Functional Abdominal Pain In Children Research Articles

Navigating through 65years of insights: lessons learned on functional abdominal pain in children.

In 1958, Apley and Naish authored a groundbreaking paper in Archives of Disease in Childhood, elucidating the epidemiology and risk factors of recurrent abdominal pain in children-a subject that had confounded clinicians of their time. Surprisingly, even after 65years, there are several unanswered questions regarding the etiology, pathophysiology, and management of pediatric abdominal pain. Contrary to the prevailing notion that children naturally outgrow functional abdominal pain, compelling evidence suggests it's possible these children develop a number of clinically significant psychological issues that could profoundly impact their quality of life and, consequently, future health and educational outcomes. In this light, we aimed to comprehensively review the current literature to update the knowledge of practicing clinicians on functional abdominal pain, summarizing the evidence from the last 65years.Conclusion: The enduring unanswered questions surrounding childhood abdominal pain continue to challenge clinicians, resulting in unnecessary investigations, thereby contributing to substantial healthcare expenditures. It is also evident that children with long-standing symptoms would progress to adulthood with the potential to develop irritable bowel syndrome and many psychological disturbances. Several key interventions using pharmacological agents, such as amitriptyline, showed that someof these drugs are no more effective than the placebo in clinical trials. Several research during the recent past suggest that psychological interventions such as gut-directed hypnotherapy alleviate symptoms and ensure better prognosis in the long run. Therefore, clinicians and researchers must join hands to explore the pathophysiological mechanisms underpinning functional abdominal pain and novel therapeutic strategies to ensure the well-being of these children. What is Known: • Functional abdominal pain disorders are common among children, with a worldwide prevalence of 13.5% of children suffering from at least one of these disorders • These disorders contribute to a significant reduction in the quality of life of affected children and their families and lead to an array of psychological problems What is New: • The biological basis of functional abdominal pain is becoming more explicit, including complex interactions between altered microbiome, deranged motility, and psychological dysfunction with gut-brain interactions • Novel approaches giving minimal emphasis on pharmacological interventions and exploring psychological interventions are showing promising results.

Functional Abdominal Pain in Children

Background: Functional abdominal pain (FAP), often affecting girls and those with mental health issues, is a prevalent pediatric disorder characterized by persistent symptoms without a clear identifiable organic pathology. The Rome IV Criteria classify it into subtypes, which have distinct symptoms and required tailored management approaches. Discussion: Subtypes classified by the Rome IV Criteria include irritable bowel syndrome (IBS), functional dyspepsia, abdominal migraine, and FAP - not otherwise specified (NOS). The pathophysiology involves gut hypersensitivity, hyperalgesia, genetic predispositions, and psychosocial triggers. Diagnosis relies on medical history, physical examination, the presence of alarm signs, and the characteristic of pain. Treatment strategies encompass dietary modifications, psychological interventions, pharmacology treatment including proton pump inhibitors, prokinetics, and antidepressants like amitriptyline. Conclusion: Recognizing the specific subtypes, as defined by the Rome IV Criteria, allows healthcare professionals to implement individualized care strategies for optimal outcomes.

Effect of Domperidone on Children with Functional Abdominal Pain: A Randomized Controlled Clinical Trial

Background: One of the most common functional problems in children is functional abdominal pain (FAP), and dysmotility is one of the possible causes of FAP. Domperidone is a prokinetic drug that increases gastrointestinal motility. Objectives: The aim of this study was to evaluate the effect of domperidone on the treatment of FAP in children. Methods: In this double-blind clinical trial study, FAP was diagnosed in 80 children aged 5 - 14 years, who were referred to Amirkola Children's Hospital in Babol for one year based on the criteria of the Rome IV. Then, they were randomly divided into two groups of 40 patients. Group A received domperidone tablets (0.25 mg/kg, three-time/day) for two months, and group B received a placebo. The primary outcome was at least a 50% reduction in both frequency and severity of pain, and the secondary outcome was a significant reduction in the duration, frequency, and intensity of pain according to the Wong-Baker scale compared to baseline. Results: A total of 80 children completed the trial (40 with domperidone). The recovery rate was higher in the domperidone group than in the placebo group after eight weeks (71.8% vs. 28.2%; P < 0.0001), and domperidone had significant superiority over the placebo in reducing the duration (4.58 ± 7.71 vs. 24.5 ± 41.45, min/day, P < 0.001), frequency (3.35 ± 3.99 vs. 10.63 ± 10.55, episode/week, P < 0.001), and intensity (2.20 ± 2.16 vs. 5.05 ± 2.37, P < 0.001) of the pain. Conclusions: Based on the results, domperidone can be useful in the treatment of FAP in children.

