Functional Abdominal Pain

Many otherwise-healthy children who repeatedly complain of abdominal pain or stomach aches for two months or more may have something called “functional abdominal pain.” The word “functional” just means that there is no underlying disease, obstruction, blockage, infection or inflammation causing the abdominal pain.

However, it is very important to recognize that the pain is 100 percent real, and is caused by something called “visceral hypersensitivity,” essentially meaning the digestive organs are extra sensitive and are perceiving pain even when digestion patterns are normal. Given that the pain is very real, it may cause the child to cry, break into a sweat or turn red or pale.

While we do not understand the exact cause of functional abdominal pain, the sensitivity in the digestive tract can be triggered by various things. These could include stress, anxiety, viral or bacterial infection or even an episode of constipation. The abdominal pain the child is experiencing may even interfere with school and play.

Functional abdominal pain in children is quite common — it is estimated that around 10-15 percent of school-aged children experience it. If you notice that your child’s abdominal pain complaints seem to be related to anxiety, functional abdominal pain is certainly a consideration. However, to be sure, it is always a good idea to discuss the issue with your pediatrician, and then further with a pediatric gastroenterologist if needed.

Your pediatrician or gastroenterologist will take a detailed history — where the abdominal pain is, when and how often it is happening, other symptoms such as changes in weight and bowel movements — to determine if any further testing is needed.

“Red flag” gastro-intestinal symptoms that would likely warrant further testing include things like:

  • bloody stools
  • weight loss or lack of growth
  • unexplained fevers
  • difficulty swallowing or painful swallowing
  • vomiting that is persistent or otherwise worrisome
  • diarrhea that is severe and chronic (more than 3 loose or watery stools per day for more than 2 weeks)
  • awakening at night with abdominal pain or bloody stool

Your provider may also ask about any urinary symptoms, back pain, family history (such as any family history of inflammatory bowel disease or celiac disease) and skin changes.

Together with your child’s healthcare clinician, and if needed, with the help of a pediatric gastroenterologist, a plan can be created to evaluate and help your child manage their abdominal pain.

Winter Safety and Kids

With temperatures near freezing, you may be wondering what you need to know to keep your child safe for the rest of the winter season.

Playing outside in the cold

Check the weather before heading outside for play or travel. This helps your family prepare to be safely dressed to prevent cold weather injuries like frost bite and hypothermia.

During cold months dress warmly for outdoor play in several layers including an appropriate coat or jacket, hat, gloves, scarf (to cover face) and boots. For children who don’t tolerate hats, fleece headbands or earmuffs are great alternatives!

When playing outside, shivering is a danger sign! If you or your child starts shivering, go inside and warm up! Remember to come in every 30 minutes to an hour to get warm and conduct a mini check.

Winter Warm Up Checklist:

  • Check fingers and toes
  • Change wet clothes
  • Drink water

If you are participating in winter activities like skating or skiing, always wear appropriate safety gear to prevent injuries. Always remember to wear sunscreen outside, even during winter months as the sun can reflect off snow and ice and cause sunburn. You might want to consider a hat and sunglasses too!

Traveling in car during the cold

Wearing a thick coat in a car seat can make it very hard to buckle in snugly. A loose car seat harness means your child is at risk of serious injury during a crash. No bulky coats and car seats.

Instead, buckle your child in their clothes without the coat on to get a snug fit. Place a blanket over the seat or put their coat on backward, overtop of the fastened harness.

For children that use a wheelchair, keep extra blankets to use over their legs in the wheelchair or car seat as they can get colder quicker.

Cold weather safety at home

Carbon Monoxide (CO) is a colorless, odorless gas that is made when appliances burn fuel. CO poisoning occurs by breathing in this gas. The risk for CO poisoning is higher in the winter months because of closed windows and heating homes.

Activities that may seem harmless can raise the CO levels in our homes. It is important not to use an oven or stovetop to heat the house. Check vents for the dryer, furnace, fireplace and stove to make sure they are not blocked, including by snow. Generators, grills and other things that burn gas for fuel should stay outside of the home.

Check your home to ensure that you have a carbon monoxide detector. Detectors can be combined with smoke alarms or can be a separate device. Detectors should be on every floor and especially where people sleep. If there are children or family members in the home who are deaf or hard of hearing, there are carbon monoxide detectors with visual warnings.

If the alarm goes off, quickly leave your home as carbon monoxide can make you confused. Once outside, call 911. It is helpful to have a family meeting place to ensure everyone is the home is accounted for. Wait until emergency responders arrive.

New Year’s Resolutions

After January 1, it seems everyone is working to improve their diet or workout regime as they proclaim their New Year’s resolutions. A great way to bring your family closer in the coming year is for everyone to take part in those resolutions.

Tips for Family Resolutions:

  • Setting reasonable goals
  • Make them specific and concrete
  • Follow-through

For example, if your goal is, “we should spend more time together as a family,” you should be more specific like, “Every Friday is game night.” Then, every Friday, decide on a specific time that the whole family will get together. Details like time and day of the week help you keep track and accomplish your goal.

Older children may become interested in setting their own resolutions. If they have a hard time coming up with resolutions, you can help them by asking a series of questions, such as, “Are there things you want to learn or are there things you want to change?”

It’s important to make sure you are not pushing the child into a goal because they are less likely to meet it, if they feel pressure. You can, however, guide them. If you have a young child who has trouble with sharing, you can tell them you will help them work on this goal.

The  American Academy of Pediatrics has put together a list of resolutions to help families come up with ideas:

5 to 12 year olds

  • Do a sport or activity three times a week
  • Wear a helmet when bicycling
  • Make friends with someone new, especially a kid who is shy or new to school

13 years old and up

  • Eat two servings of fruit and two servings of vegetables a day
  • Play only non-violent video games or watch only non-violent televisions shows for only one or two hours a day
  • Help out in the community by volunteering
  • Never text or use a cellphone while driving

All of these resolutions are beneficial to the whole family. Parents can even accomplish multiple goals of improving diet and exercise together as a family, just by planning to eat a healthy dinner together every night, followed by a family activity.

Suicide In Children During COVID-19

The coronavirus (COVID-19) pandemic has shaped 2020 in countless ways for children and teens. What started as “sweet, two weeks off school!” for many youth has turned into increased stress, isolation and sadness. Rates of anxiety and depression have been increasing and with that, providers have seen an increase in suicidal ideation. Now more than ever it is important to know the suicide warning signs and to feel comfortable talking about suicide and safety with your child.

Suicide risk factors and warning signs

Certain suicide risk factors are important to be aware of including presence of psychiatric illness, a previous suicide attempt, history of trauma or abuse, bullying and others.

Beyond risk factors, it helps to be aware of some common warning signs including:

  • Increased thoughts of suicide or self-harm
  • Discussion of death or feelings of emptiness/hopelessness
  • Changes in mood (anxious or agitated), behavior, eating or sleep
  • Increased isolation or withdrawing from others
  • Risky behaviors or saying goodbye

Protective factors for suicide

There are several protective factors which can be encouraged to help your child:

  • Life skills (problem-solving, coping)
  • Social support from family, friends and others
  • Positive school experiences

Since the COVID-19 quarantine began, it has been more difficult for children to do the things they love. Staying active, going to indoor activities and seeing close friends are just a few things that children have not been able to do in the same way as before. Parents are encouraged to find creative ways to help kids stay connected with peers (i.e. video calls, virtual game nights) and to help kids stay physically active (i.e. socially distant walks, at home workout videos).

Dos and don’ts when talking to your child about suicide

Talking to your child about suicide may feel scary but there are some helpful dos and don’ts that can make this process a little easier! You can use these tools yourself and share them with other parents!

