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A gastroenterologist considers more complex causes when GI problems continue. A dietician can suggest changes in diet which may relieve some symptoms. Complex care and palliative care clinicians can help treat pain that occurs without a clear cause.
Abdominal Pain
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Abdominal pain is common in children. In many cases, there is a clear cause and treatments can help resolve the problem causing the pain. Other times, the pain continues without an identifiable problem or despite treatments aimed at helping improve intestinal health. Children with SNI are at increased risk for abdominal pain without a clear source, and treatment requires considering how their brain and their intestines are communicating. In children with SNI, signals to and from the brain to move food and fluid and to digest the contents can become dysregulated, leading to problems with motion in the GI tract as well as pain.
ESP The nervous system sends sensory signals from the gut to the brain. Changes in the nervous system can change the signals being sent from the gut causing pain. One type of pain is visceral hyperalgesia, which is increased sensitivity to pain in the internal organs, like the stomach, pancreas or intestines. Another type of pain is central neuropathic pain, which is pain initiated or caused by a dysfunction in the central nervous system.
Recurrent functional ileus, sometimes referred to as intestinal pseudo-obstruction, occurs when the intestinal motility suddenly slows down and the cause is not a blockage mechanical obstruction in the intestines. The medical team will assess for mechanical obstruction. Functional ileus presents with acute severe distention of the abdomen along with pain. It can sometimes be triggered by an acute illness, like a bladder infection or pneumonia. Changes in the nervous system may also be a reason these episodes occur, without an acute illness as a trigger. These changes alter how the nervous system regulates motility of the intestines. The medical team can help manage an episode of functional ileus and determine how recurrent episodes might be managed each time.
No test can indicate that the nervous system is the cause of GI pain, but information from your child’s history can suggest when this is the case. GI pain may be suspected when pain occurs with normal or mild distention in the intestines. Examples include pain noted with a bowel movement followed by improvement after, when distention in the colon has decreased. This is because changes in the nervous system can lower the amount of distention that causes a pain signal, even if the distention is mild. Medications for neuropathic pain can decrease these abnormal pain signals. They can also decrease the frequency and severity of pain events, though milder breakthrough pain can still occur as no treatment can fix or cure what causes this type of pain.
ESP Managing pain can be a particularly frustrating aspect of caring for a child with SNI, especially when the child is non-verbal. Trust your instinct and develop a relationship with clinicians who are committed to helping you address any pain your child may experience. Also trust the experience that you gain as one of your child’s primary caregivers. Some parents become more comfortable with taking a watch-and-wait approach with GI symptoms after seeing past negative tests and knowing that symptoms will likely improve over time. Other parents feel more comfortable with testing for the problems they don’t want to miss, such as a urinary tract infection. You can also gain experience in what helps manage symptoms in the moment. For example, you may come to know that using a suppository relieves your child’s discomfort, even if they are not expressing pain.
