What types of treatments might be recommended?
For all children, we recommend:
- Continuation or return to normal daily routine, including school, chores, and other activities. These daily activities are important in keeping children connected with their peers, maintaining a high level of distraction, minimizing focus on illness, and reducing potential secondary gain issues. Further, absence from school can increase academic demands (e.g., make up work), disrupt continuity of classroom learning, and result in negative interactions with teachers. All of these issues further increase stress and make pain episodes more likely to occur in the future.
- Parent encouragement of positive coping with pain and/or stress. The ways that parents cope with their own illnesses provides a model for children to follow, so it is important for parents to be aware of their own behavior when not feeling well and to make an effort to model positive functioning (e.g., going to work, limiting complaints, taking medication as directed, staying busy with distracting activities). Further, parents must be aware of how they respond to a child's illness. Certain behaviors (e.g., keeping the child home from school/activities, visiting the doctor frequently, bringing treats home, spending more time than usual with the child) may result in children believing their illness is more serious and that they lack the ability to cope with it effectively. Parents can be most helpful to children when they can stay calm, maintain consistent daily expectations, remind children what pain management strategies might be helpful, and then notice/reward children for trying to engage in positive coping behavior.
Medications may be prescribed to suppress gastric acid, reduce gut inflammation, increase relaxation in the stomach, decrease bacterial overgrowth, improve movement through the GI tract, decrease nerve sensitivity throughout the GI tract, and improve sleep. Although not common, children also sometimes will be referred to a psychiatrist for medication to reduce anxiety and/or depression associated with their abdominal pain.
Biofeedback-assisted relaxation training (BART) with a certified biofeedback practitioner may be recommended to help children learn to balance their autonomic nervous system in order to reduce physical stress, improve coping with mental stress, enhance pain management skills, improve sleep, and reduce GI symptoms.
Cognitive-behavioral therapy (CBT) with a licensed psychologist may be recommended to help children modify their thoughts and behaviors in response to pain, anxiety, and/or stress. Modification of the home and/or school environments to support improved coping, increased daily functioning, and decreased GI symptoms often is included as part of the treatment package.
Other possible recommendations:
- Promotion of sleep quality through consistent sleep routine/schedule and good sleep hygiene.
- Sleep evaluation/study to examine and address more significant sleep disturbance.
- Physical therapy and/or consultation with an exercise physiologist to aid in return to normal activity level or sports participation.
- Therapeutic massage to reduce physical tension and stress.
- Psychoeducational testing to assess for possible unidentified learning difficulties that may be creating stress at school.
- Individual therapy to address more broad emotional and/or behavioral issues.
- Family therapy to address significant stress within the home environment.
- Herbal/natural/homeopathic remedies to control specific GI symptoms (e.g., ginger for nausea).
- Acupuncture (the placement of very small needles at specific pain points) to reduce pain and nausea, as well as to promote healing.
How often will my child need to come in for follow up visits?
During initial treatment, patients seen in the Abdominal Pain Clinic will be scheduled for monthly follow up visits with one of our highly-trained advanced practice providers, under the ongoing direction of Dr. Friesen and Dr. Schurman. Additional follow up will be provided, as needed, through phone contact with our dedicated nursing staff. Phone contact is usually requested on at least a biweekly basis.
Once your child has been symptom-free for 2-3 months, we will begin to wean medications. At that time, the frequency of follow up visits and phone calls to the APC will decrease. However, your child should continue with other recommended treatments (e.g., BART, CBT, etc.) as directed by those providers to ensure maximum benefit in the short- and long-term.