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Suggest treatment for persistent stomach pain in a child

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Dr. Suma Parinam

General & Family Physician

Practicing since :2008

Answered : 1704 Questions

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Posted on Wed, 5 Apr 2017 in Child Health
Question: Greetings Doctor,

My 10 year old daughter has repeatedly had complaints about stomach pain on and off over the years. We have been to various docs and even to the ER on October 8, 2016. They did x-ray and ultrasound. We ruled out appendix. We did not do cat scan (pet scan?) due to high radiation. They did not have an MRI option which I am told is better. They gave her pantoprazole (proton pump inhibitor) that she took for a very short while as needed. Does is stated as 20 mg once day at about 7 AM. After ER she went home and things got better.

She was previously tested for Celiac disease (I am told she does not have it). But a friend tells me that doesn't mean that wheat doesn't contribute to her problem since my friend has that issue based on breakdown products (sugars?) created when it metabolizes.

After ER, soon went to pediatric gastroenterologist (about 2 hours away at Dartmouth Hitchcock Med Center in New Hampshire, USA). He does not think she is lactose intolerant based on her ability to eat milk sometimes without issue (mainly ice cream). They did not do the complicated test however since it requires lots of back and forth travel. My daughter has often said that she thinks that sometimes she has pain after drinking milk, but we don't know if it is related.

Talking to docs in the past, they often blame stress.

Current situation: She has had a stomach ache for at least 6 days. Started with headache. The next day stomach pain started too. There was an illness going around, so we thought it was related. Headache has been gone for 3-4 days, but stomach has not improved and even is getting worse. She has not vomited. She is a in a great deal of pain at times. It comes in waves. When bad, she says the pain is 8 on scale of 1 to 10 and she is complaining vigorously. This AM it even made it hard to breath. When not bad, pain is about 4 and it never completely goes away since it started. Hurts a lot in mid and mainly upper stomach. Symptoms feel like burning cramp. Has had some regurgitation (tastes like vomit) that goes up and then down. Temp has not really climbed much above 99.7 and has also been normal. She has not been eating a lot and has lost a pound. She can sleep but the pain can make it hard to sleep or wake her up. I asked her to sit up with pillows instead of lying down. It helps a little, but it is harder to sleep like that. She says her back is now hurting. Not sure if it just due to bed or tension, or stomach.

Went to local doc office yesterday and saw physician’s assistant. She does not suspect appendix. Says advised us to continue doing what we have been doing. I restarted the pantoprazole the night before last. We are giving her half an adult dose of Advil (or Tylenol) as pain killer, Pepto-Bismol, and occasional tums. Do it for 10-14 days.

When I took her to the doctor’s office and grocery shopping yesterday, being up and about appeared to distracted her from pain, but she still had pain.

At grocery store, she wanted the usual things that younger kids tend to like, often emphasizing white flour which I know is not good. She is a very picky eater. She is not eating a lot now. Sometimes her stomach pain gets worse after eating. She favors bland foods like rice, pasta, mac and cheese, French bread, ramen noodles, chicken noodle soup, crackers, grilled cheese, turkey, sharp cheddar cheese, peanut butter, apples, oranges, broccoli, carrots, strawberries, ice cream, strawberry yogurt, popsicles, desserts, tacos, hamburgers, chicken fingers, fries, salmon. This week she has been eating very little including rice, bananas, pasta, chicken noodle soup, oatmeal, popsicles, ginger ale, water. Little fruit (broccoli) and veggies (apple). She had a lot of almonds early in the week about when the problem started. She has lost about a pound. Weighs 70 lbs. and stands about 4’5” tall.

That about tells the story. I am wondering what may be causing this, if it is serious, what to look for to know if it is serious, and what the best next steps/tests should be.

Thank you for your help.

XXXX
cell: XXXX-XXX-XXXX
YYYY@YYYY
000 XXXXXXX Ave
XXXXXXX Center, VT XXXXXXX
doctor
Answered by Dr. Suma Parinam 11 hours later
Brief Answer:
Pediatric Gastroenterology

Detailed Answer:
Hi,

thank you for long narrative. This helps a lot understand the nature of pain.
At the outset your daughter is in pain up to 8 over 10, sometimes 4 as well. She is eating bland, lost a pound of weight. You had been to number of doctors all could not figure out the cause.

In my opinion your next step is to admit your daughter in hospital under observation by pediatric gastroenterology when she is in pain. It really helps to investigate when she is in pain especially CT SCAN ABDOMEN with contrast IV. It helps to determine if there are inflammatory disease starting early age. It helps to check for unusual ulcers... as she sometimes complaining pain aggravating after food. An ultrasound abdomen to look for obvious causes like pancreas, liver, spleen and gall bladder. An abdominal migraine may be.....

so in my opinion get investigation till cause was found.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Suma Parinam 8 hours later
Thank you. I think we will take her to ER now.
doctor
Answered by Dr. Suma Parinam 16 hours later
Brief Answer:
Will be available for follow ups after admission

Detailed Answer:
Hi, glad that you took a decision. I suggest to insist the doctor to find the cause. Without exact reasons for pain it is difficult to treat... it would be like shooting an arrow at the targe in the dark...
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Suma Parinam 47 hours later
Thank you. Appreciate your help.
doctor
Answered by Dr. Suma Parinam 5 hours later
Brief Answer:
Please close and rate the answer

Detailed Answer:
Thank you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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