Persistent Diarrhea and Abdominal Pain in Children

Child experiencing diarrhea and abdominal pain?

Hello, my child is nine years old and is about to enter the third grade.
She weighs 36 kg and has been experiencing diarrhea since early June.
Additionally, she has persistent pain in the area just below her navel, which is tender to the touch.
We have visited a major hospital and several clinics, and she has undergone X-rays, ultrasounds, and tests for urine and stool, all of which came back normal.
Some doctors have suggested gastroenteritis and rapid peristalsis, but the medications prescribed have only reduced the frequency of her diarrhea without improving the condition itself.
Every morning, she wakes up complaining of stomach pain and loose stools, which are watery in consistency, although the volume has decreased.
She has been eating very bland foods and continues to take the gastrointestinal medications prescribed by her doctor, but there has been no improvement.
I am unsure what other tests or potential rare causes could be investigated for treatment.
Prior to this, her appetite was good, and she only occasionally experienced stomach pain and diarrhea, which would resolve on its own.
Currently, she has lost 2-3 kg due to eating less and sticking to a bland diet.
Her energy levels are okay, but she continues to report stomach pain and diarrhea.

coco, 30~39 year old female. Ask Date: 2012/07/02

Dr. Xiao Kaiwen reply Pediatrics

Diarrhea lasting more than two weeks is referred to as chronic diarrhea.
The most common cause is often due to damage to the intestinal mucosa following acute gastroenteritis, which may take time to recover, sometimes lasting 2-3 months or even up to six months.
In such cases, medication can be helpful, but dietary management is also crucial (it is advisable to avoid greasy foods, vegetables, fruits, and dairy products), and probiotics may be supplemented.
Other less common causes include malabsorption of carbohydrates (such as congenital lactose intolerance), malabsorption of fats, cow's milk protein allergy, parasitic infections, autoimmune diseases, and certain medications (such as some antibiotics that can cause diarrhea).
The investigations for these less common causes can be quite complex, and if necessary, consulting a pediatric gastroenterologist at a medical center is recommended.

Reply Date: 2012/07/02

More Info

Persistent abdominal pain and diarrhea in children can be concerning for both parents and healthcare providers. In your case, your nine-year-old child has been experiencing these symptoms for several months, which can be indicative of various underlying issues. Given the extensive testing that has already been performed, including X-rays, ultrasounds, and laboratory tests, it is important to consider both common and less common causes of these symptoms.

Possible Causes
1. Functional Gastrointestinal Disorders: One of the most common causes of chronic abdominal pain and diarrhea in children is functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). These conditions often do not show up on standard imaging or laboratory tests but can cause significant discomfort and changes in bowel habits.

2. Dietary Factors: Sometimes, dietary intolerances or allergies can lead to persistent gastrointestinal symptoms. Common culprits include lactose intolerance, gluten sensitivity, or other food allergies. Keeping a food diary to track what your child eats and any corresponding symptoms may help identify potential triggers.

3. Infections: While you mentioned that tests for infections have returned normal, it is worth noting that some infections can be persistent or recurrent, especially if they are viral in nature. Viral gastroenteritis can sometimes cause prolonged symptoms, although it typically resolves within a few days.

4. Psychological Factors: Stress and anxiety can manifest as physical symptoms in children, including abdominal pain and changes in bowel habits. If there have been any recent changes in your child's life, such as starting a new school or other stressors, this could be a contributing factor.

5. Inflammatory Bowel Disease (IBD): Although less common, conditions such as Crohn's disease or ulcerative colitis can present with abdominal pain and diarrhea. These conditions often require more specialized testing, such as endoscopy or colonoscopy, to diagnose.

6. Malabsorption Syndromes: Conditions that affect the absorption of nutrients, such as celiac disease or pancreatic insufficiency, can lead to diarrhea and abdominal pain. Testing for specific antibodies or stool tests to assess fat malabsorption may be warranted.

Recommendations for Further Evaluation
Given that your child has already undergone a significant amount of testing without a clear diagnosis, consider the following steps:
1. Referral to a Pediatric Gastroenterologist: A specialist in pediatric gastroenterology may have additional insights and testing options that can help identify the underlying cause of your child's symptoms.

2. Dietary Review: Consulting with a pediatric dietitian can help assess your child's diet and identify any potential food intolerances or allergies. An elimination diet may be recommended to pinpoint specific triggers.

3. Psychological Assessment: If there are any indications of stress or anxiety, a referral to a child psychologist or counselor may be beneficial. They can help address any emotional factors that may be contributing to your child's symptoms.

4. Further Testing: If not already done, consider discussing the possibility of more advanced imaging or endoscopic procedures to rule out conditions like IBD or other structural abnormalities.

5. Symptom Management: In the meantime, focus on managing your child's symptoms. This may include dietary adjustments, hydration, and possibly medications to help with diarrhea and abdominal pain, as advised by your healthcare provider.

Conclusion
Persistent abdominal pain and diarrhea in children can be multifactorial, and while it can be frustrating when initial tests return normal, it is essential to continue seeking answers. Collaborating with specialists and considering both physical and psychological aspects of your child's health will be crucial in finding an effective treatment plan. Your child's well-being is paramount, and with the right approach, improvement is possible.

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