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Tuesday, March 11, 2014
Frequent Abdominal Pain
First off, I am asking this question because I am having second thoughts about a negative celiac test done @ 20 mo old on my child who is now 6 years old.(two of the blood draws needed to be redone the following week but they said the Celiac was OK??). It was originally done due to chronic diarrhea since birth along with falling off growth chart in weight at 18 mo.(good diet). He is currently at 25% and otherwise healthly except he VERY frequently has abdominal pain, complains on average every day with episodes of it getting really bad that it brings him to tears. It is at these times that his abdomen will become very hard and distended. He is not constipated as he still has frequent diarrhea, sometimes a few times a day. I have 2 other children that have none of this. I also find that he has "odd" complaints in the last year that I tend to "blow-off" but now am thinking I should be giving it more thought. His complaints will be out of the blue, no ryhyme or reason. Ex: blurry vision, "the TV is blurry again, brief loss of vision in one eye "it`s like my eye is closed but it`s not" ,joint pain (knee, ankle, wrists), thigh pain (always the same thigh), neck pain, chest pain, "my heart hurts", nosebleeds. All these episodes are sporatic and not long lasting, usually under 10 minutes except the abdominal pain that may last up to 30. He also is the shortest of all my children with the others being around 80%, he is at 30%. I don`t want to paint a picture of an unhealthy child. He is normally very active, eats a decent diet, is happy and friendly. I just am beginning to take more notice of these events and thinking they could be related. I would feel just awful if he has had Celiac all along and we have been doing nothing to ease his discomfort, that all of this could have been avoided. One of the reasons it is in my mind is because I refused a colonoscopy/endoscopy when the blood work came back fine and he was back on the growth chart at 5%. The GI doc left it up to us and we declined. No one else in our family has Celiac, so not sure why I`m still thinking of it. Do you think his complaints are enough to have him go back to a GI doc. Are they complaints that match another diagnosis? Or is he just a normal 6 year old with odd complaints? Thank you so much for reading this long question, I look forward to your reply.
This is not a straight forward problem. I can respond to the question regarding celiac disease with the comment that none of the blood screening tests for celiac disease are totally reliable before the age of 2 years. If symptoms persist, it would make some sense to repeat them when the child is older and the tests more reliable.
The additional complaints such as blurred vision and abdominal pain may have some relationship to migraines and review by a good neurologist may be indicated. The presence of complaints in multiple locations would likely indicate that migraine is less likely and that the pain is more functional or caused by things we do not understand so well but is real.
The complaints described may be compatible with irritable bowel syndrome but most pediatric GI specialists are loathe to label kids in the first years of life with this diagnosis. We see adults and children who may have pain associated with bowel distention or bowel movement that would not affect some others. In addition, behavioral issues such as stress or anxiety may also exacerbate these symptoms.
James E Heubi, MD
Professor and Associate Chair of Pediatrics
College of Medicine
University of Cincinnati