Episode 98: Food Intolerances and Tummy Pain

Episode 98: Food Intolerances and Tummy Pain

Is food causing your child's tummy pain?

Tummy pain is such a common concern in children, but it can be really hard to work out what's actually going on. Is it constipation? Is it a food intolerance? Is anxiety playing a role? Or is there something else that needs to be investigated?

In this episode, I'm breaking down some of the most common causes of ongoing tummy pain in kids, including constipation, lactose and fructose intolerance, and other carbohydrate intolerances.

I'll also talk about something I see far too often: parents removing whole food groups from their child's diet because they think they're helping, when actually they may be unnecessarily reducing their child's fibre, vitamins and overall nutrition.

If you have a picky eater or fussy eater with ongoing tummy pain, it's really important to understand what's causing the symptoms before restricting their diet. The goal isn't to take away as many foods as possible. It's to work out what's causing the problem, manage the symptoms and still make sure your child is getting plenty of nutritious foods.

In This Episode

Is It Really Food Causing the Tummy Pain?
Why tummy pain can have many causes, including constipation, illness, anxiety and food-related triggers.

The Constipation That Parents Often Miss
Why a child can still poo every day and actually be constipated, and how this can contribute to ongoing tummy pain.

Lactose, Fructose and Carbohydrate Intolerances
I explain how different carbohydrates can cause bloating, gas, diarrhoea and cramping in young children.

Why Going Gluten-Free Isn't Always the Answer
Why gluten and fructans aren't the same thing, and why unnecessarily removing wheat can have consequences for fibre and nutrient intake.

Finding the Right Plan for Your Child
Why a food and symptoms diary can be so useful, and when it's important to get support from a paediatric dietitian or paediatric gastroenterologist.

Highlights:

Introduction: Episode Overview & Kids' Tummy Pain - 00:00.084
Food Intolerance, Diet Restrictions, and the Gut-Brain Connection - 02:11.276
Identifying Tummy Pain Causes (Excluding Sickness and Anxiety) - 04:37.934
Constipation: A Hidden and Common Cause of Tummy Pains - 06:57.634
Carbohydrate Intolerance (FODMAPs, Lactose, and Fructose) - 09:19.092
The Mechanism of Fermentation and Discomfort - 11:32.512
Gluten Confusion and Avoiding Unnecessary Restrictions - 13:47.094
Hypersensitive Nerves, Post-Infectious IBS, and Medical Investigations - 16:08.044
Summary: Taking Action and Getting Proper Help - 18:32.746

Show notes

READ TRANSCRIPT

Show Notes & Resources

Healthy Recipes for Kids:
https://nourishwithkarina.com/healthy-recipes-for-kids

Nutrition Consultation:
https://nourishwithkarina.com/nutrition-consultation

Membership:
https://nourishwithkarina.com/membership

Introduction: Episode Overview & Kids' Tummy Pain (00:00.084)
You're listening to the Easy Feed Podcast, episode number ninety-eight. Food intolerances and tummy pain. Is food causing your child's tummy pain?

Hi there, I'm Karina Savage, and with over 20 years' experience feeding children, including my own, I've learnt all the secrets that busy mums need to get their children eating better and actually enjoying healthy foods. So a huge welcome to the Easy Feed Podcast. Welcome back everybody. It's great to have you. I hope you're really well. Today I want to talk about tummy pain because it is such a common concern and

Issue in kids. And as a parent, it's so hard to navigate sometimes. It's so hard to know as a parent what's going on sometimes and whether it's that they don't want to go to school because they're anxious, there's something else going on, or whether it's just genuine tummy pain. And if it is, then what the cause is. Are they constipated? Is it something else going on? Is it food related? It can be really hard to navigate and actually pull apart.

This whole tummy pain issue. And look, I saw a child the other day in an online consultation. He has missed the first eight weeks of school, basically, because of ongoing tummy pain and issues. And this was a child who two years ago was diagnosed with fructose and lactose intolerance. So he had the breath testing done. And mom had put him on a low FODMAT diet without seeing a dietitian. They've never seen a dietitian. And

You know, I mean, look, she did the best she could, but I think this is a part of the reason why he has been off for the first eight weeks of the school term, because they've been grumbling along but not really getting anywhere and not seeing significant improvements because he was still eating things that were probably causing the tummy pain and also over restricting other things, like completely pulling out gluten.

