Treatment Plans
Evidence-based management protocols including pharmacological and non-pharmacological interventions, dietary advice, follow-up schedules, and referral criteria.
Pharmacological Management
| Drug | Dose | Duration | Notes |
|---|---|---|---|
| Hyoscine butylbromide | 10mg TDS (>6 years) | 2-4 weeks trial | First-line antispasmodic |
| Peppermint oil capsules | 187mg TDS (>8 years) | 2-4 weeks | For IBS symptoms |
| Amitriptyline | 10-20mg nocte | 3-6 months | Low-dose TCA for refractory cases |
| Probiotics (Lactobacillus GG) | 10⁹-10¹⁰ CFU daily | 4-8 weeks | Especially for IBS |
Non-Pharmacological Interventions
- Cognitive Behavioral Therapy (CBT)
- Gut-directed hypnotherapy
- Relaxation techniques and guided imagery
- Regular physical activity
- Maintain normal school attendance
- Symptom diary to identify triggers
Dietary Advice
- Low FODMAP diet trial (6-8 weeks) for IBS
- Adequate fiber intake (age + 5g/day)
- Regular meal times
- Adequate hydration
- Limit carbonated drinks and caffeine
- Consider lactose-free trial if symptoms suggest intolerance
Follow-up
Review in 2-4 weeks. If no improvement after 8 weeks of multimodal therapy, consider referral to pediatric gastroenterologist.
Referral Criteria
- Failure to respond to 8 weeks of treatment
- Diagnostic uncertainty
- Significant school absence (>2 weeks)
- Severe psychological comorbidity
Key Patient Education Points
- Functional pain is REAL pain - it is not imagined or 'in their head'
- The gut-brain connection explains why stress worsens symptoms
- Goal is return to normal function, not necessarily complete pain elimination
- Reassurance: functional pain does NOT indicate serious disease
- Most children improve with time and appropriate management
- Avoid reinforcing sick role - encourage normal activities
Note: Drug doses are guidelines only. Always verify doses using local formulary (e.g., BNF for Children) and adjust for individual patient factors including weight, renal/hepatic function, and drug interactions. Source: DynaMed Evidence-Based Guidelines.