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Are your child’s tummy problems real…or imagined?

By Dr. April Ulmer

When it comes to kids’ tummy problems, a wide range of potential causes may be to blame. Some of the most common culprits, such as the flu, are easiest for caregivers to identify. As important as it is to pinpoint the physical, or “organic,” causes of gastrointestinal symptoms in children, it also is critical to understand and acknowledge the effects that functional symptoms can have on a child’s quality of life. Functional means that nothing physical, such as damage in the gut, is causing the symptoms. Instead, a functionally symptomatic gut just misbehaves. Functional GI problems in children are very common, and the symptoms can be severe and even debilitating. 

Functional symptoms develop when the nerves of the gastrointestinal tract become hypersensitive. There are lots of things that can lead to such hypersensitivity, ranging from prior infections, physical stress, emotional stress and even medications such as antibiotics that alter the balance of bacteria in the GI tract. Once the gut nerves are sensitized, those nerves start sending the wrong messages to the brain by way of what I like to call the brain-gut highway. 

Under normal circumstances, the brain and the gut “speak” to one another in a measured, systematic, biochemical kind of way. For example, when you’re excited and get butterflies in your tummy, it’s your brain communicating with your gut that causes that sensation. In a healthy tummy, the brain-gut highway is patrolled by “nerve police” that regulate when the traffic (messaging between the brain to the gut and vice versa) occurs, decides which traffic is appropriate and when the traffic should slow down or stop. 

To better illustrate this point, let’s say a child needs to have a poop. To someone without functional issues, that simply feels like “I need to poop.” However, for a child with gut hypersensitivity, needing to poop can manifest as severe pain, nausea or anything in between. Keep in mind that pain is not imaginary; it’s just coming from a different place than pain caused by ulcers or damage. 

Unfortunately, diagnosis and management of functional problems in children can be tricky at best and downright difficult at worst. When first evaluating any patient, including those who ultimately are diagnosed with functional symptoms, I begin by establishing a rapport. I assure them that whatever’s causing their trouble, we’ll figure it out together. It is important to validate what they’re going through because in so many instances, they’ve been told the symptoms must be in their head — especially if they’ve undergone prior evaluations such as labs or imaging that have been read as normal. I explain that I believe what they’re experiencing is real; we just need to figure out the best way to approach it. In addition to getting a thorough history, a targeted physical examination and sometimes even an endoscopic evaluation are needed. Upon diagnosis, I discuss all treatment options that are practical and appropriate for that specific child. 

Such options can range from lifestyle changes to medications, counselling and sometimes much more. It’s also important to note that studies have shown functional GI symptoms are strongly associated with anxiety and/or depression. To that end, children with these conditions, if their conditions are poorly controlled, tend to suffer more commonly with significant functional tummy symptoms. The converse is also true: Untreated functional GI symptoms often agitate or worsen anxiety and/or depression. Given this association, it sometimes is necessary to enlist the help of a mental health professional to ensure adequate treatment of the whole child. 

Untreated functional GI symptoms can negatively affect a child’s confidence, participation, activity level, socialization, school attendance and performance, just to name a few. Even if a child is growing well and prior studies have been normal, he or she still could be suffering from life-altering functional GI symptoms. Timely evaluation and management by a skilled and experienced pediatric GI physician are key. Ultimately, it’s all about ensuring that your child thrives and enjoys the best quality of life possible. 

Dr. April Ulmer, aka “The Tummy Dr.,” is a board-certified pediatric gastroenterologist who practices at Kids and Tummies in Gulfport. Reach her at 

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