“MOMMY, IT HURTS!”

Apart from the usual scrapes and bumps of a boisterous childhood, a surprisingly large number of children also suffer from recurring stomach aches that have no specific medical cause.

Known clinically as recurrent abdominal pain (RAP), this can produce pain intense enough to interfere with a child’s usual activities in 10 to 15 percent of school-aged children. In the vast majority of RAP cases the child reports this pain even though a thorough medical investigation cannot come up with an answer.

Researchers continue to look at a number of possible causes for RAP. Anxiety and psychological distress have been investigated, although most children with RAP have been found to be psychological quite normal. Some scientists believe that such children have an ill-defined physical disturbance that makes them vulnerable to abdominal distress.

Recent research has concentrated on the fact that children may learn within their family certain behaviors relating to pain. This idea is based on the fact that pain is a subjective experience and that people react differently to pain depending on their own personal tolerance. Contrast the child who accidentally hits his thumb with a hammer, lets out a quick yell, holds back the tears and tries again, with the child who screams the house down, bellowing and sobbing with such conviction that his parents may well believe the entire arm has been torn off.

The things we say and do when we are in pain are termed ‘pain behaviors.’ These behaviors help communicate to others the amount of distress we are suffering and affect our own subjective experience of pain. Children naturally look to their parents to take their pain away. Complaining of pain brings them lots of attention — sympathy, cuddles, reassurance and perhaps a day at home instead of school.

While this kind of attention is appropriate for isolated episodes of pain, it can cause problems with a child suffering chronic, recurring pain. In this case, the episodes of pain will not go away for quite a while and the constant attention may lead the child to complain more, not less.

So while it can be reassuring for parents of children who have been found to suffer RAP to know that there is nothing medically wrong with their child, it is often hard to know exactly how to handle such a situation. If no physical cause for their pain can be found is your child merely ‘putting it on?’

The short answer is ‘no.’ Despite the absence of any identified physical cause, the pain is indeed real and while many children with RAP simply grow out of it, up to a third may experience pain for several years. It is important therefore that an effort is made to help the child cope with pain in an effective way.

If your child suffers persistent pain that has been medically assessed as RAP it is important to let your child know that they are not seriously ill but that they will have to learn some new strategies to deal with pain. These strategies may include relaxation training through the use of audio tapes, or positive thinking which replaces self-thoughts such as “I hate this, I can’t bear it.” to “Hang in there, this will pass.” Ask your doctor about these approaches to dealing with chronic pain.

Parenting Tip

A good way to monitor your child’s progress when learning new strategies to cope with chronic pain is to draw up a simple pain diary using a 4 inch line in the shape of a thermometer with one end marked “no pain at all” and the other “really bad pain.” Your child marks a point on the line rating how much pain they are feeling at three set times each day.

 
Dr. Matthew Sanders is a clinical psychologist at the University of Queensland in Australia and founder of the Triple P - Positive Parenting Program.