  • DO stay calm. This helps your child see that you are not upset at them and that they are not in trouble.
  • DO be direct. Ask them, “Have you wished you were dead? Have you had any thoughts about killing yourself?” Being able to openly discuss these thoughts and feelings is critical. Asking directly builds connectedness and helps to communicate that you care.
  • DO reassure. Let your child know that there is help and that this feeling will not last forever. Ask your child what you can do for them during moments of distress, whether it is sitting with them, giving them a hug or doing a shared activity together.
  • DO remove means for self-harm. Work to keep the home environment safe by removing unsafe items such as weapons, sharp objects, medications, belts, ropes and cords. If these items cannot be removed, having a safe place where they are locked is an alternative option.
  • DON’T judge. Create a safe space for your child and show them that that talking about suicide and safety are things they can do with you. The thoughts and feelings they are experiencing reflect the pain they are experiencing. As a parent, you can show empathy and validation which will help your child feel heard and increase their comfort talking about these difficult feelings.
  • DON’T leave them alone. If your child is expressing thoughts of harming themselves, do not leave them on their own. Encourage your child to keep the bedroom door open and monitor them regularly. If your child is expressing thoughts of suicide, stay with them until they receive a safety assessment.

Sometimes you may feel uncertain whether your child is safe or you may be unsure how to talk with them. If this occurs, call 911 or take them to the emergency department for a safety assessment. You can also contact the National Suicide Prevention Hotline for help: 1-800-273-TALK (8255).

A Teething Toodler

Soothing a teething toddler can be a major concern for parents. Their frustrated faces, loud cries and aching gums all want relief as soon as possible.

Infants typically begin teething when they are 3 to 6 months old, but the “first year molars” usually come when children are 1 to 1 ½ years old. Because these are larger teeth than the first few that come in, they can be a bit more painful. Typical symptoms include an increase in drooling (though kids at this age drool a lot regardless), fussiness, putting things in their mouth (though again, this happens a lot regardless) and trying to chew on things. Often you can see the tooth beginning to break through.

Home remedies for teething pain

Teething tends to seem worse at night or when children are tired, as that is a time when they will be most bothered by discomfort and harder to distract. The gums can be quite sore, especially during the period when the teeth are close to erupting. My personal preference is to try non-pharmacologic remedies first before moving to medication.

What I find most effective is letting toddlers chew on a washcloth soaked in ice cold water. The cold helps with pain relief, and the texture of the washcloth is soothing on the gums. Other cold things can be helpful too – such as drinking ice water or cold fruit, but be careful of small things that could be choking hazards.

Medications and teething toys

Oral medications such as acetaminophen or Ibuprofen are longer acting and can also provide pain relief.

Teething toys can be effective, but are not really necessary. I think the best teething toys are those that you can freeze. If you decide to use teething toys, it’s important to make sure that they really are designed for young children to chew on, without small parts or materials that could break off and become choking hazards.

The most important thing is to remember that the pain and discomfort are only temporary!

Halloween During COVID-19

Parents, the following is an article by a pediatric psychologist which discusses celebrating Halloween during the pandemic. The following discussion and article will be comfortable for some and less so for others. Keep in mind that perceptions, opinions and dispositions vary widely amongst parents regarding the disease and the proper way to approach it.

As we enter into a new season with the ongoing coronavirus (COVID-19) pandemic and ongoing social distancing guidelines, many families are wondering how to modify their fall traditions — most notably…Halloween. Children who have been lacking social interaction with alternate schooling formats and drive-by birthday parties may be especially excited about Halloween. They are likely anticipating what is “normal” — dressing up in costumes, having parades, parties and running with large groups of neighborhood kids to collect candy during trick-or-treating. With the ongoing COVID-19 pandemic, many of these traditions are simply not a safe option. Halloween, as with everything else since March 2020, will need to look different this year.

Parents may feel nervous about “crushing their child’s dreams” and piling on yet another disappointment in a long string of losses. Some parents may avoid thinking or talking about Halloween because it feels difficult and, let’s be honest, all the parents are exhausted. But parents will likely find that mustering the energy to plan ahead will make Halloween more fun and exciting.

Children and teens (like their adult counterparts) do best when they know what to expect. Halloween looking different this year will be more disappointing if your child spent weeks creating and looking forward to a plan that is not workable. However, if your family can slowly start talking and planning ways that Halloween — and the fall season in general — can look different this year, you can create fun and exciting opportunities that your kids will look forward to.

