“Mommy, I’m hungry!” and this is where it starts. My five year old seems to be endlessly hungry, but as soon as she has had three bites, “Mommy, I’m full. My tummy hurts.”
She is my stomach kid. There are days of inexplicable tummy pain. Endless weeks of checking whether she is pooping properly and a reality game show of trying to figure out which foods, times of day, or school events are setting off this seemingly endless range of random yet real, small-kid, tummy pain.
Ten days ago she suffered from a flu like gastritis, but instead of it getting better, she only seemed to get worse. I couldn’t get an appointment with our GP, (because I can never get an appointment with our GP) and I was ready to do anything to ease her pain. We were on day six of this illness; Fiona was curled up on the floor and the regular placebo fixers (iPad, tv, chocolate bribe) had no affect on her desire to move. Knowing this wasn’t heading in the right direction, I hustled the other two kids off to school, and we headed to the E.R.
She is my third child. I have a croupe kid, a never-get-sick kid, and now a stomach kid. I know she is not alone because non-specific stomach pain is one of the top reasons children visit the doctor between the ages of 4-17.
As we headed to the hospital I was certain we were looking at appendicitis. She had pain around her belly button, more localized on one side. She couldn’t eat and the only position she could tolerate was yoga’s aptly named child’s pose. As we wound our way through triage and registration the pain was getting worse. The E.R. doctor entered the room (also a mom of two kids) and began her systematic checks. When she was done poking and prodding, she turned to me and said,
“It could be appendicitis, but it could also be mesentery lymphadenitis. We will give her some pain medication, an anti nausea med, and we will send her to ultrasound as soon as possible.”
What? She has what-what? I pride myself on my microbiology background and staying current with advances in medicine, (it’s my secret hobby) so when the Doctor threw out this mouthful, I was dumbfounded.
Mesenteric adenitis (or MA) is an inflammation of the mesenteric lymph nodes. The name comes from mesentery, which is the part of the abdomen where the glands are located. Adenitis which means inflamed lymph glands. It is sometimes called mesenteric lymphadenitis. In short, the lymph nodes that surround the stomach, and sit just above the transverse colon (poop tube) become inflamed. When kids suffer from a virus or gastritis, these lymph nodes swell up (similar to the ones found in your neck and throat) and press on the stomach and the colon. The triad ensues; vomitting, diarrhea and stomach pain.
When Fiona went for the ultrasound the tech showed me the clumps of swollen glands. She couldn’t see an enlarged appendix, and it wasn’t for lack of trying. She spent a solid thirty-five minutes checking all the bits and pieces that might be causing this pain. Fiona’s blood test also came back normal, so it didn’t appear to be related to a bacterial infection. When she finished, we were sent back to the exam room with the advice to continue alternating Advil and Tylenol every four hours and to come back if anything got worse or we felt something had changed.
So you might be asking, “How could this explain my kid’s constant stomach ache?”
As it turns out a significant number of mesenteric adenitis goes undiagnosed because it doesn’t reach the level of pain that warrants an ultrasound. The enlargement of mesenteric lymph nodes frequently causes abdominal pain in children, vomiting and fever are the most common other symptoms in kids. The most common cause of MA is acute diarrhea and respiratory tract infection.
Please DO NOT mistake my medical hobby for real world actual Doctor advice.
If this sounds like your kid, here’s is some real life and internet wisdom I’ve learned:
- Mesenteric adenitis affects kids mostly between the ages of 5-15
- These lymph nodes can become inflamed after having any virus (flu, cold, croup, gastritis etc..)
- Unless the pain escalates to the level of ours, you may never know because no ultrasound will be performed.
- The pain is real. It can be treated with anti inflammatories but sometimes those don’t even help.
- MA can be recurrent and inconsistent in it’s presentation.
- You can never assume it is not appendicitis and should check each episode as if it were.
- Some people have found their children only have one episode, and it lasts about two weeks and doesn’t return.
- The pain is real. It can be treated with anti inflammatories but sometimes those don’t even help.
- If it’s recurrent, some people have found a gluten free diet helps.
- Some kids are hospitalized for the pain and dehydration due their inability to eat or drink.
- Some kids go through periods of wellness and return to the pattern of pain.
- Many kids miss school because of it. Lots of school.
- The pain can come on suddenly. It can also leave suddenly.
- The pain seems to be exacerbated with eating.
What does all this mean? Lots of ‘stomach kids’ suffer from real pain. Fiona has been like this since she started school – which also coincides with bringing home about 600 viruses a year. The link seems more obvious to me now. At the end of what would to be a typical illness (cold, flu, croup) she would then start to complain about her stomach and I would get confused. I wondered, was she still sick? Did she get another virus on top of the first one? Was she allergic to some food? Did she just want to stay home? I could never pin down what caused the pain and why it seemed to so random.
Going forward, when the pain strikes I will give her Advil, and keep her on a course of anti inflammatories and hopefully it won’t reach the level it did previously. I will also let her curl up in a ball and give her some time to let it pass, or understand that we are in for ‘one of those days’. Going forward, I will have a clearer idea of what is happening inside her little stomach, and I’ll know that she is not just trying to get the better of me.
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