Kids can make themselves sick with worry

There's a certain type of sensitive, conscientious, caring and high-achieving child that gets frequent tummy aches so excruciating that the child may end up in the A&E department, being checked for appendicitis or Crohn's disease.

Known medically as Recurrent Abdominal Pain (Rap), such tummy aches are a "functional" illness, meaning that there's no known organic cause and no medical cure, although the pain is very real.

Stress is a major factor in Rap, since affected children usually have serious, unexpressed worries about school, their parents' health, a relative's death or other traumas that have affected the family. A TV programme on cancer may be enough to make some children literally worry themselves into pain.

About 10-15 per cent of children experience Rap, usually between the ages of six and 14, although younger and older children may be affected. This makes Rap a "huge" medical issue for doctors, says Dr Billy Bourke, gastroenterologist at the Our Lady's Hospital for Sick Children, Crumlin.

"Because it's so common among high achievers, in any hospital you could say that at least half the doctors and nurses had severe tummy aches as children," says Bourke.

Rap is usually a general pain affecting the middle of the tummy and it tends to occur first thing in the morning or last thing at night.

Exposing the child to medical and surgical investigations for Rap can actually make the problem worse, by convincing the child that he or she has a serious medical condition, such as cancer.

"We tell children that Rap is not a disease, it's a feeling," says Bourke. "In our experience, which is borne out by research, the vast majority of children need no more than appropriate reassurance for the pain to subside and eventually disappear."

It's important that such children keep going to school, despite the pain, so that they learn that the pain is "normal". The child may go pale during an attack and appear extremely unwell, but if the teacher sends the child home, this reinforces the pain by convincing the child that there is something seriously wrong.

Parents need to calmly listen to their children, to discover what stress triggers are in the background. Often, the children are worried about their parents' health or financial problems and may be concerned that something terrible will befall the parents while they are separated from them.

Psychological counselling tends not to help children with Rap. What they really need is reassurance from parents and doctors that all is well.

During a pain episode, a painkiller may help, although a gentle, parental cuddle and tummy-rubbing usually does the trick just as well. When they grow older, children with Rap tend to have a more than average incidence of anxiety disorders, which again fits the profile of a highly sensitive, high-achieving individual. These children don't, however, have a higher risk of Irritable Bowel Syndrome, another stress-related functional illness.

Dr Marian Roland is currently completing research on Rap at Our Lady's Hospital, which will soon lead to a diagnostic guide for doctors, helping them to discern when tummy pain is the likely result of personality type and social factors, and when it is likely to be disease.

The results should save more parents from late night trips to the A&E.