Our son Matthew is 30 months old and has had diabetes for almost two years. His control has been pretty good, and his A1C's are in an acceptable range for a 30 month old (according to his endocrinologist). For over the past two months, he has been announcing to us that his tummy hurts. When this first started, we looked at other factors. Was our younger son Andrew getting more attention, and Matthew was doing this to get some? Was Andrew sick, and Matthew wanted to draw attention to himself? All this proved to be not true, and Matthew is not one to complain about much of anything. He can decipher if a body part hurts, i.e., knee/leg/head. There has also been no additional stress in our house, fighting/etc. We have also not been asking him, "Matthew does your tummy hurt?" so as not to lead him to say that.
So now onto the specifics. He has increasingly told us about his tummy hurting, and now as of the last few days, once - twice daily. There is no pattern as far as morning vs. night, but it seems to be mostly after he eats, usually within 20 - 30 minutes. There have been no changes in his meal plan, he eats fruits (bananas/melons/kiwi), starches, milk, peanut butter, etc. He doesn't keep saying it repeatedly, and he goes about his business after he says it.
We spoke to his endo about this, and we are now keeping a detailed log of this. I had noticed a previous question about a 5 year old girl complaining that her stomach hurt. The response was it could be autonomic neuropathy, but to have it checked out. This is our gameplan: if it keeps up for another month, we will take him to see a gastroenterologist. His endo says there were a few young kids in his practice who have this "problem" and they take medication to aid in digestion/opening of the stomach. He also said they outgrow it. They also have not had diabetes for many years.
Thank you for any input you have for us.
This is an interesting question because the problem of toddlers complaining of tummy pain is extremely common. When they have diabetes, an extra dimension is added.
Let me start by saying that the least likely diagnosis in the textbook is autonomic neuropathy. This doesn't affect children as young as this with very short duration diabetes.
I note that you have considered attention seeking - I wouldn't rule this out too quickly even if you don't think you differentiate between your children.
The clue to what's going on is in the timing. You say that your son's pain is usually 20-30 minutes after meals. Thus, it is most unlikely to be due to hypoglycaemia (nonetheless, worth checking a sugar next time). After eating, the gut begins to contract quite vigorously and this can provoke a colicky discomfort. In young children this may be overinterpreted. It is also quite common for them to suffer from mild constipation because they don't empty their bowel properly each time they go to the toilet. This can be true even if their diet is as good as you describe.
There's certainly nothing serious going on since he continues with what he's doing. I think you can safely forget about autonomic neuropathy.
Follow-up from Dr. Lebinger:I see quite a few kids with non-specific abdominal pain. A few of them turn out to have lactose intolerance. Their digestive system is missing the enzyme or chemical necessary to digest lactose, the sugar in milk. If the lactose cannot be digested, it is not absorbed properly and can cause diarrhea, bloating and abdominal pain. Although there is a formal test to diagnose this condition (a hydrogen breath test) this requires drinking a large amound of carbohydrate as lactose first. An easier way to tentatively diagnosis this is to remove all lactose ("dairy products") from the diet for 2 weeks and see if the symptoms resolve. It doesn't take much milk to give symptoms (12 grams of lactose/8 0z), as opposed to cheese, which is mainly protein and usually has less than 1 gram lactose per slice. Butter has none.
Nowadays you don't have to give up dairy products to avoid lactose. You can buy 100% Lactaid milk which has the missing enzyme added directly to the milk to predigest the lactose for you. All the lactose has been changed to glucose, causing little effect on diabetes management, though it may work a little faster theoretically. You can also buy Lactaid caplets and drops in the pharmacy to add to dairy products to digest the lactose.
If the symptoms go away off lactose and return when lactose is reintroduced into the diet, you have a good presumptive diagnosis. It is important to diagnose lactose intolerance in a child with diabetes as the malabsorption of the lactose can cause erratic blood sugar control.
If you feel your child may have lactose intolerance, it is important to discuss with with your own physician to confirm the diagnosis and decide whether any dietary or insulin changes are necessary.
Original posting 9 Aug 96
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