Complaints & connections · borters.ch
Rom-IV-Kriterien
A diagnosis made positively, with its own criteria — the pain is real, the signalling is too loud, and more tests do not make it safer.
Also known as: abdominal migraine · functional abdominal pain in children · periumbilical pain · recurrent abdominal pain · Rome IV · gut-brain axis
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
In roughly one school-age child in ten, belly pain returns over months without any inflammation, germ or organ damage being found. That is not a leftover and not an embarrassed guess: functional abdominal pain is a diagnosis in its own right, with its own criteria, and it is made positively rather than by exclusion — at least two months of recurring pain, growth and weight fine, no warning signs, an unremarkable examination. More tests do not make the diagnosis safer; they only make the worry larger. The pain itself is real: gut and brain are linked by a dense nerve network, and in these children the gut reports normal events — stretching, gas moving, the reflex after eating — more loudly than it should. One particular form is abdominal migraine: attacks lasting hours to days, with pallor, loss of appetite and nausea, while between them the child is completely free of symptoms. Knowing these patterns gives a name, an explanation and routes — and that is exactly what improvement depends on.
That a perfectly ordinary stretch is reported as pain is neither an evasion nor imagination but a studied process at the nerves of the gut wall — with treatments of its own.
A spoken name ends the search and starts the treatment. “We found nothing” does the opposite.
Staying home tightens the loop. Going, with an agreed fallback, loosens it.
In children one of the most effective measures there is — recordings exist to listen to, and the effect often lasts for years.
The gut likes regularity. Ten minutes on the toilet after breakfast, without hurry, is a lever in itself.
Note triggers, catch the attack early with quiet and darkness — and discuss with the doctor whether prevention makes sense.
Taken often, painkillers irritate the stomach and can maintain the very pain they are meant to ease.
Part of the short exclusion list before the diagnosis is made positively — especially with a course that comes in waves.
Filled to hand warmth, wrapped in a cloth, applied for 20 to 30 minutes.
Lightly crush a teaspoon of the seeds, pour over hot water, cover and steep for ten minutes.
Pour hot water over a teaspoon of dried leaves, cover and steep for ten minutes, drink after eating.
Walk ten to fifteen minutes two or three times a day, plus a large glass of lukewarm water in the morning.
It breaks down quickly in the sample and is only found if the laboratory looks for it on purpose. The link with the complaints is not settled in every case.
In children there is no drug that removes functional belly pain — acid blockers and antispasmodics do hardly better than a dummy in comparisons. What works targets the processing: gut-directed hypnosis in about six sessions helped around two thirds in studies, and the effect lasted years. Peppermint oil has been studied. What matters is the clear statement that the pain is real — it is.
About ten to fifteen in a hundred school-age children are affected, girls somewhat more often. The diagnosis needs complaints over at least two months and the absence of warning signs — weight loss, blood in the stool, waking at night from pain, fever. Abdominal migraine lasts hours to three days and comes in episodes with completely symptom-free periods in between. In about half it improves clearly within a year.
The further from the navel and the more fixed to one spot, the closer one looks.
Pain that wakes a child from sleep is not part of it and is a reason to look further.
The growth chart is the single strongest argument that nothing serious lies behind it.
Hours to days with pallor, nausea and loss of appetite — then weeks with nothing at all. Often there is migraine in the family.
Gut and brain exchange signals constantly. Here normal events are reported too loudly — that is signal gain, not imagination.
At this age it is one of the most common reasons to consult — and most children grow out of it.
The one test that separates an inflammatory from a functional cause. Normal really means normal here.
Part of the short exclusion list, together with total IgA. After that, usually nothing more is needed.
Enough together with calprotectin — a normal CRP alone says little about the gut.
Soluble fibres like psyllium and oats bind water and make the stool supple. Wheat bran and a lot of raw vegetables, by contrast, increase bloating and pain in a sensitive gut — this distinction explains most of the failures.
Fibre without water makes the stool harder instead of softer. The two belong together, and the effect only sets in after some days.
Draws water into the bowel and therefore works with a sluggish stool. The belly shows the upper limit: if the stool gets too loose, the dose at once was too high.
Yoghurt, kefir, sauerkraut and the like bring living cultures with them. Many tolerate them well; with a strongly bloated belly they can also do the opposite in the first weeks.
Studied and effective in children with functional abdominal pain. 0.2 ml three times daily over 2–4 weeks; only the enteric-coated form reaches the gut.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
In these children the gut wall reports the same stretching as more painful — that is measurable and not invented. “Nothing found” therefore does not mean “nothing there”: the pain arises in the transmission, not in the tissue.
Most of the serotonin sits in the gut wall and steers movement and sensation. That is the physical reason belly and mood hang together — and not a paraphrase for “psychological”.
Fixed times and calm eating often do more than any elimination diet. It becomes judgeable after about 3–4 weeks.
For some it eases symptoms within 2–4 weeks. Then reintroduce — the strict phase is not a permanent state, least of all in children.
Belly-focused relaxation methods are studied in children and work over months.