Safety and Efficacy of Lactobacillus rhamnosus GG (ATCC 53103) in Children with Functional Abdominal Pain: A Randomised, Doubleblinded, Placebo-controlled Trial

Introduction: Functional Abdominal Pain (FAP) is a major concern in developing countries, especially in school-going children. Recently, some probiotics have shown clinical evidence in managing abdominal diseases. The role of Lactobacillus rhamnosus GG (LGG) (ATCC 53103) for FAP in children has not been studied in India. Aim: To evaluate the safety and efficacy of LGG (ATCC 53103) in children with FAP in terms of frequency, severity, and adverse effects. Materials and Methods: This double-blinded, placebocontrolled study was conducted at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India, from February 2021 to July 2022, after obtaining permission from the Institutional Ethical Committee (IEC). Children aged 5-18 years with FAP were included in the study. A total of 82 children were included in the study and were randomised into the LGG group and placebo group. The LGG group received LGG (ATCC 53103), and the placebo group received sugar powder for a period of four weeks. These patients were followed-up after 2, 4, and 8 weeks for evaluation. Student’s t-test (unpaired) was used for quantitative data, and Chi-square test was used for qualitative data. Statistical Package for the Social Sciences (SPSS) PC-20.0 version was used to evaluate the data. Results: Out of 82 children, a total of 77 children were enrolled during the study period, with 38 in the LGG group and 39 in the placebo group. The severity of abdominal pain at four weeks and eight weeks was significantly less compared to placebo (p-value=0.009 and p-value=0.01, respectively). The frequency of abdominal pain at four weeks and eight weeks was also significantly less compared to placebo (p-value ≤0.001 and p-value≤0.001, respectively). There was no statistically significant difference in adverse effects between the two groups (p-value =0.115). Conclusion: This study concluded that LGG decreases both the severity and frequency of abdominal pain in children aged 5-18 years without any significant side-effects. Thus, it can be safely used in the management of childhood FAP.

Ability of polymicrobial probiotic and mono-strain probiotic to reduce functional abdominal pain in children: a randomized clinical trial.

Chronic abdominal pain is a common problem in childhood. Due to the prevalence of functional abdominal pain (FAP) and the importance of probiotics, this study aimed to compare the ability of 2 probiotics to reduce and improve FAP in children. This open-label randomized clinical trial included 116 children aged 5-15 years with FAPP who met the ROME-4 criteria and were referred to the gastrointestinal clinic of Amir-Kabir Hospital in Arak in 2020-2021. The children were randomly allocated to receive polymicrobial probiotic (PMP group) or mono-strain probiotic (MSP group) once daily for 4 weeks. The standard Wong-Baker Faces scale was used to assess symptom severity. Of the 116 subjects, 62 (53.5%) were boys; the mean participant age was 7.39 years (standard deviation, 3.4 years). A significant intergroup difference (P=0.003) was observed in pain severity; 10.34% of children in the PMP group had no pain, while all patients in the MSP group reported low-degree pain. There was no intergroup difference in mean pain score (P=0.466), but it decreased over time in both groups (P= 0.001). Although significantly more children were painless in the PMP versus MSP group, no significant intergroup difference in pain score was noted and symptom severity decreased in both groups. A future study with a placebo group is recommended to validate our findings.