Food Intolerance, Diet Restrictions, and the Gut-Brain Connection (02:11.276)
when he possibly didn't need to because mum had been told by someone that that might be a good thing to do. And it'd been years. And so this is something that is a very complex area. The same rules don't apply for adults and kids. So if there is food intolerance going on and it's diagnosed food intolerance, please make sure that you get the right help, the right support from a pediatric dietitian, because otherwise you can excessively pull out things from the diet. It can go on too long.

Or there can be other things that need to be pulled out to actually improve symptoms and get this child living their fullest, healthiest life, getting them back to school. So food intolerance can be a huge cause of tummy pain in kids. Not always. Absolutely bad viruses can cause tummy pain in kids. Anxiety causes tummy pain in kids and adults. You know, the gut brain connection is huge. So we can have, you know, feel like we've got to go the runs if we're anxious. I remember when I used to ha play tennis and we had a

Big, you know, game and might have been a final and you still have to run off to the toilet because I was nervous. It changes your gut nerves, anxiety, adrenaline, it changes the way that your gut works. And so there are other factors that will influence tummy pain and altered gut movements, but food is a significant contributing factor to tummy pain and gut issues in kids. But it can be really confusing as a parent when your child has this sort of

Ongoing residual tummy pain. And it's something that is sort of always hanging around there in the background. And you just can't put your finger on it. You just can't work out exactly what's going on. You might have tried to change the milk a bit or change the bread, or maybe you haven't tried anything and you're just hoping it will go away. Because it's it's really tricky to work it out unless you a keep a proper food and symptoms diary and then take that food and symptoms diary to someone who knows what they're talking about.

can actually analyze it for you and work out what the heck's going on for your child. Because there's many factors that could be causing tummy pain in kids. And so I'm going to walk you through some of those today, just to give you a little bit of an understanding if your child has tummy pain, about the types of things that you might like to consider as contributing factors.

Identifying Tummy Pain Causes (Excluding Sickness and Anxiety) (04:37.934)
for their tummy pain. And this is assuming that you've ruled out, you know, anxiety, you've ruled out any other sickness or tummy bug that could contribute to their tummy pain. Because often, and I know with my kids too, when they get sick, often the first thing is tummy pain. So we want to make sure that it's not sickness. We want to make sure as best we can that it's not anxiety or nerves related. And then we can focus on food and what they're eating a little more.

So let's start with a common cause of tummy pain. And this is a bit of a chronic problem in a lot of kids, and that is constipation. Now, constipation is hugely variable, and sometimes parents don't even realize their child is constipated. I saw a patient online the other day and the mum's like, I didn't even realize that they were constipated and significantly constipated too, so much so that they were full of poo and had to go to hospital and get a full clear out disimpaction.

And it can catch you out when children are still actually doing a poo regularly. But the thing is they're not fully clearing out and stuff gets stuck in there and it gets backed up. And poo stays in the bowel. And the longer it stays in the bowel, the harder and the drier it gets, acts like a plug. And then it really just builds up and gets backed up. And so you do get a little bit flowing around the sides, and often you can get overflow, but

And bits of poo may make it past the plug. And so, you know, kids are still doing a poo daily, but it doesn't mean that they're not constipated. So it can be quite confusing and it can go undetected for a very long time when that scenario is playing out. Kids aren't necessarily showing obvious signs of holding on. And as I said, they're going to the toilet regularly, but they're not actually fully clearing.

So constipation starts, it builds up, it builds up, and it builds up to the point where children are feeling really uncomfortable and it can be painful. Children get quite sore tummies and they say, My tummy hurts. And so constipation is a common cause of tummy pain. And it can be something that we miss unless we really know about constipation. And sure, you can take your child to the doctor.

Constipation: A Hidden and Common Cause of Tummy Pains (06:57.634)
and get them to feel their tummy and their bowel area to feel whether there is poo sitting in their bow. Because if there is, then you may need to rule that out as a contributing factor to your child's tummy pain. And if you discover that they do have constipation, then it's about managing that and making sure that you put an action plan together to resolve the constipation. And that action plan will vary according to the child. And I certainly see lots and lots of children online.

with constipation. So please reach out to me if you want an action plan for your child. Okay, so aside from constipation, what else could be causing tummy pain? Well, a very, very common cause of tummy pain in toddlers and young children is carbohydrate intolerance. Now, what happens with carbohydrate intolerance, and this is things like lactose intolerance, fructose intolerance, and there's many more carbohydrate intolerances as a group

Collectively in the adult world, it's called FODMAPS. Now, in the child world, we do not need to necessarily avoid all of the FODMAPs or the carbohydrates, but there are definitely two or three that are known to be problematic and cause tummy pain in young children. And certainly when I see patients online, I troubleshoot for all of those carbohydrates. I look at the food they're eating.

