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Joseph Levy, M.D., has been listed in Top Doctors in America and Best Doctors in New York since 1996. Dr. Levy is a professor of clinical pediatrics at Columbia University Medical Center in New York City. He is also a board-certified pediatric gastroenterologist and director of the Children's Digestive Health Center at the Morgan Stanley Children's Hospital of New York-Presbyterian Hospital, where he practices.

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My Tummy Hurts

Fireside

Introduction

Stomachaches rank second only to upper-respiratory infections as a reason for nonroutine visits to the doctor. A child's familiar complaint of "my tummy hurts" is one that a parent cannot ignore. It can conjure up your worst fears: appendicitis? food poisoning? worms? Are you overreacting? It could be just too much ice cream or Monday-morning school aversion.

Most parents feel insecure about appraising their child's symptoms and evaluating the degree of discomfort: all they can see is that their child is in pain. My Tummy Hurts will provide parents and caregivers with a guide to the puzzling and often frightening topic of stomachaches. It will enhance your ability to ask the right questions and identify the problems, as well as offer practical advice to provide a clearer analysis of the problem. It will show how to manage common problems and how to recognize the important factors that make the difference between benign forms of pain and those requiring immediate or urgent medical attention.

Taking care of children is a partnership between the caregiver and the health care provider. The better the communication between them, the better the care will be. Much of what physicians use to reach a diagnosis is based on having an accurate history of the problem, knowing the sequence of events, and assessing the child's response. It is all in the details. As facts and details -- and test results, if appropriate -- accumulate, the diagnosis becomes apparent.

And so, after over twenty years of experience as a pediatric gastroenterologist, I have spent many hours fielding questions from parents, moving them along to a better understanding of their child's problem, and giving them a solid handle on how things work. With a clearer picture of how the intestine works and why it hurts, parents become more confident about their own instincts and observations.

With this philosophy in mind, the organization of part I of My Tummy Hurts was developed to provide a general foundation on how the digestive system works and how to maintain good health through proper nutrition. It starts with chapter 1, "The Digestive System and How It Works," which introduces the components of the gastrointestinal tract and the interrelationships among them. In chapter 2, "Nutrition: What to Eat, When to Eat, and How Much to Eat," provides commonsense advice on building good eating habits and making mealtimes less stressful. The United States Department of Agriculture's New Food Pyramid is also presented, and the reasons for changes to the recommendations of previous models are explained.

In part II, "Why Does the Tummy Hurt? Pinpointing Pain," I explore the reasons for stomachache pain and what to look for when a child complains. When parents have the tools to more accurately describe the character, location, and timing of the pain, they will be better able to assist in figuring out what is wrong. The role of stress and the interaction between the "brain in the gut" and our conscious awareness of the pain is also reviewed, and new strategies are provided to conquer and successfully cope with chronic pain. I conclude part II with chapter 5's description of diagnostic tests that help investigate digestive problems ("Digestive Detective: Diagnostic Gastrointestinal Tests"). There you will find such practical information as descriptions of various common tests, the duration of each, why it is performed, what preparation is needed, and what you can tell your child about it.

In part III, "The Most Common Gastrointestinal Disorders," I describe those frequently encountered conditions for which a general understanding will enhance parents' ability to recognize and manage the problems more effectively. Included are chapters on feeding difficulties, infantile colic, acid reflux, gas, lactose intolerance, diarrhea, and constipation. Each chapter briefly describes one of these conditions, how it manifests itself, what is needed to confirm the diagnosis, and what can be done to treat it effectively. These chapters need not be read sequentially -- and certainly not in one sitting: they are there for you to review when needed.

Finally, part IV, "When It's More Than Just Pain," covers how to choose a pediatric gastroenterologist, as well as some of the less common conditions such as inflammatory bowel disease, celiac disease, H. pylori gastritis, pancreas and liver disorders, and cyclic vomiting syndrome (CVS). Although these conditions fortunately occur much less frequently than those discussed in part III, many parents whose individual circumstances dictate it will find the information useful and reliable.

Reading the book will familiarize you with many aspects of normal digestive and nutritional health and will enhance your understanding of gastrointestinal problems. Whether or not your child is suffering from any of these conditions, sooner or later, this information will come in handy and will allow you to manage your child's complaints with self-assurance.

Copyright © 2004 by Joseph Levy, M.D.

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