Functional Abdominal Pain of Children: Therapy with Bacillus Coagulans GBI-30, 6086 and Insight into Its Probiotic Properties

Background: Probiotics are effective in the treatment of functional gastrointestinal disorders in adults but there is lack of enough clinical evidence in children.
 Aim: To evaluate effectiveness of Bacillus Coagulans GBI-30, 6086 along with digestive enzymes in the treatment of childhood functional abdominal pain (FAP).
 Methods: Children with FAP, based on the Rome IV criteria (n = 95, aged 5-16 years), received Bacillus Coagulans GBI-30, 6086 along with digestive enzymes from a commercially available preparation - Tummysoft® for three weeks. Treatment response was assessed by improvement in the Quality of Life in Reflux and Dyspepsia Questionnaire (QOLRAD) score and Global Overall Symptom (GOS) scale.
 Results: Patients diagnosed with FAP upon receiving a 3-week treatment with Bacillus Coagulans GBI-30, 6086 along with digestive enzymes, registered statistically significant improvement in both QOLRAD (Baseline, 30.27 ± 5.95; 10th Day: 108.39 ± 7.06; 21st day: 173.71 ± 6.71, P=0.00) and GOS scale (Baseline, 3.10 ± 0.37; 10th Day: 2.15 ± 0.73; 21st day: 1.00 ± 0.00, P = 0) signifying the efficacy of the probiotic in FAP.
 Conclusion: Bacillus Coagulans GBI-30, 6086 along with digestive enzymes from a commercially available preparation - Tummysoft® was found to be effective in the treatment of childhood functional abdominal pain (FAP).

Функциональная абдоминальная боль у детей

Абдоминальная боль является одной из самых распространенных жалоб детей в практике педиатра и семейного врача. В большинстве случаев причиной хронической боли в животе является неорганическая, функциональная абдоминальная боль (ФАБ) без объективных признаков основного органического расстройства. В настоящее время среди различных групп спазмолитиков при лечении функциональных расстройств пищеварительного тракта отдают предпочтение селективным миотропным спазмолитикам — блокаторам быстрых натриевых каналов клеточной мембраны миоцита (мебеверин). В клинической практике при лечении пациентов с абдоминальной болью заслуживает внимания мебеверина гидрохлорид (СПАРК®, ПАО «Фармак»). Изучение эффективности применения мебеверина СПАРК® при ФАБ у детей проводилось на базе гастроэнтерологического отделения детской клинической больницы № 19 г. Харькова. Под наблюдением находилось 44 ребенка в возрасте от 10 до 18 лет с ФАБ. В структуре функциональной патологии зарегистрированы: функциональная диспепсия (ФД) — 54,1 %, синдром раздраженного кишечника (СРК) — 20,8 %, функциональные расстройства билиарного тракта (ФРБТ) — 79,2 %; ФД + ФРБТ — 34,1 %, ФД + СРК — 16 %, ФРБТ + СРК — 8,3 %. Диагноз был верифицирован согласно унифицированным протоколам лечения. Пациенты получали комплексную патогенетическую терапию и селективный спазмолитик СПАРК® по 1 капсуле два раза в день на протяжении семи дней. Оценка болевого синдрома проводилась на момент обращения и ежедневно в течение периода наблюдения. Для оценки интенсивности боли использовалась цифровая рейтинговая шкала боли. При наблюдаемой тенденции к купированию абдоминальной боли у всех пациентов из группы наблюдения уже с 5-го дня от начала терапии не отмечали абдоминальной боли дети с незначительно выраженной болью, а с 6-го дня — с умеренно выраженной болью. Более длительно, до 7 суток, сохранялась боль у детей с выраженной болью. Таким образом, абдоминальная боль — одна из наиболее часто встречаемых и сложных проблем в практике врача. Наиболее часто она возникает при функциональных расстройствах желудочно-кишечного тракта. Применение селективных миотропных спазмолитиков (мебеверин) для купирования абдоминальной боли патогенетически обосновано. Полученные результаты показали эффективность препарата СПАРК® при лечении функциональной абдоминальной боли у детей. Побочных эффектов и аллергических реакций при приеме препарата не отмечалось. Мебеверин (СПАРК®) может быть препаратом выбора и рекомендован при абдоминальной боли у взрослых и детей в возрасте от 10 лет.

