Are probiotics a good option for my child?

• How can we track symptoms and measure improvement?

FAP has long been ignored as an invisible condition, but parents today have more information and treatment options to get their child back on track. With the right tools, FAP can be managed to get kids healthy, happy, and pain-free.

Lotta Johansson is a microbiologist and is part of the scientific affairs team at BioGaia.