Have you ever noticed your child experiencing nausea, diarrhoea, or butterflies in their stomach before an exam or a stage performance? Or perhaps you've seen them become low in energy and unhappy due to abnormal bowel habits?

This could be linked to the Enteric Nervous System (ENS), often referred to as the “second brain.” This complex system of millions of nerve cells runs from the oesophagus to the anus, releasing neurotransmitters and hormones that regulate digestion, gut motility, secretions, sensations, and immune responses. Essentially, your child’s “two brains” – the gut and the brain – communicate with each other to maintain balance.

Often, issues such as colic, recurrent abdominal pain, stomach upset, constipation, faecal soiling, bloating, vomiting, and indigestion in children are due to what we call Disorders of Gut-Brain Interaction (DGBIs), commonly known as Functional Gastrointestinal Disorders. These conditions can be distressing for both children and parents, often leading to unnecessary testing out of fear of a more serious condition.

Functional Gastrointestinal Disorders

It’s important to understand that DGBIs don't have a specific lesion that, if treated, would make the pain disappear. These disorders cannot be diagnosed through blood tests, imaging studies like ultrasound or CT scans, or endoscopy. Instead, expert Paediatric gastroenterologists make a positive diagnosis based on the Rome IV symptom questionnaire, rather than a diagnosis of exclusion after numerous invasive tests. They carefully evaluate red flag symptoms and signs that could indicate an organic problem through
detailed history and examination. In some cases, they may perform specific tests tailored to the child’s needs.

Treatment is multifaceted. It involves identifying and addressing pain triggers, using cognitive behavioural therapy and biofeedback to manage and control pain, and making dietary adjustments. Occasionally, medications that alter pain perception, like neuromodulators, may be used.

In essence, a Paediatric Gastroenterologist acts like a counsellor, working to soothe the “second brain” with a personalized approach. The goal is to improve the child’s overall functioning, manage symptoms effectively, and help reintegrate them into daily activities and school.