Children's Beliefs about Pain: An Exploratory Analysis.

Functional abdominal pain (FAP) is one of the most common childhood medical complaints, associated with significant distress and impairment. Little is known about how children understand their pain. Do they attribute it to personal weakness? Do they perceive pain as having global impact, affecting a variety of activities? How do they cope with pain? We explored the pain beliefs of 5- to 9-year-old children with FAP using a novel Teddy Bear Interview task in which children answered questions about a Teddy bear’s pain. Responses were analyzed quantitatively and qualitatively. Results indicate that the majority of young children with FAP are optimistic about pain outcomes. Children generated many types of coping strategies for Teddy’s pain and adjusted their calibration of Teddy’s pain tolerance dependent on the activity being performed. Early warning signs also emerged: a subset of children were pessimistic about Teddy’s pain, and several children identified coping strategies that, while developmentally appropriate, could lead to excessive help seeking if not intervened upon (e.g., physician consultation and shot). The Teddy Bear Interview allows children to externalize their pain, making it a useful tool to access cognitive pain constructs in younger children. Thus, these findings highlight the importance of early intervention for childhood FAP.

Functional Abdominal Pain Disorders in Children

Diagnostic criteria for functional abdominal pain has developed in the last decade, from the Rome III criteria to the Rome IV criteria. The major change was in the phrase "abdominal pain related gastrointestinal disorders" to "functional abdominal pain disorders (FAPD)". According to Rome IV criteria, FAPD are divided into functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, and functional abdominal pain-not otherwise specified (FAP-NOS). In order to diagnose FAPD, it is important to pay attention to alarm signs that can indicate organic abnormalities. The pathophysiology of FAPD was a complex interaction between psychosocial, genetic, environmental and life experiences of children through the gut brain axis. The risk factors for functional abdominal pain in children include psychological factors including anxiety and depression, stress conditions, negative experiences, and socioeconomic status.

Effect of a synbiotic on functional abdominal pain in childhood.

Background:One of the common functional gastrointestinal disorders in children is functional abdominal pain (FAP). The aim of the present study was to determine whether the administration of a synbiotic composed of fructo-oligosaccharides (FOS) and the seven types of beneficial bacteria is useful in FAP of childhood.Methods:In this placebo-controlled, double-blind trial, 4-15-year-old children who met the Rome III criteria for FAP were randomly divided to receive either synbiotic or placebo twice daily for 4 weeks. Primary outcome was at least 50% reduction in the number of pain episodes, and secondary outcomes were a decline of at least two scales in the pain duration and intensity based on Wong-Baker scale. Response to therapy was decrease of pain frequency/intensity.Results:A total of 67 children completed the trial (35 with synbiotic). Response rate was higher with synbiotic than placebo after four weeks (53.1 vs 11.4%; p<0.001), and synbiotic had significant superiority to placebo to relieve the duration (4.56±9.12 vs12±18.59, min/day, P=0.04), frequency (0.31±0.53vs 1.17±0.7, episode/Wk., P<.001) and intensity (2.38±2.29 vs 5.49±1.83, p<0.001) of abdominal pain.Conclusion:Synbiotic compared to placebo significantly decreased the intensity, frequency and duration of FAP in children.

