Doctors Lounge - Pediatrics Answers
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Forum Name: Pediatric Topics
|hunterjaylyn - Thu Feb 08, 2007 1:37 pm||
My 6 year old daughter has been having episodes of abdominal pain off and on for a year. She has had no previous illnesses nor surgeries. Family history is my sister had RTA and one kidney died when she was two. Her episodes have grown more frequent since December. In one month time she had 4-5 of them. Sometimes the pain is so bad she cries and she will just lie there. Sometimes the stomach ache is accompanied by a fever ranging from 99.0 - 104.0f and sometimes she will vomit once or twice after hours of pain. Her stomach aches have gone from a couple of hours to 1-2 days at a time. Sometimes the pain isn't so severe but she will get quiet. She was on prevacid now we are trying stool softeners but she has a bm at least every other day and they aren't hard and small looking. She gets very pale with the aches and very cold. Only one round of blood tests done and a ultrasound which came back normal. Stomach aches come on at various times sometimes in the middle of the day, beginning or even when she is sleeping. Any advice is appreciated. Thank you for taking the time to answer me back.
|Dr. Chan Lowe - Thu Feb 08, 2007 10:05 pm||
Abdominal pain can be one of the most difficult and ellusive things for a pediatrician to diagnose. So many of the illnesses have essentially the same symptoms.
I do have a few thoughts for you along with a few questions. Has she lost any weight? How is her appetite? When she does vomit, does she vomit any blood or dark green color? Does she ever have diarrhea? Does she have any blood in her stools?
If it has not already been done, I would recommend evaluation for celiac disease. This is essentially an allergy to gluten which is found in many foods. Celiac disease (also known as celiac sprue) is much more common than previously thought-even upwards of 1 in 100 people. It often presents with vague abdominal pain that can be severe.
Also, food allergies can be quite painful. Unfortunately, GI food allergies are caused by a different mechanism than are "hay fever" allergies, so the routine skin testing that is done for other allergies is NOT helpful in these cases (despite their persistent usage by doctors). The best way to determine these allergies is by doing elimination diets. There are 9 main foods that cause about 90% of food allergies: milk, eggs, dairy, wheat, tree nuts, peanuts, soy, fish and shellfish.
If you are able to eliminate all sources of these foods for 2-4 weeks and the symptoms go away, this is likely the cause. At that point you can add the foods back one at a time very slowly to see which one was the cause of the pain.
Gastritis is possible but the prevacid should help with this. It does take a few weeks for prevacid to have its full effect. If sufficient time has gone by and the symptoms persist gastritis is unlikely. Testing of a bacteria called H. pylori is a good idea as this bacteria can cause quite severe gastritis and even ulcers. Treatment for this involves a proton pump inhibitor (such a prevacid) as well as an antibiotic and either an additional antibiotic or a coating agent.
If none of these things are helping I would suggest that you have your daughter seen by a gastroenterology specialist. At that point, she may need an endoscopy to use the camera to look at the lining of her stomach, etc. and take a few biopsies to look for the cause.
Hope this helps. Keep us updated.
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