How to Help Your Child Handle Chronic GI Problems at School

Planning ahead is imperative for parents

Contributor: Kadakkal Radhakrishnan, MD

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Children with chronic gastrointestinal problems pose a unique challenge to themselves, their families and the school system when back-to-school season hits. Although I cannot address every single medical condition, I’ll try to address some of the most common problems that pediatric gastroenterologists encounter at the start of school year and how they can be handled.

Many children with chronic abdominal pain encounter flares in their symptoms at the start of school year. Chronic abdominal pain is a set of conditions where, although clinical evaluation and work-up do not reveal a cause, children truly perceive pain. Conditions that fall into this category include irritable bowel syndrome, functional constipation, dietary fructose intolerance or lactose intolerance.

For many children suffering from these conditions, the start of school year creates stress and worry about whether or not pain will affect their education or social life. Some children may feel embarrassed by their diagnosis and worry about their classmates knowing about their personal information.

Children with irritable bowel worry about gas and bloating that may require frequent visits to the bathroom. Those with acid reflux might also see an uptick in their symptoms at the start of the school year, and those symptoms can be aggravated by stress and anxiety.

Chronic gastrointestinal disorders

Children with inflammatory bowel disease, like Crohn’s disease, can experience early morning cramping and bowel movements that affect their before-school routine and their ability to attend morning classes. Children with Crohn’s disease may also have frequent bowel movements or require medications that need to be administered at school. The stress of starting a new school routine and anxiety related to their illness can also cause flares.

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Parents of children with specific food requirements, especially children with food allergies, should know what problems could arise while at school. Children with dietary restrictions like celiac disease or other food allergies are at risk of exposure to foods that they need eliminate and avoid at school.

The school should be made aware of precautions that need to be taken for children with allergies, including having an EpiPen available in case of an allergic reaction. Some children may have food intolerances instead of a true allergy, as in lactose or dietary fructose intolerance. This may occur as part of irritable bowel syndrome and may require dietary modification to alleviate symptoms.

Planning ahead

It’s important for parents of children with chronic gastrointestinal disorders to plan ahead. The first step should be to schedule a visit with your pediatric gastroenterologist or your pediatrician to identify any potential problems that may arise in relation to the child’s diagnosis. Once potential problems are identified, the parent should work with school authorities or the school nurse to implement a plan that could be put in place to help the child.

For example, a child with Crohn’s disease who may have cramping, abdominal pain and bowel movements in the morning could be allowed to start classes at a later time. Also, these children may be given special permission to use the bathroom when they get to urge to go. Schools can also help provide support to ensure that the educational needs of children are met and to keep the child’s lifestyle as normal as possible.

Schools may require letters from the physician detailing the diagnosis, management options and medications. This information can help the school implement a plan to help with the care of the child while at school.

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If medications need to be administered during school hours, forms may to be filled out by parents or physicians with the details of the medications, time of administration and the dose, as well as any potential side effects that the school may need to be aware of.

Regarding children with food allergies or intolerances: It’s important to start working with the school ahead of time and to alert the school about your child’s specific requirements. A pediatric dietitian could help teach your child how to make smart food choices at school. Those with severe allergies should have an EpiPen available at school for emergency use.

Some pediatric patients with chronic gastrointestinal experience extreme anxiety and may develop school phobia at the start of school year. Seeking the help of a pediatric psychologist could help with this anxiety; a school psychologist may also be of help. In some cases, anxiety may exacerbate the symptoms of a chronic illness. If anxiety is interfering with your child’s school function or causing worsening symptoms, a trial of SSRIs could help. These medications are slow to take effect and should be discussed with a pediatrician or pediatric gastroenterologist.

This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.

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