Use of probiotics in the treatment of functional abdominal pain in children—systematic review and meta-analysis

Functional abdominal pain is a very frequent functional gastrointestinal disorder but still without adequate treatment options. Therefore, the main aim of this systematic review and meta-analysis was to evaluate strain-specific probiotic effects on functional abdominal pain in children. This was a systematic review and meta-analysis of randomized controlled trials published in a period up to 1st of April 2020 that analyzed probiotic interventions for pediatric functional abdominal pain. We included 9 randomized controlled trials (a total of 702 children, 506 with functional abdominal pain; 4 to 18years); 8 studies were available for meta-analysis (a total of 641 children). Lactobacillus rhamnosus GG and Lactobacillus reuteri DSM 17938 were the only two probiotic strains investigated. Significant reduction in pain intensity (6 trials, n = 380, mean difference - 1.24, 95% CI - 2.35 to - 0.13) and increase in number of days without pain (2 trials, n = 101, mean difference 26.42, 95% CI 22.67 to 30.17) were found in children taking L. reuteri DSM 17938. For all other outcomes, there were no significant differences between probiotic and placebo.Conclusion: Based on the available evidence, no firm conclusions can be given; however, L. reuteri was proven to decrease the pain intensity in children with functional abdominal pain. Further trials regarding long-term outcomes, possibly involving longer interventions, are needed. What is Known: • Previously published systematic reviews have suggested that probiotics may have an effect on the pain in children with functional gastrointestinal disorders, but limited data exist on strain-specific effects. What is New: • This systematic review provides evidence on the probiotic use on the strain-specific level. • This systematic review showed that the use of Lactobacillus reuteri DSM 17938 modestly reduces the pain intensity in children with functional abdominal pain.

"My Body Hates Me": A Qualitative Analysis of the Experience of Functional Nausea in Adolescent Girls and Their Mothers.

Nausea is a somatic sensation typically associated with the need to vomit in order to remove a toxin from the body. When nausea occurs in the absence of a specific structural cause or toxin, it is classified as a functional gastrointestinal disorder (FGID). Functional nausea was newly recognized in 2016 as a FGID in children and little is known about its prevalence, course or patient experiences. Nausea co-occurring with functional abdominal pain in childhood has been associated with long-term risk for anxiety and ongoing somatic symptoms into young adulthood. However, few studies have focused uniquely on the experience and impact of nausea on youth. The present study aimed to qualitatively understand the experiences of adolescent girls with functional nausea and their parents. Five mother–daughter dyads were recruited from a specialized pediatric gastroenterology clinic focused on nausea and completed semi-structured interviews. Interviews were transcribed and coded using interpretive phenomenological analysis (IPA). Four main themes emerged: nausea interference, body frustration, misunderstanding of symptoms, and maternal helplessness and guilt. These themes were similar to prior studies on the experiences of youth with chronic pain but also indicated unique challenges due to nausea, such as significant food restriction and subsequent weight loss.

Comparison of child abuse history in patients with and without functional abdominal pain: a case-control study

BackgroundGastrointestinal (GI) disorders are ranked first amongst medical diseases as a trigger of requests for mental health counselling. Child abuse has been regarded as one of the main causes of the development of functional abdominal pain (FAP) in children. This study aimed, therefore, to compare the prevalence of child abuse experience among two groups of patients with and without FAP.MethodsA case-control study of children in Arak, Iran, in which experience of child abuse was compared in children with (n = 100) and without functional abdominal pain (n = 100). Three categories of child abuse - emotional abuse, physical abuse, and neglect - were assessed using the Child Abuse Questionnaire. The data were analyzed using Stata software.ResultsAfter adjusting for potential confounders, there were group differences in emotional abuse (96% vs. 81%, aOR = 5.13, 95% CI: 1.3–20.3, p = 0.017), neglect (28% vs. 8%, aOR = 4.27, 95% CI: 1.8–11.8, p = 0.001) and total child abuse score (98% vs. 84%, aOR = 8.2, 95% CI: 1.5–43.8, p = 0.014) but not in physical abuse (57% vs. 46%, aOR = 1.47, 95% CI: 0.81–2.60, p = 0.728).ConclusionsAs the prevalence of child abuse is higher in patients with FAP, child abuse appears to be related to the occurrence of FAP in children. However, the results of this study cannot be generalized to Iranian society generally and further longitudinal studies are recommended.

Lactobacillus reuteri DSM 17938 is effective in the treatment of functional abdominal pain in children: Results of the double-blind randomized study.

