Dear Dr Sue:

My son is 11 years old and since this term began he has had repeated episodes of abdominal pain especially on Mondays. He is not a big eater and most times refuses to have anything before going to school. He is presently preparing for GSAT and I am very worried that something may be seriously wrong or is this just exam stress?

Worried Mum

Dear Worried Mum:

Until we can find a better way to assess our children the first big academic hurdle for them will be the GSAT exam. With the mock exams currently taking place in many of the schools, a number of children and young teens are having symptoms of stress induced gastritis or irritable bowel syndrome.

The first thing you need is to get your son to describe his pain to you. Is it a burning pain or is it a colicky pain, has there been a change in his bowel pattern, is it worse with hunger or after eating, and is it associated with vomiting or other symptoms such as fever, headache or urinary symptoms?

If there are no major associated features, you need to address his diet. He cannot go to school and not have something to eat in the morning! He doesn't have to have a large meal but he should have something nutritious. Perhaps a small bowl of porridge or some hot chocolate with a sandwich and a fruit. Is he going to the toilet before school or is he keeping it and then not feeling comfortable to use the lavatory at school? Both hunger and constipation will cause him to have abdominal pain and feel nauseous in the morning.

The next thing you need to do is to have a talk with his teacher and find out if there are any problems at school that may be contributing to Monday morning anxiety. You also need to enlist her help in making sure he eats the appropriate food at school. Rather than giving him money it may be more prudent to prepare something at home and send it along. Anything too spicy or greasy may make his abdominal pain worse and now is not the time to spend each day in the sick bay. In the evening make sure he has some vegetables and complex carbohydrates such as sweet potato or boiled yam with his supper.

Simple products such as antacids may be useful for him to have in between meals and there is also Zantac, which is now available over the counter, which can be given morning and evening. Try and defuse some of the stress in the house as related to the exams. Let him know that you love and support him no matter what the outcome.

If having tried your home methods his pain persists and certainly if there are other associated features, please have him assessed by a physician who will perhaps use this mid-term to do some investigations and determine an appropriate solution.

Sincerely yours,
Dr Sue

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