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November 14, 2001

Aches and Pains

Question from Spokane, Washington, USA:

My four and a half year old daughter, who was diagnosed with type 1 diabetes four months ago, is definitely in a honeymoon, but I am concerned because she complains quite regularly about her stomach hurting with no other symptoms. Should I be concerned? Should I have her diabetes team look for something in particular?

Answer:

I’ve often had younger kids with type�1 complain periodically of abdominal pain. It generally is not severe enough to limit activities or affect appetite or bowel habits, and usually we find no explanation. The possibilities that immediately come to my mind are:

Check for ketones (even in the light of non-elevated glucose values). Ketones can cause abdominal pain.
Have her diabetes team consider the possibility of celiac disease The definitive test is a view down the stomach and intestines with a scope and obtain a biopsy, but the screening test involves simple blood tests.
Children get stressed and can get “acid reflux” just like adults. While a formal visit to a doctor may be needed to consider a definite test for that too (which may also involve the scope-view of the stomach and esophagus lining), you can easily give a trial of over-the-counter liquid antacid to see if that offers relief. If it does, her doctor might want to consider pursuing this more aggressively.

While there are other possibilities, I think that they would be associated with other symptoms or present more severely than what you’ve implied.

DS