“Our 9-year-old was diagnosed with autism when he was about 3 years old. While he receives speech therapy, occupational therapy and applied behavior analysis, we have not seen any improvement in his gut issues. Ever since he’s been an infant, he has had severe abdominal/gastric pain. Most days, he cries and throws tantrums like rolling on the floor, trying to bite, etc. We are vegetarians and have tried a gluten-free casein-free diet. But it has not helped. It is not only some type of foods that cause his problem, but also if he eats too much. We are at our nerve's end trying to figure out how to help him.”
Today’s “Got Questions?” answer is from gastroenterologist Tim Buie. Dr. Buie practices at Massachusetts General Hospital’s Lurie Center for Autism. The center is one of 14 sites in the Autism Speaks Autism Treatment Network (ATN).
Editor’s note: The following information is not meant to diagnose or treat and should not take the place of consultation, as appropriate, with a qualified healthcare professional.
I am so sorry for your son’s discomfort. But it’s good that he’s able to communicate his pain to you. Many of the behaviors you describe – including tantrums and rolling on the floor – can be signs of belly pain, particularly when you observe them after a child eats.
Before discussing possible causes and suggestions, I want to emphasize that it’s important for you seek a full medical evaluation of your son’s GI pain. It may help to further explore his eating patterns and their relationship to the pain you describe. If your son’s current doctor is reluctant to work with you, I recommend a seeing pediatric gastroenterologist. Ideally, you want to see someone familiar with autism.
One place to find GI specialists familiar with autism is within the Autism Speaks ATN.
Find the nearest ATN center here.
Here are some possible causes and solutions that you and the doctor can explore:
Constipation – and accompanying belly pain – is particularly common among people who have autism. Eating stimulates the colon to contract. That’s one of the reasons we often see increased cramping after meals when someone is constipated. While it’s understandable to try to identify what particular foods trigger the pain, in these situations, the trigger is simply eating.
Does your son pass stools infrequently or pass hard, pellet-like stools? In my practice, I also see children who regularly pass stool, but fail to complete the bowel movement. Here again, the unpassed stool can build up and produce gas pain and a bloated belly.
I recommend that your son receive a thorough examination for constipation, perhaps even an X-ray to look for hard, unpassed stools in his colon. The good news is there are many helpful treatment strategies for chronic constipation.
Acid reflux is another common cause of belly pain in people who have autism. It tends to occur after meals, when stomach acid backs up into the esophagus, or swallowing tube. I recommend asking your son’s doctor to evaluate him for reflux in the context of other symptoms and possibly conduct a trial treatment to see if he responds.
The most common treatments for acid reflux are antacids. It’s important that the doctor calculate the proper dose based on your son’s weight. This often reduces regurgitation, vomiting and spitting up as well. However, in some patients with reflux, there is a problem with the mechanical emptying of the esophagus and the stomach. Antacids don’t help with these issues. In such situations, expert treatment may need focus on the physical problem. In addition, smaller more frequent meals may help.
Gastritis, or irritation of the stomach, is a possible culprit if even small quantities of foods cause belly pain. In this case, the stomach acid produced when your son eats is irritating the lining of his stomach. Sometimes, gastritis pain worsens when the stomach gets stretched after meals. In this case, the pain may indeed be greatest after a larger than typical meal.
As with reflux, an antacid may bring relief. But it’s not a long-term solution. Rather, if the antacid helps and reflux has been ruled out, the doctor may want to order a stool test for Helicobacter pylori. Certain strains of this bacterium cause gastritis. If the test comes back positive, the doctor may prescribe the antibiotic regimen that’s been developed to clear this bug.
Delayed stomach emptying is yet another cause of uncomfortable bloating, or distention of the stomach. Because the food isn’t passing out of the stomach as promptly as it should, the stomach overfills. Over the course of the day, additional food can make the distension and pain get worse. We don’t fully understand what causes delayed stomach emptying. It likely involves the nervous system. The good news is there are medicines that can help. Often times, the way to diagnose this condition is to try one of these medicines and see if it solves or eases the pain.
Still other times, incomplete digestion can produce painful gassiness and bloating. You mention that certain types of food trigger your son’s pain. Common culprits include complex carbohydrates such as those in beans and raw vegetables.
If you think certain foods are the problem, I recommend discussing your son’s diet with a dietician. I think it’s especially important to get professional advice as your son’s diet may already be somewhat narrowed by your vegetarian restrictions. The nutrition expert can also discuss digestive aids (natural enzymes) and probiotics, which in some cases help with carbohydrate digestion.
Thanks again for your question. Please let us know how you and your son are doing in the comment section below or by emailing us again at GotQuestions@AutismSpeaks.org.
Also see these “Office Hours” video segments with Dr. Buie: