Dr Phil Kieran: My daughter complains of tummy pain — could she be a coeliac?

I get some variation of this question at least once a week in my surgery. It is something many parents struggle with and worry about. There can be many causes of tummy pain in children and, while we don’t want to over-medicalise it, we all worry about ignoring something serious.

It is helpful that you narrowed down the triggers and have found that stopping toast in the morning is easing your daughter’s pain. This would certainly make me wonder about coeliac disease, but before we jump to that conclusion, there are some more common causes of tummy pain I would want to explore.

Constipation is one of the most likely causes of tummy pain in children and is where I would start in this case. Does the child have a normal bowel movement every day? A normal bowel movement should pass easily and be the consistency of toothpaste or soft ice cream (apologies if I have turned anyone off brushing their teeth or favourite dessert).

Many children either do not have a daily bowel movement or pass small hard stools, leading to recurring tummy pain, which is often worst after eating. This pattern can falsely make you think that a specific food is causing the symptoms. If constipation is the cause, try to ensure your child is eating enough fibre in fruit and veg (more so veg than fruit — bananas particularly can worsen constipation) and drinking plenty of water. If this isn’t the cause, we look at the next most common issue.

Stress or anxiety in children can manifest as stomach pain. If you notice your child is getting tummy pain at specific times (like during the school week but not weekends or holidays), it is crucial to explore if they are worried about anything. I would recommend not asking the child outright if the tummy pain is caused by worry, but to mention it as an aside if you notice this pattern.

If neither pattern exists, we need to consider coeliac disease. I would be looking to see if all sources of gluten cause symptoms rather than just the morning toast. If the child can eat pasta or cake without difficulty, the toast is almost certainly a red herring. Other signs of coeliac are irregularity with the bowel, struggling to gain weight, or pallor. If testing for coeliac disease, do not exclude gluten for the six weeks before the test, as this can give a false negative.

On the whole, abdominal pain in children can be a tricky one to solve, but coeliac disease is worth considering, particularly if they can’t tolerate any gluten-containing foods.

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