The appearance of persistent and long-term symptoms from the digestive system in children is one of the most frequent reasons for seeking medical attention, both from the general pediatrician and from the specialized pediatric gastroenterologist.

These symptoms can be due to various and sometimes serious, organic diseases. Nevertheless, in daily practice, the great majority of these symptoms do not have an organic etiology. In the cases of these children, the most frequent reason for visiting and seeking medical care is functional digestive disorders.

What are functional disorders?

The term “functional”, derived from a translation of the English term “functional”, indicates situations in which there is no underlying organic disease of the digestive system, that is, the gastrointestinal system of these children is not “sick”, does not “suffer”. The etiology of the symptoms in these children has not yet been fully explained. The most widespread theory supports the bio-psycho-social model, in which the brain-gut axis is involved, with a dominant role. This interpretation is not unknown in Greek reality, as the Greek language is full of expressions that connect emotion and the psyche in general, with digestive symptoms: “I have a tightness in my stomach”, “I have a knot in my throat”, “I can’t to digest it with nothing.” Folk experience and wisdom, then, has recognized for centuries the correlation between brain and gut.

An image of the frequency of these conditions in the general population in Greece can be obtained from a study by the School of Medicine of the University of Athens. It was found that approximately one in four children aged 6-18 show, at times, symptoms of a functional disorder. As the nature of these conditions is often long-term, a significant proportion of these families will seek pediatric gastrointestinal consultation, making them by far the most common conditions in the pediatric gastrointestinal practice and one of the most common conditions in pediatrics overall.

The list of functional disorders is extensive and includes 7 conditions in infants and 12 in children and adolescents. Let’s briefly look at the most typical and frequent of them:

Functional abdominal pain

It occurs most often in children aged 3-10 years. Children locate the discomfort around the navel and often use words like “tightness”, “heaviness”, “loud gurgling”. The appearance of the discomfort does not appear at certain times of the day, is not associated with meals and can last from a few seconds to hours. There is variation in symptoms and days of severe discomfort may alternate with long periods without symptoms.

Functional nausea

It usually manifests itself after the age of 6, until puberty. It is characterized by a strong tendency to vomit, i.e. nausea which, however, will rarely be accompanied by actual vomiting. Children say they are “messed up” and many times, especially teenagers try to vomit to relieve themselves, to no avail. It is more intense in the morning and evening hours. Many of these children get “dizzy” easily on car trips.

Functional constipation

It usually concerns children from 1 to 5 years old. In these cases there is a voluntary inhibition of bowel movement (small children “hold their poo”) due to fear that comes from a previous painful bowel movement. This sets off a vicious cycle of fear-inhibition-dehydrated/hard stools-painful bowel movement and perpetuation of fear, which can be long-lasting if medical intervention is not provided.

Functional disorders are characterized by their long-term nature, the absence of other symptoms and the child’s normal growth and development. As they are not organic diseases, they do not present a risk of complications and long-term consequences. Nevertheless, they can have serious consequences on the quality of life of the child and the family, as they lead to increased intra-family stress, disruption of normal daily life with absences from school and other activities and inevitably multiple medical visits. For these reasons, advice from a specialized pediatric gastroenterologist is necessary, on the one hand, because it will confirm the benign nature of the symptoms and the absence of organic disease, and on the other hand, to reassure the parents and to discuss the real causes and possible interventions, which will relieve the children and the family.