Possible therapeutic effect of Lactobacillus (L.) reuteri DSM 17938 has been reported in children with functional abdominal pain (FAP) but data are inconclusive. This is a randomized double-blinded controlled trial (RCT) which assessed effect of L. reuteri DSM 17938 (dose 108CFU/day) in children (age 4-18 years) on FAP during an intervention period of 12 weeks and follow-up of 4 weeks. This study was performed after the interim analysis and had different labeling of products and a new randomization. Data presented here are results of this RCT and pooled data from both RCTs (before and after interim analysis). This RCT included 46 children (median age 10.1 vs 10.6 years; 11 vs 13 girls). Abdominal pain was less severe in intervention group during the 4th month of the study and there was significant increase in the number of days without pain. Pooled data from both parts of the study included 101 children. Number of days without pain was significantly higher in the L.reuteri group (mean difference 26.42 days, 95% CI 22.47-30.17). Significant difference in the pain intensity was found after 2nd, 3rd and 4th month of the intervention. There was no difference between groups in the number of children in whom symptoms completely ceased (Risk Ratio 1.09, 95% CI 0.75-1.58). Administration of L.reuteri DSM 17938 was associated with the reduction in the intensity of pain and with significantly increase in pain-free days in children with FAP.

Comparison of the Efficacy of Buspirone and Placebo in Childhood Functional Abdominal Pain: A Randomized Clinical Trial (2351)

Comparison of the Efficacy of Buspirone and Placebo in Childhood Functional Abdominal Pain: A Randomized Clinical Trial (2351)

Comparison of the Efficacy of Buspirone and Placebo in Childhood Functional Abdominal Pain: A Randomized Clinical Trial.

Pharmacological interventions have not been successful in the treatment of childhood functional abdominal pain (FAP) hitherto. Buspirone is suggested to be efficacious in some of the abdominal pain-related functional gastrointestinal disorders based on evidences from the studies on adults. We aim to investigate the efficacy of buspirone on childhood FAP. This randomized clinical trial was conducted on 117 patients with childhood FAP aged 6-18 years. We randomly assigned patients to receive buspirone or placebo for 4 weeks, with the adjusted dosage for age. Participants completed the questionnaires assessing pain, depression, anxiety, somatization, and sleep disturbances at baseline, at the end of the 4-week therapy (first follow-up), and at 8 weeks after medication discontinuation (second follow-up). The primary outcome was treatment response rate, defined as reduced pain score of ≥2 or reporting no pain at the follow-up assessments. Ninety-five patients completed the 4-week therapy (48 and 47 in buspirone and placebo groups, respectively). Both buspirone and placebo reduced pain after 4 weeks of treatment, and these effects were persistent 8 weeks after medication discontinuation (P < 0.001 for both groups at weeks 4 and 12). Treatment response rates for buspirone and placebo were 58.3% and 59.6% at week 4 (P = 0.902) and 68.1% and 71.1% at week 12 (P = 0.753), respectively. Buspirone effectively improves pain and associated psychological symptoms including depressive symptoms, anxiety, somatization, and sleep disturbances in childhood FAP but has no superiority over placebo. Further studies, with the higher doses of buspirone and longer follow-ups are recommended.

Exploring the Clinical Response of Childhood Functional Gastro-Intestinal Disorder Symptoms to Deep Tissue Massage of Psoas Muscles: Results of Two-Year Clinical Audit with Telephone Follow-Up

There is a high incidence of chronic recurrent functional abdominal pain in children causing significant disruption to schooling, quality of life, and costs to the health care system. Treatment routinely includes behavioral, pharmacological, and invasive surgical interventions, with varying levels of impact. This study aims to examine the response of symptoms of functional gastro-intestinal disorders (FGID) in children to treatment of psoas muscle tension and tenderness using remedial massage therapy. Pediatric surgeon's rooms, remedial massage therapist rooms, consenting children aged 2-18. Two years of clinical observations were analyzed including patient-reported symptoms, surgeon and remedial massage therapist observations, with 122 children suffering from moderate to severe FGID symptoms. Over the two year observation period, 96 children with FGID symptoms completed a course of remedial massage therapy to their psoas muscles. Improvement in psoas tension and tenderness on palpation was observed for all participants after an average of 5 treatments (range 2-12). Complete resolution of all symptoms of abdominal pain, reflux, vomiting, nausea, and bowel upset was seen in 88/96 (92%) participants at the time of treatment completion without side effects. Over the observation period, 72 children were followed up after completing remedial massage therapy; 75% reported they remained symptom free, 18% continued to have marked improvement and 7% mild improvement. Despite study design limitations, more research is warranted on the potential for this low-cost, noninvasive therapeutic intervention to assist symptom management for children with FGID.