I look at their symptoms and I can pretty quickly work out what I think the carbohydrate triggers are for that child. There are different types of carbohydrates. There's the natural fruit sugar, fructose. There's the natural milk sugar, lactose. There's these natural sugar polyoles such as sorbitol and manitol, and then you'll see them written as xylitol and erythritol. There's all sorts of different polyoles that can be problematic.

Then there's fructans, then there's galactans, there's different long chain carbohydrates that can also cause tummy pain. Not as commonly in children, but absolutely can be a problem. So carbohydrate intolerance is a very common cause of tummy pain, especially the lactose, the fructose, and some polyols. What happens is when these carbohydrates are not digested and absorbed properly.

Carbohydrate Intolerance (FODMAPs, Lactose, and Fructose) (09:19.092)
In the small bowel or the small intestine, where they should be absorbed. So fructose and lactose should be absorbed in the small bowel. When fructose and lactose are not absorbed in the small bowel and they make their way into the large bowel in too big a quantity, they sit there and they get fermented by the gut flora, by the gut microbes in our large bowel. And they

Eat these carbohydrates up all day long for breakfast, lunch, and dinner. For as long as they're in there, they will munch on them, they will ferment them, and they produce a lot of hydrogen as a result, usually in people. Sometimes in people they produce methane, but most of the time, let's just call it gas. So these microbes are munching on this unabsorbed carbohydrate or undigested carbohydrate, and they munch on it and they produce a whole lot of gas. And what also happens is that.

It can cause water to be drawn into the large bowel. It's called an osmotic effect. They get urgent loose bowel actions, and that can cause a lot of tummy pain and cramping, almost a bit like a gastrotype pain. So extreme carbohydrate intolerance is really painful as the carbohydrate is not being absorbed properly. It's ending up in the large bow. It's getting fermented. It's basically ripping through the child. And it can also cause.

A very sore red bottom because when these carbohydrates are in the large bowel and they're getting fermented, they're getting munched up by the microbes, those little microbes are producing as a byproduct short chain fatty acids. And those acids in the poo can burn. And so some parents will say to me, Yeah, they're pop-offs, they're farts, they're flatulents, it's really smelly, as are their poos. And it's that acid.

Acidic, it's the short chain fatty acids. It's that acidic nature that makes them stink even more. And that's because of that fermentation of the carbohydrates, the lactose and the fructose. The polyoles have a little bit of a different mechanism. They're not meant to be absorbed. So they just make their way into the large bowel and add to that fermentation process. And it's just a recipe for discomfort, really.

The Mechanism of Fermentation and Discomfort (11:32.512)
So these poor little ones, it used to be called toddler diarrhea, fructose intolerance. So they basically don't absorb it well. Apple juice and apples and pears are really high in fructose. They have too much of that kind of thing, they can get the runs. So really that's the mechanism of carbohydrate intolerance or fructose or lactose intolerance. And it can be a big cause of tummy pain in young children.

I've seen little ones who have red raw bottoms because of carbohydrate intolerance and it's really sad to see because they're in a lot of pain and people think, fruit's healthy and sure it's healthy, but it's not always healthy for individuals that are really fructosensitive. So it's about setting up an action plan that's gonna support them to still be able to enjoy fruit, a variety of healthy foods, but

really reduce that intake of the carbohydrate that's going to cause them tummy pain. Lactose is the same. Now there are some kids that will be intolerant to parts of those other BODMAP groups. So the fructans, the galactans and others, but for the majority of kids we start with those carbohydrates that I discussed first, like the fructose and the lactose and the the polyols. You know, sugar-free gums rich in sorbitol. There's a reason why on the packet it says

Excessive consumption may have a laxative effect. So very, very common in the children I see, but not as well known about, obviously, you know, to a mum and dad in the playground, because it's something that you really have to understand properly. Often gluten is removed unnecessarily because people think that that is part of the FODMAP. Well, it is in a way, it's the carbohydrate part of the wheat, but it's not the gluten. The gluten is the

protein. And I know I'm getting very technical here, but when you look at a grain of wheat, carbohydrate is the fructan and the protein is the gluten. So people only have to avoid gluten if they have celiac disease or if they're gluten intolerant. People with bloating and irritable bowel often have to avoid the carbohydrate side of things, which is the fructane.

Gluten Confusion and Avoiding Unnecessary Restrictions (13:47.094)
Look, taking wheat out and going gluten-free will fix both of those issues. But yeah, it's it's really confusing and sometimes parents will unnecessarily remove gluten like this patient I saw this week because they think they're doing the right thing by their child. But when you take gluten out, you take out so many foods, you take out fiber, you take out B group vitamins. So you have to be really careful with removing.

whole food groups or food types from a child's diet because it can be quite detrimental to their nutrient intake and their fiber intake, which in turn affects their gut health. So it's really important to seek help from someone who knows what they're talking about so that you can create a plan for your child so that the tummy pain is fixed, but you're not pulling out a whole lot of nutrients that are going to affect your child negatively. The goal of a dietitian should be

always to put in more foods than we take so that we are giving plenty of variety for your child and also plenty of nutrition, but pulling out the foods that are problematic for your child. So you're basically getting rid of the symptoms, getting rid of the problem, and making sure their nutrition is still amazing. And this has to be within the context of foods that a child will eat because it's one thing telling an adult what they should or shouldn't eat.

But it's another thing getting a child to eat particular food. So it also needs to be very practical and doable for that child with the eating behaviors slash feeding preferences of that child. Some children and adults will be really sensitive to bloating or any stretching or changes to the way that the bowel works. Some people's nerves, there's plenty of nerves that are around your gastrointestinal tract.

And some people's nerves are really hypersensitive. People with irritable bowel syndrome will often have very hypersensitive nerves around the gastrointestinal tract. So it's really important to try and reduce that bloating and discomfort so that there's less nerves being triggered that's feeding back to the brain, going, ouch, ouch, ouch, my tummy hurts or my bowel hurts. There are definitely disorders of the gut-brain interaction.

Hypersensitive Nerves, Post-Infectious IBS, and Medical Investigations (16:08.044)
Including irritable bow syndrome and what's called functional abdominal pain. And it's very common to get these diagnoses after a bad gastrointestinal infection or influenza, even. And you get a post-infectious irritable bow. And I've certainly seen many patients like that. Now, as I said before, it's important to rule out anxiety and worry as a cause of your child's tummy pain because

The gut and the brain talk all the time and the signals travel in both directions. So if they're stressed and worried, it can absolutely cause tummy pain and ongoing issues. And if you've ruled out anxiety, worry, and food as a cause of your child's tummy pain and they're still getting tummy pain, it is really important to exclude another medical underlying cause, which is why you would definitely.

Get a referral to a doctor, to a pediatric gastroenterologist, and have a full checkup, look at the bloods, look at anything else that is worth looking at to make sure that there's nothing else underlying that's contributing to your child's tummy pain. That is definitely, you know, the minority of kids. It's definitely not usually needed, but certainly is important in some situations and certainly with the.

Children I see who have had newly diagnosed celiac disease, they have needed that further investigation to understand their tummy pain. And they did get that diagnosis. Now, I know it's only, you know, 1% of the population, but in those situations, it is important to get that referral and you have the blood test, and then if needed, have an endoscopy to work out what is going on. So, in summary, food often causes tummy pain in children.

I would say, you know, over 50% of the time, probably over 70% of the time, food is playing a role in your child's tummy pain. And there are many factors relating to food that could be causing your child's tummy pain, whether it's constipation, whether it's a carbohydrate intolerance, or whether there is something else going on that needs further investigation, such as celiac disease, which again

Summary: Taking Action and Getting Proper Help (18:32.746)
Is related to the gluten in food, it is important to pay attention and get help. Do it once, but do it properly. Don't let tummy pain grumble along for years without getting the proper help that you need. Keeping a food and symptoms diary is super helpful. And I certainly provide that to you prior to a consultation with me. Otherwise, getting support from a pediatric gastroenterologist to rule out any other medical causes.

Is another smart move if this has been going on for many years. So please reach out to me if you want to chat more about your child's gut health, constipation, food intolerance, or ongoing tummy pain. You'll also find more information on my website, nourishwithkarina.com, whether you click on the consults tab, whether you click on my blog, you'll find lots of information there, as well as other episodes of my podcast. I will wrap it up there. I wish you a beautiful week.

And I look forward to chatting with you again soon. Bye for now.