Reinforcement Response

The pain behavior evokes a characteristic reinforcement response from parents, school, and the primary physician (see Table 40-4). When the pain occurs, the patient is given periods of rest, more attention by the parents, and medication. The parental response following a report of pain consists of requesting the child to lie down on the couch or bed; providing television, toys, books, drinks, or food to distract the child; and giving some symptomatic therapy, either massaging of the abdomen or antispasmodics. Pain usually lasts < 1 hour, but the child is kept all day from school and resumes normal home routine after the pain subsides. Schools unfortunately reinforce the pain by sending the child home when complaints of pain occur while at school. The family physician or pediatrician may prescribe medications on an as-needed basis rather than request that the child either be kept in school or come to

TABLE 40-3. Questions to Ask Parents Specifically/Questions to Ask Patient

Questions to ask parents specifically

1. What do they think is the cause of the abdominal pain?

2. Do they think the condition is life threatening?

3. What symptoms do they the parents develop when stressed?

Questions to ask patient

1. What does the patient think is the cause of the abdominal pain?

2. Does the patient think the condition is life threatening?

It is best to ask these questions in private.

TABLE 40-4. Things Parents Do to Reinforce Pain Behavior

1. Attention given to child at time of pain (massaging abdomen, providing heating pad)

2. Lying down on bed or couch during pain

3. Medication at time of pain

4. Absence from school on days of pain

5. Leaving school when painful episodes occur

6. Normal activities at home once episodes of pain pass and when absent from school the office to be examined. When patients are seen by a gastroenterologist, about half will have been symptomatic for < 1 year, and the remainder anywhere from 1 to 5 years. The gastroenterologist is at a disadvantage by being the second or third physician to examine the patient.

Primary care physicians often have difficulty making a positive diagnosis of a functional GI disorder, because they fail to recognize the typical history. They do a series of diagnostic studies to preclude organic disease and feel uncomfortable doing it. The parents, rather than being reassured by the absence of positive test findings, become more frustrated, anxious, and angry, particularly if the only alternative diagnosis is perceived to relate to the child's behavior. Parental uncertainty or unwillingness to accept a functional diagnosis often increases the stressful environment that brings on or reinforces the behavior. This may result in further diagnostic tests, hospitalization, and referral to subspecialists.

A Positive Diagnosis

Functional abdominal pain is a positive diagnosis. The condition is established by a carefully taken history, the absence of specific localizing findings on physical examination, and normal, basic laboratory investigation. The treatment can be started if the above criteria are met.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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