Functional Abdominal Pain in Relation to Behavioral Pattern Triggers in Children

Background: Functional abdominal pain (FAP) in children is a common problem encountered by clinicians. The etiology of FAP is multifactorial and this study explains the correlates of FAP to certain behavioral patterns in children. This is the first Indian study which looks into this area. Methods: Eighteen participants between 4 and 18 years old who had consulted pediatric gastroenterologist with abdominal pain in one single multi-specialty hospital were included. A written consent was obtained from parents. The Child Behavior Checklist (CBCL) was given to the parents to understand the various behavioral problems in the children; and intelligence quotient (IQ) assessments were done in all children. A 5-point Likert scale was used to assess anxiety in children which was rated by the child. Results: The CBCL identified the stressors reported by children such as academic pressure, difficulty to comprehend, need for affection from parents, interpersonal problems at home (frequent arguments between parents, comparison with a brighter sibling) and poor self-esteem. It is observed that 11/18 (61%) children had average or above average IQ and 7/18 (39%) children had low average or dull IQ. The anxiety levels of children in majority, 16 out of 18 children (88.8%) who presented with FAP, were found to be high or very high on a Likert scale. Conclusions: Children with FAP have variable IQ levels and high anxiety levels. The need for clinicians to counsel parents and children in order to address the stressors at home and school is warranted as this may help in management of FAP in children. Further multi-centric research is necessary to understand these findings in Indian children. Int J Clin Pediatr. 2020;9(2):31-34 doi: https://doi.org/10.14740/ijcp371

Probiotics for Childhood Functional Gastrointestinal Disorders: Do We Know What We Advise?

Limited information is available on clinicians’ advising practices and perceived familiarity of probiotics in the management of childhood functional abdominal pain disorders (FAPDs) and functional defecation disorders (FDD). This study aimed to investigate pediatricians’ and general practitioners’ (GPs) advising practices and perceived familiarity of probiotics in the management of FAPDs and FDD. A cross-sectional survey was administered to Dutch pediatricians and GPs, including 27 questions about perceived familiarity of probiotics, followed by questions related to advising practices and reasons for advising or not advising probiotics. The responses of 319 pediatricians and 67 GPs were included. Significantly more pediatricians indicated to be familiar with probiotics compared to GPs (71% vs. 48% respectively, p < 0.001). Significantly more pediatricians advised probiotics compared to GPs for FAPDs (54% vs. 25%, respectively, p < 0.001) and for FDD (17% vs. 7%, respectively, p < 0.05). Primary reason to advise probiotics was patient request; main reason not to advise probiotics was personal lack of knowledge regarding probiotic use. Conclusions: Increased familiarity and appropriate advising of probiotics in treatment of childhood FAPDs and FDD among pediatricians and GPs is required. Improved familiarity of probiotics is important to provide appropriate information about probiotic use to children and caregivers and may facilitate shared decision-making.

Implementation of a low FODMAP diet for functional abdominal pain

The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. A table was designed in which foods were classified according to their FODMAP content, as well as a 'Symptoms and Stools Diary'. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41-3.33] versus 2 [IQR: 1.33-6.33] daily episodes, P=.024), less pain severity compared to baseline (1.41cm [IQR: 0.32-5.23] versus 4.63cm [IQR: 2.51-6.39] measured by 10-cm Visual Analogue Scale, P=.035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods.