Chronic Abdominal Pain
Abdominal pain in a child or teen that lasts a long time can be frustrating for your entire family. The gastroenterology specialists at OHSU Doernbecher are here to help.
- Our family-friendly video explains why chronic abdominal pain occurs and what you can do about it.
- We offer a list of strategies you can use right now to put your child on the path to recovery.
- We provide two exercises you and your child or teen can use to cope and begin to heal.
Watch our video
Our short animated video explains:
- The difference between acute and chronic pain.
- How pain signals from the gut to the brain can go wrong.
- How your child or teen can turn the pain signals down.
Tips for parents
Here are ways you can help your child or teen start to feel better.
Realize that the pain is real
The nerves in our bellies and our brains are constantly interacting. Sometimes our belly nerves can become hypersensitive to pain, sending signals to our brains that make us worry about pain. This can start a cycle of thinking about pain and feeling pain.
If the body has been in pain for a long time, the brain can continue sending pain signals even if there is no longer any tissue or nerve damage. This is why many of our patients have been told that because there is nothing medically wrong, it must be psychological.
Encourage normal activities
Chronic abdominal pain can restrict children's daily activities tremendously. Therefore, the first step in improvement is measured by increased functioning. Your child is starting the road to recovery when you see him or her improve in day-to-day functioning.
For most of our patients with chronic abdominal pain, the pain begins to go away after the child is functioning normally. So we need all those involved to encourage usual activities unless otherwise indicated by the medical team.
Don't ask your child about the pain
It is our belief that pain loves an audience. While our natural instinct is to rest when we feel pain or ask our children about their pain, this can actually exacerbate the pain cycle.
Abdominal pain is worse when you are paying attention to it and better if you are distracted from it. If you ask your child if she is in pain, she will scan her body looking for pain and find it. If she happens to be distracted from her pain at that moment, we want that moment to continue.
Avoid the "sick role"
Children with chronic abdominal pain often taken on a sick role, wherein they may stop normal activities and miss many days of school. To help your child get out of this role, encourage him or her to get back to normal routines. While staying at home in pajamas and a heating pad may relieve pain in the short term, it reinforces the pain cycle in the long term.
Promote healthy exercise habits
Moderate exercise is another useful tool for breaking the pain cycle. It not only improves the immune system, it can reduce the intensity and frequency of pain signals. When the body and brain are in good health, your child's pain signals will have less power.
Encourage sleep hygene
Sleep is essential for overall health, particularly for children with chronic abdominal pain. Consider the following sleep hygiene recommendations:
- Develop a sleep routine.
- Engage in relaxing activities 60 to 90 minutes before bed and turn off all screens.
- Avoid afternoon naps.
- Avoid caffeine, particularly in the afternoon.
- Use the bed for only sleep — for example, use a separate chair for homework or reading.
Nourish the body
A healthy, balanced diet is important for any child buy particularly for a child with chronic abdominal pain. Avoid spicy foods or drinks high in sugar, as these may aggravate the stomach and send pain signals firing.
Monitor for depression and anxiety
The nerves in the belly and in the brain are constantly interacting. When our belly isn't feeling good, our brain receives a signal that something is wrong.
In the same vein, if our brain isn't feeling good, our belly may receive a signal that something is wrong and cause pain. While depression and anxiety are not direct causes of pain, they can contribute and prolong chronic abdominal pain. So if your child is experiencing symptoms of depression and/or anxiety, it's important to seek treatment to improve pain and overall health.
Practice coping skills
Encourage your child to practice coping skills to reduce pain and manage stress. Repeated practice with these skills will be critical for reversing the pain cycle:
- Diaphragmatic breathing
- Relaxation strategies
- Guided imagery
Teach positive thoughts
When children have chronic abdominal pain, it can be easy to catastrophize and sink into a spiral of negative thoughts and statements. Here are some examples of common negative versus positive thoughts and statements:
| Negative | Positive |
| The pain will never stop | This will pass |
| My life is over | I can get through this |
| Pain controls my life | I have the power to help myself |
Reinforce adaptive coping
Reward your child whenever he or she practices adaptive coping. Rewards can be tangible (such as a sticker or toy) or verbal (such as praise and acknowledgment). Your definition of a reward will obviously depend on the age of your child. Do whatever works for your family as long as it encourages your child to continue coping adaptively.
Go beyond medication
Medications can help reduce pain and calm the nerves in the belly. However, for children with ongoing abdominal pain, other strategies are more helpful for long-term improvement. They include stress management, physical therapy, coping-skills training, biofeedback and acupuncture.
Practice patience
There is no quick fix for chronic abdominal pain, particularly if the pain cycle has strengthened for some time. However, practicing the pointers above will likely put your child on the road to recovery.
Guided exercises
Here's a script to learn how to breathe from the diaphragm, or belly. Repeatedly practicing this can help reduce pain and stress.
- Lay on the floor or sit up straight with your feet supported.
- Put one hand on your chest and the other over your belly. With diaphragmatic breathing (or belly breathing), we want the hand on our belly to move while the hand on our chest stays relatively still.
- Imagine you have a balloon underneath your belly button that inflates as you inhale and deflates as you exhale.
- Breath in through your nose for three seconds, like you are smelling freshly baked cookies. Pull the air deep into your lungs. Feel your belly expand, like a balloon blowing up. Notice that the hand on your belly is moving but the hand on your chest is not.
- Exhale slowly through your mouth, like you are blowing out birthday candles on a cake. Feel your belly go back in, like a balloon deflating. Again, check to make sure that your hand on your belly is the one that is doing all the moving.
- Breath in slowly again through your nose for three seconds and exhale for six seconds. Continue this pattern for five to 10 minutes, keeping an eye on your hands to make sure that all of the air is going into your belly, not your chest. You may have a parent or a friend do this with you to continue to perfect the technique together.
Here's a forest scene that can help you lower stress and pain:
Begin by finding a comfortable position sitting or lying down. Allow your body to begin to relax as you start to create a picture in your mind. Our goal will be to incorporate all of the senses to take you on a mental vacation.
Imagine yourself walking on a path through a forest. The path is soft beneath your shoes, a mixture of soil, fallen leaves, pine needles and moss. As you walk, your body relaxes and your mind clears, more and more with each step.
Breathe in the fresh mountain air, filling your lungs completely. Now exhale. Breathe out all the air. Feel refreshed.
Take another deep breath in and breathe out completely, letting your body relax further.
Continue to breathe slowly and deeply as you walk through the forest.
The air is cool but comfortable. Sun filters through the trees, making a moving pattern on the ground in front of you.
Listen to the sounds of the forest: Birds singing. A gentle breeze blowing. The leaves on the trees shifting and swaying in the soft wind.
Your body relaxes more and more as you walk. Count your steps and breathe in unison with your strides.
Continue to breathe like this, slowly and deeply, as you become more and more relaxed.
As you walk through the forest, feel your muscles relaxing and lengthening. As your arms swing in rhythm with your walking, they become loose, relaxed and limp.
Feel your back relaxing as your spine lengthens and the muscles relax. Feel the tension leaving your body as you admire the scenery around you.
Your legs and lower body relax as well, feeling free and relaxed.
As you continue to walk through the forest, you begin to climb up a slight incline. You easily tread along smooth rocks on the path.
The breeze continues to blow through the treetops, but you are sheltered on the path, and the air around you is calm.
Small saplings grow at the sides of the path.
Around you is an immense array of greens. Some of the leaves on the trees are a delicate, light green. Some leaves are deep, dark, true forest green.
Many trees have needles that look very soft and very green. The forest floor is thick, green moss.
Tall trees grow on either side of the path. Picture the variety of trees around you. Some have smooth, white bark. Others are darker, with coarse, heavy bark, deeply grooved. Enjoy the colors of the bark on the trees —white, tan, brown, red, black ... many combinations of color. You admire the rough, brown bark of pine trees and enjoy the fresh pine scent.
Smell the forest around you. The air is fresh and filled with the scent of trees, soil and mountain streams.
You can hear the sound of water faintly in the distance. The gentle burbling sound of a creek.
As you continue to walk through the forest, you are gaining elevation and getting closer to the sound of a stream.
Continue to enjoy the forest around you.
As you near the top of the mountain, you hear the stream very close now. The path curves up ahead. You can see sunlight streaming onto the path.
As you round the corner, you hear the water and see a clearing in the trees up ahead.
You are growing tired from your journey. Your body feels pleasantly tired and heavy.
Imagine yourself walking toward the clearing and the stream. Stepping stones make an easy path across the stream and toward the edge of the mountain. Step on each large flat stone to easily cross the small, shallow stream.
Up ahead is a large, smooth rock, like a chair waiting for you to rest. The rock is placed perfectly, high up on this beautiful lookout point.
Sit or lie down on the rock if you wish. It is very comfortable. You feel very comfortable and at ease. The sun shines down on you.
Looking around, you see mountains in the distance. Faint and blue.
You can look down from your viewpoint into a valley with trees and a blue lake. Across from you is another mountain.
Feel the sun warming your body as you relax on the rock. Enjoy the majestic landscape around you and feel your body relaxing even more.
Your body becomes very warm and very heavy.
Continue to breathe the clean, fresh air.
You feel so relaxed.
Calm.
At peace.
When you are ready to leave this peaceful place, slowly begin to reawaken your body.
Know that you can return to this forest in your imagination whenever you like.
As you reawaken, keep with you the feeling of calm, peace and relaxation.
Wiggle your fingers and toes to wake up your muscles.
Shrug your shoulders. Stretch if you want to.
When you are ready, open your eyes and return to full wakefulness, feeling alert and refreshed.