How to start: remind your kids that fall means that Halloween is coming up. Ask them about what they have enjoyed most about Halloween and fall in the past. Talk about the social distancing precautions and how things like school parades and large indoor parties will not be taking place. Be honest — if you are unsure if your friends or neighbors will have modified trick-or-treating, let your kids know that it is still unclear. If you know your family will not participate in any trick-or-treating, let your kids know that, too. Now, the important part, brainstorm ideas together. Think about ways to modify your favorite activities or create new activities that may become part of your future family traditions. Add activities to your schedule so your kids can look forward to the next fun event.

Trick-or-treating alternatives

Here are some brainstorming suggestions to help your family get started:

  • If your kids typically dress up for Halloween, let them help order or make costumes. Consider trying themed costumes with your family or with some of their friends.
  • Plan a Zoom Halloween party for your kids’ friends or for your extended family. Encourage everyone to dress up. You can plan games or send ahead craft plans so the kids can do a shared activity.
  • Research themed snacks and treats to make and share as a family.
  • Plan a socially distanced (outdoor with masks) pumpkin carving party for a small group or with neighbors from everyone’s front yard.
  • Decorate the yard/house in the days leading up to Halloween. Consider starting a house decorating contest in your neighborhood.
  • Make signs or chalk drawings for neighbors to enjoy.
  • Look into safe/socially distanced pumpkin or apple picking farms near you.

Remember, different isn’t necessarily bad, it’s just different. The more time your kids have to adjust to disappointments with any traditions that will be cancelled or modified, the more time they have to create fun alternatives and build excitement about new plans!

Returning To School

As this highly abnormal school year gets underway, you probably have questions about returning to school. To help you, we’ve compiled some FAQs about COVID-19 transmission in children, masks, school buses, physical distancing at schools and more.

Will my child infect other family members?

Available evidence has revealed that children, especially those under 10 years of age, are unlikely to spread the virus to others. Studies from Australia, Ireland and The Netherlands have shown that children usually were infected by other family members and not the initial source of infection.

What kind of face covering should I use?

There are many types of face coverings available. A recent study by the University of Florida tested several types of face coverings and found that the best face covering for home and the community was the cloth face mask made with at least two layers of cotton cloth and stitched together. Higher count cotton material and more layers worked the best. A commercially-available cone-shaped mask also worked well.

At what age should my child wear a mask?

Children older than 2 years can usually wear a mask for a period of time. Like any new activity, wearing a mask takes practice, to allow the child to tolerate mask-wearing for a long period of time. It also helps to model good behavior by having adults wear masks to help children and adolescents see it as normal behavior. Of note, children should only wear a mask if that does not lead to touching the face more than usual. Most children with medical conditions, including asthma, are able to wear masks as well.

What is recommended to keep students physically distant at school?

There are several strategies to keep students physically distant at school:

  • First limit the number of students in class, depending on the size of the room, to allow at least three to six feet between students.
  • Keep students and teachers in one class or cohort, particularly in elementary school, though this may be harder at the middle and high school levels. Limit switching students or teachers between classes.
  • Hold class outside when weather permits or open windows and doors in classrooms to increase ventilation. Fans, however, are discouraged to avoid spreading air particles.
  • Stagger start times to limit the number of students in the hallway or school entrances.
  • Use Plexiglas in areas that do not allow distance or when masks cannot be used – lunch, certain types of instruction, etc.
  • Mark the floor to remind students and teachers of spacing requirements.

Should my child play on the playground?

Physical activity is important for everyone and may help students concentrate during class time. Therefore, the risk of exposure on the playground does not outweigh the benefits of play for children. The most important factor is to wear masks, avoid touching your face and either wash hands or use hand sanitizer when finished playing.

Can my child ride the school bus or van?

Yes, but use good practices to physically distance students. Buses or vans create a close environment where viruses can be spread.

  • It is important that students wear a mask when traveling in a school bus or van.
  • If weather permits, keeps the windows on the bus open to allow for good flow of air.
  • Seating should be limited to 50% occupancy or one student per seat in a school bus.
  • Students should board and exit the bus in an organized manner allowing six feet spacing between students in the aisle.
  • Students should wash hands or use hand sanitizer after exiting the bus.
  • The bus should be cleaned after each trip, including seats, handles and windows.

What if my child becomes sick?

If your child becomes sick, you should notify your school so they can determine when your child can return to school and monitor your child’s class/cohort for signs of illness.

Do not send your child to school if he/she has any of the following:

  • Fever (100.4°F)
  • Coughing
  • Sneezing
  • Runny nose
  • Diarrhea
  • Vomiting
  • Headache
  • Sore throat
  • Is not well

What if someone in my child’s class gets sick?

Fortunately, studies have shown that children are less likely to spread the COVID-19 virus. Your school will inform you if any monitoring or change in school location needs to occur.

Should my children receive their vaccinations?

Children need to be protected against vaccine-preventable diseases. Check ups are essential services and help make sure children are protected. Children who are not protected by vaccines may be more likely to get diseases like measles and whooping cough.

As communities are opening up, it’s important for parents to work with their children’s doctor or nurse to make sure their children stay up to date on routine vaccines.

Feeding Solids

I am often asked about the right time to start introducing solids. It is recommended to start introducing solids between 4-6 months of age if your baby is developmentally ready. However, age alone cannot be the only indicator of whether or not your baby is ready to start solids. He or she also has to be developmentally ready; some of the developmental cues to look for to assess their readiness include: Do they sit up unsupported or with minimal support in a high chair? Do they have good head control? Are they bringing hands/toys to their mouths? Are they interested in food when other people are eating around them?

Once you determine whether or not your baby is developmentally ready for solids, you can start to offer infant purees (usually stage 1 baby foods or you can choose to make at home. Start by offering 1 tablespoon 1-2 times per day for play/exploration of these new foods and textures. If you notice they are turning their head away, pushing food out of their mouths or refusing to open their mouth, this could indicate that they’re not quite ready for solids. Stop for now and consider restarting in another few weeks or consult with your pediatrician.

When starting solids, you want to introduce one new food every 5 days to monitor for allergic reaction. Once your baby has had several different foods and tolerated them well without sign of reaction, you can start to combine foods to diversify flavors. Examples include pureed bananas mixed in oat cereal, sweet potatoes mixed with carrots, green beans and avocado, etc. By 6 months of age, it is also recommended to start introducing pureed meats, poultry and fish, as complementary foods, into your baby’s diet.

According to, “there is no evidence that waiting to introduce baby-safe (soft), allergy-causing foods, such as eggs, dairy (cheese or yogurt; no straight milk), soy, peanuts or fish, beyond 4 to 6 months of age prevents food allergy.” If you or a family member has a known food allergy or if you believe your child has an allergic reaction to a food (diarrhea, rash, vomiting) talk with your child’s healthcare provider. You can introduce peanut butter by thinning it out with breast milk or formula (to prevent choking) and mixing it into infant cereals or fruit purees. You can also puree a boiled egg (whole egg including yolk is great!), again, mixing with breast milk, formula or water and offering it to baby. Be sure to introduce all foods, especially high allergenic foods, every 3-5 days to allow time to monitor for allergic reaction.

Pickey Eaters!

Pediatric clinicians frequently encounter parents who express concern for a child who they describe as a “picky eater.” This complaint is often associated with children between 2 and 5 years of age.

If your child has a history of poor growth, you may be especially prone to hypervigilance regarding their eating, which can lead to stress and anxiety surrounding mealtimes. While there are some children that will require intervention, most parents can be reassured that their child is getting the nutrients they need to grow and thrive.

Portion sizes

The following portion size pictures may be helpful for parents of young children who are felt to be difficult or picky eaters.

sample portion sizes

Easy to chew proteins

Protein foods can be challenging for some kids in this age group. Foods that are easy to chew are good alternatives to more traditional options.


  • Scrambled
  • Poached
  • Soft boiled
  • Fried
  • Hard boiled, chopped or sliced
  • Egg salad


  • Cheese stick
  • Grated cheese
  • Melted cheese
  • High calorie yogurt
  • Whole milk
  • Sliced cheese – rolled, cut in strips or fun shapes
  • Cottage cheese
  • Cream cheese
  • Powdered milk
  • Yogurt (no fruit added)


  • Canned tuna or salmon
  • Flaky white fish or fish sticks
  • Crab meat – fresh or canned

Meat and poultry

  • Hot dogs – chopped, cut in long strips
  • Deli meats – thin slices, rolled, cut in strips
  • Breakfast sausage – chopped, cut in long strips
  • Bacon cooked crispy
  • Chicken nuggets or sticks
  • Cooked ground chicken
  • Turkey meatballs

toddler nutrition guide

General feeding guidelines

  1. Meals should be offered at 3-4 hour intervals with only water offered in between. Even small amounts of juice or milk can diminish appetite for the next meal.
  2. Offer your child 2-3 foods in small amounts that include at least two foods you know they have eaten happily in the past. If they don’t eat any of these, do not look for alternatives.
  3. Eat family meals whenever possible. Role modeling is probably the most powerful step you can take to help improve your child’s feeding behaviors.
  4. Your child should sit at the table whether or not they are eating for at least 15 minutes. Tell them that they need to wait until everyone else is finished.
  5. Do not pay attention to whether or not your child is eating consistently at mealtime. Do not cajole or plead with them to eat. No games (think airplane in the hangar) to get them to eat more.
  6. If your child does not eat anything after 15-20 minutes, they should be allowed to leave the table if the family meal is completed. Nothing should be offered until the next scheduled meal or snack. If they ask for food soon after the meal, tell them that the kitchen is closed for now and then remind them when the next meal or snack is.
  7. Be creative when it comes to foods offered at meal times. An example would be serving pancakes and eggs for dinner!
  8. Offer the highest calorie foods to your child first when they are most likely to eat them. Lower calorie foods such as fruits and vegetables can be offered towards the end of the meal.
  9. Aim for one or two good meals a day. If your child seems super hungry at snack time, make sure you offer them something substantial such as yogurt, cheese, or granola bar.

Feeding division of responsibility

It is your job to decide:

  • when your child will eat
  • what your child will be offered to eat
  • where they will eat

It is your child’s job to decide how much they will eat!

Visiting Grandparents?

We understand that these have been really challenging times for families and that it has been very hard for people to remain physically distanced from their loved ones during the pandemic. Many people are starting to question when it may be okay to have grandparents visit their grandchildren or to travel themselves to visit family members. While social distancing and isolation are crucial to controlling the spread of the COVID-19, we recognize that mental health and family relationships are also critical during this strange “new normal.”

Evaluate your risk factors and risk tolerance

There is no single answer, but here are some things to consider when evaluating your family’s risk factors and risk tolerance. Do the grandparents have high risk medical conditions? In general, the risk of getting very sick due to COVID-19 is higher in older people, but medical conditions such as lung disease, heart problems and diabetes can place people at higher risk for a more serious infection. Consider how well each family member has been socially distancing – have any family members still been working outside the home on a regular basis? Some jobs may be riskier than others (for example, healthcare and grocery store workers) due to how much contact they have with other (potentially sick) people.

If you do visit, reduce the risk

If you decide to visit with grandparents, some options for reducing risk of the visit could be:

  • Spend the visit outdoors (studies show that transmission of COVID-19 is significantly decreased outdoors compared to a closed indoor space).
  • Do not share utensils or a family style meal together.
  • Consider driving instead of flying and minimizing public rest-stops.
  • Consider traveling to the grandparents instead of grandparents traveling to you if air travel is required for the visit.
  • If possible, both the grandparents and the visiting family should be diligent about socially distancing for two weeks prior to the visit to reduce the risk of any member of the group acquiring and even unknowingly spreading COVID-19 infection.
  • Consider meeting somewhere geographically neutral if family members live in a high COVID-19 prevalence area.
  • Consider pre-visit testing if this is available in your area. The nasal PCR test can accurately identify active COVID-19 infection; but, so far, none of the antibody tests can reliably determine immunity or confirm past infection.

As we continue to learn more about this new virus, please note that the above guidance may change. Lastly, remember that frequent hand washing, wearing a mask, while in public, avoiding touching your face, social distancing and sanitizing high-touch surfaces remain critical to controlling viral spread.