Recurring stomach aches

Q: Nearly every morning lately our 4-year-old has a bad tummy ache (cramping pain), followed by painful diarrhea (usually after eating milk and cereal for breakfast). Then he’s fine for the rest of the day. Could he be lactose intolerant?

A: As strange as this may sound, some of this may just be a normal pattern for your child. Eating breakfast can stimulate a gastrocolic reflex that may be causing your son to have a bowel movement within several minutes of eating. 

In general, if your 4-year-old is just having the one bowel movement each day in the morning, there’s generally not much to worry about. 

If there’s a large amount of watery mucous or blood accompanying the bowel movement, that’s a much different story, even if it’s just once a day. 

If your child is having several bowel movements daily, each of which appears to be like diarrhea, that can be a sign that he or she needs an evaluation. 

Children can develop problems with issues like lactose intolerance, but it’s usually a gradual process and tends to run in families. Other causes of troublesome intestinal symptoms include gluten sensitivity (celiac disease), food (protein) allergies, fructose and other carbohydrate malabsorption and even parasites or bacterial overgrowth. 

Ruling out all the items on that list will definitely require a visit with your pediatric clinician with the possibility of additional testing. 

Thankfully, much more serious conditions or the need for a referral to a pediatric gastroenterologist are uncommon.