Case Study Part 2

Recurrent abdominal pain (RAP) in children is common. Since as far back as 1958 it has been described in the literature that children susceptible to RAP are more likely to be fussy, excitable, anxious, timid , apprehensive and ‘highly’ strung.

They are also more susceptible to sleep disturbances and appetite difficulties.

The ROME criteria sets out to classifiy DGBI . To meet the criteria , symptoms need to present for at least 12 weeks in the preceeding 12 months.

Management involves a thorough investigation and reassurance by the medical team (sometimes this is enough), then pain control.

Peppermint oil can be trialled.

Psychological interventions such as CBT and family therapy have shown some successs.

Research into dietary therapy in this patient group is in its infancy.

Single dietary component removal rarely brings results , lactose involvement is often suspected but rarely a problem.

 The patient should be encouraged to keep a food symptom diary prior to the first appointment, this could guide the dietitian as to what the best treatment route may be. The dietitian will analyse this for dietary balance and appropriateness for age and stage. The dietitian will assess for the involvement of certain food components or FODMAPs and add this to the dietary plan.

Each patient should be individualized.

Max was started off on first line advice for IBS with a special focus to reduce his intake of free fructose (which he was consuming in large amounts every day) and also to balance his fibre intake better from a physiochemical perspective.

He was asked along with his parents to be mindful of better relaxation strategies and healthy family activities.

He was asked to keep a Food/ pain diary and return for follow up in 3 weeks.

On follow up things had improved from the diarrhoea side, the bowel had slowed down and was now producing 2 stools a day, consistency was better.

The abdominal pain was still a problem. His habits around meals and relaxation were improved .

The family felt anxiety about friends and school was driving this as the pain did not seem to be around at the weekends.

Food / symptom diary Extract