Selected Podcast
How the Mind-Gut Connection Can Affect Abdominal Pain in Children
Dr. Rina Sanghavi shares valuable information about how experts at Children’s Health take the mind-gut connection into consideration when it comes to diagnosing abdominal pain in pediatric patients.
Featured Speaker:
Dr. Sanghavi earned her medical degree from Seth G.S. Medical College in Mumbai, India. She completed a pediatrics residency at SUNY Downstate Medical Center in New York City and a pediatric gastroenterology fellowship at Children's Medical Center Dallas. In addition, she has trained in GI motility at Boston Children’s, Nationwide Children’s and at Cincinnati Childrens.
"I enjoy being able to make a difference in the lives of young children and then see that life blossom into an adult that makes a difference in society and our world," Dr. Sanghavi says.
Dr. Sanghavi was named a “Mom-Approved Doctor” by DFWChild in 2012, 2014 and 2016.
She enjoys spending her free time volunteering at school, dancing and with her 2 young children.
Rina Sanghavi, MD
Rinarani Sanghavi, M.D., is the director of the Neurogastroenterology and GI motility program and co-director of the Functional Abdominal Pain and the Pediatric Aerodigestive programs at Children’s Health℠. She is a pediatric gastroenterologist who specializes in pediatric GI motility, neurogastroenterology, aerodigestive disorders, abdominal pain, anorectal malformations and bowel management. Additionally, she was the first to place a gastric stimulator in a pediatric patient in North Texas.Dr. Sanghavi earned her medical degree from Seth G.S. Medical College in Mumbai, India. She completed a pediatrics residency at SUNY Downstate Medical Center in New York City and a pediatric gastroenterology fellowship at Children's Medical Center Dallas. In addition, she has trained in GI motility at Boston Children’s, Nationwide Children’s and at Cincinnati Childrens.
"I enjoy being able to make a difference in the lives of young children and then see that life blossom into an adult that makes a difference in society and our world," Dr. Sanghavi says.
Dr. Sanghavi was named a “Mom-Approved Doctor” by DFWChild in 2012, 2014 and 2016.
She enjoys spending her free time volunteering at school, dancing and with her 2 young children.
Transcription:
Caitlin Whyte: Welcome, and thanks for joining us for Pediatric Insights, Advances, and Innovations with Children's Health. I'm your host, Caitlin Whyte. Today, we're talking about how the mind gut connection can effect abdominal pain in children. We talk about just what this means and how it can help in diagnosing children. To help us out today, we have Dr. Rina Sanghavi. She is the Director of the Neuro Gastroenterology and GI Motility Program and the Co-Director of the Functional Abdominal Pain Program at Children's Health, as well as an Associate Professor at UT Southwestern. First, Dr. Sanghavi, can you explain what the mind gut connection is for those of us who don't know?
Dr. Sanghavi: So, the mind gut connection is simply a way of saying that the brain and the intestine are in constant communication with each other and changes in one will affect the other one. A great example of this is when you are super excited, think back to your wedding day or to graduation day, we all had butterflies in our stomach, and that's a result of the mind gut connection. Now, this connection has pathways that have been studied. In fact, recently in the last few years, scientists actually found specific cells that communicate messages back and forth between the brain and the gut. But these are not messages that you're consciously aware of, which means that you're not consciously aware of, Hey, I'm digesting food. Look, I'm creating poop now. And if those messages do reach brain on a conscious level, the brain will immediately send a message down to the gut that says, stop, be quiet. I don't care. Good to know, but just do your job. But the connection between the two is what will change, when one or the other stress, the messaging and the signaling that goes between the brain and the gut. So it will inevitably affect the other one.
Host: And how can this mind gut connection affect abdominal pain in children?
Dr. Sanghavi: The way it affects abdominal pain in children is through a more broader term that we call irritable bowel syndrome, but you don't necessarily even have to have a diagnosis of irritable bowel syndrome, which is going back to my example that I gave on your excited and you get butterflies in your stomach, or you're nervous, and you feel like you're going to throw up. So the way it affects it is for children who have irritable bowel syndrome, unnecessarily normal body function signals are constantly reaching the brain. And number two, the brain is not sending those stop. Be quiet signals down to the gut. So in these children, think of it as constant static noise coming from your gut to the brain. And you add to it, any kind of stress. For example, I'm worried I have to go back to school or I'm so worried I have an exam and I think I'm not going to do well.
Any of this is going to make that static noise go all the way to radio volume of 10 out of 10. This makes the brain react as if you were in a fight or flight situation, which means something's bad going to happen. And the brain sends messages that release a whole lot of hormones down to the gut. Some of these hormones speed up the intestine. Other hormones will slow down the intestine. And so you have this mismatch between some parts of my intestine are quick, and some parts are slow, which in itself can cause belly pain. So think about this in terms of anxiety, when your brain has a lot of anxiety, so stress on your brain, and that causes the brain to send signals down to the gut that will make that radio volume go all the way to a level 10 out of 10. Which in turn is going to cause belly pain, usually can be associated either with constipation or with diarrhea or a combination of the two.
Host: And then where does this connection come into play when it comes to diagnosing patients with abdominal pain?
Dr. Sanghavi: So, I think this connection is actually very important for physicians to address when they are dealing with children with abdominal pain, especially longstanding abdominal pain, where all the tests have shown that there is structurally nothing wrong with the intestine. So understanding what is it that is causing the brain to get stressed out is an important part of understanding why there is ongoing abdominal pain and then treating that's stress on the brain is also going to help relieve the abdominal pain. I also want to make sure that physicians keep in mind that stress can also come from the gut. Sometimes the most common type of stress that I have seen is that children are constipated. And as a result of that, their mood changes. We see this specifically in our autistic children who, when they're constipated, they're much more angry and behaviorally difficult to control. And when we control their constipation, their behavior improves quite a bit. So understanding this connection and dealing with it from both ends, the gut as well as the brain, is really important to help move forward in both diagnosis and treatment of abdominal pain.
Host: So, what other factors do you consider when diagnosing patients with this abdominal pain?
Dr. Sanghavi: Several things. Number one, I'd like to see how long the pain has been going on for and how intense the pain has been? So someone says their been has been going on for years, and it has been very intense. Let's say a 10 out of 10 for many years, that sort of gives us a clue that there may be something related to the brain gut connection going on because the only other place where you would get a 10 out of 10 belly pain is when something is really surgically wrong with your gut. And again, to have been ongoing for so many years, without it leading to a surgical emergency is unheard of. So that is one of the things we certainly like to keep in mind. And then a lot of other things, what else has been going around with the children in terms of their social situations, either at home, at school. Has it been something as insidious as we moved to a different house, and the child is without realizing it is missing an old neighborhood or an old bedroom. But we really try to look at all of these different things, how long it's been going for, and what are the other factors that are in play in the child's life when we're diagnosing this.
Host: Now children, as well as adults are facing many unknowns due to COVID-19, how does this worry and anxiety translate to abdominal pain in kids? And what advice do you have for providers during this time?
Dr. Sanghavi: I certainly think that these are unusual times and our children, even though they outwardly might seem like they're coping very well, are anxious. And there are children who are anxious, both ways. Some of them are very anxious about going back to school because of the whole unknown of am I going to get COVID and they've all heard that COVID is something really bad. Some children on the other hand are very anxious because they are worried that they will not be able to go back to school and they miss their friends and their social gatherings, and that in itself causes anxiety in them. So I think it's very important for adults and whether it is the parent, the teacher, or the physician, to be aware of what kind of personality the child has? And try and specifically tease out what is it about COVID that the child is anxious about?
Is it not being able to see their friends, or is it the fear of getting really sick? A lot of times it would be both, but you've got to figure out which one is the dominant one and then addressing that fear, which means you don't minimize it. You don't say, yeah, that's nothing nothing's going to happen to you, validate it, address it and talk through all the possible scenarios. Usually something that helps the child a whole lot. And then again, from the gut standpoint, a lot of children who have been home during quarantine have not had the chance to really be physically active or have really fallen off the tracks, so to say, in terms of their good diet, and these children may be constipated. So keeping that in mind as well, making sure that they have regular bowel movements is something else that had like physicians and parents to be aware of.
Host: Dr. Sanghavi, is there anything else that you would like to share with other providers when it comes to the mind gut connection and abdominal pain in pediatric patients?
Dr. Sanghavi: I would say that it is very, very under-recognized, but it's also somehow become a taboo topic, which means a lot of parents will immediately say, well, it's not in his head or it's not in her head. And I think it's important for the parent, as well as the physician to realize that we're not saying that the pain is made up, the pain is absolutely real. It's almost like having a migraine headache. You can have a migraine headache and do an MRI on your head. And by all means, it's going to be normal because it's not a change in the structure. It's a change in the sort of subtle functioning in the body. So, so I think I'd like both parents and physicians to be aware that this anxiety and or stress of different situations, usually plays a big role in the mind gut connection and plays a big role in longstanding abdominal pain. And that's the one subject I see that most physician and parents are least excited about talking about. So everybody tries to avoid this topic, but I think thinking about this, talking about this and addressing it is really the key to helping the child move on.
And by addressing it, I want to make sure I also emphasize we don't want them to avoid it. So a lot of parents will come to me and say, well, my child is worried about going to school. Some just not going to let them go to school and that's not what we want to teach our children. So the second thing I want our parents and physicians to know is if you find out what it is that's stressing them out, help the children work through it and move forward with continuing to do the activity they need to do, rather than helping them avoid the activity. We have a clinic at Children's Health, Children's Medical Center of Dallas, where we deal with second and third opinions of children who have had long-standing abdominal pain. And we have a multidisciplinary team of physicians and healthcare practitioners who really get down to the bottom of what is it that's causing the pain, and help our children feel better.
Host: Well, thank you so much for your time, Dr. Sanghavi it's always a great reminder to remember just how in tune and connected our bodies are. And thank you for listening to Pediatric Insights, Advances and Innovations with Children's Health. Find more information about everything we discussed today at children's.com/GI. I'm your host, Caitlin Whyte, stay well.
Caitlin Whyte: Welcome, and thanks for joining us for Pediatric Insights, Advances, and Innovations with Children's Health. I'm your host, Caitlin Whyte. Today, we're talking about how the mind gut connection can effect abdominal pain in children. We talk about just what this means and how it can help in diagnosing children. To help us out today, we have Dr. Rina Sanghavi. She is the Director of the Neuro Gastroenterology and GI Motility Program and the Co-Director of the Functional Abdominal Pain Program at Children's Health, as well as an Associate Professor at UT Southwestern. First, Dr. Sanghavi, can you explain what the mind gut connection is for those of us who don't know?
Dr. Sanghavi: So, the mind gut connection is simply a way of saying that the brain and the intestine are in constant communication with each other and changes in one will affect the other one. A great example of this is when you are super excited, think back to your wedding day or to graduation day, we all had butterflies in our stomach, and that's a result of the mind gut connection. Now, this connection has pathways that have been studied. In fact, recently in the last few years, scientists actually found specific cells that communicate messages back and forth between the brain and the gut. But these are not messages that you're consciously aware of, which means that you're not consciously aware of, Hey, I'm digesting food. Look, I'm creating poop now. And if those messages do reach brain on a conscious level, the brain will immediately send a message down to the gut that says, stop, be quiet. I don't care. Good to know, but just do your job. But the connection between the two is what will change, when one or the other stress, the messaging and the signaling that goes between the brain and the gut. So it will inevitably affect the other one.
Host: And how can this mind gut connection affect abdominal pain in children?
Dr. Sanghavi: The way it affects abdominal pain in children is through a more broader term that we call irritable bowel syndrome, but you don't necessarily even have to have a diagnosis of irritable bowel syndrome, which is going back to my example that I gave on your excited and you get butterflies in your stomach, or you're nervous, and you feel like you're going to throw up. So the way it affects it is for children who have irritable bowel syndrome, unnecessarily normal body function signals are constantly reaching the brain. And number two, the brain is not sending those stop. Be quiet signals down to the gut. So in these children, think of it as constant static noise coming from your gut to the brain. And you add to it, any kind of stress. For example, I'm worried I have to go back to school or I'm so worried I have an exam and I think I'm not going to do well.
Any of this is going to make that static noise go all the way to radio volume of 10 out of 10. This makes the brain react as if you were in a fight or flight situation, which means something's bad going to happen. And the brain sends messages that release a whole lot of hormones down to the gut. Some of these hormones speed up the intestine. Other hormones will slow down the intestine. And so you have this mismatch between some parts of my intestine are quick, and some parts are slow, which in itself can cause belly pain. So think about this in terms of anxiety, when your brain has a lot of anxiety, so stress on your brain, and that causes the brain to send signals down to the gut that will make that radio volume go all the way to a level 10 out of 10. Which in turn is going to cause belly pain, usually can be associated either with constipation or with diarrhea or a combination of the two.
Host: And then where does this connection come into play when it comes to diagnosing patients with abdominal pain?
Dr. Sanghavi: So, I think this connection is actually very important for physicians to address when they are dealing with children with abdominal pain, especially longstanding abdominal pain, where all the tests have shown that there is structurally nothing wrong with the intestine. So understanding what is it that is causing the brain to get stressed out is an important part of understanding why there is ongoing abdominal pain and then treating that's stress on the brain is also going to help relieve the abdominal pain. I also want to make sure that physicians keep in mind that stress can also come from the gut. Sometimes the most common type of stress that I have seen is that children are constipated. And as a result of that, their mood changes. We see this specifically in our autistic children who, when they're constipated, they're much more angry and behaviorally difficult to control. And when we control their constipation, their behavior improves quite a bit. So understanding this connection and dealing with it from both ends, the gut as well as the brain, is really important to help move forward in both diagnosis and treatment of abdominal pain.
Host: So, what other factors do you consider when diagnosing patients with this abdominal pain?
Dr. Sanghavi: Several things. Number one, I'd like to see how long the pain has been going on for and how intense the pain has been? So someone says their been has been going on for years, and it has been very intense. Let's say a 10 out of 10 for many years, that sort of gives us a clue that there may be something related to the brain gut connection going on because the only other place where you would get a 10 out of 10 belly pain is when something is really surgically wrong with your gut. And again, to have been ongoing for so many years, without it leading to a surgical emergency is unheard of. So that is one of the things we certainly like to keep in mind. And then a lot of other things, what else has been going around with the children in terms of their social situations, either at home, at school. Has it been something as insidious as we moved to a different house, and the child is without realizing it is missing an old neighborhood or an old bedroom. But we really try to look at all of these different things, how long it's been going for, and what are the other factors that are in play in the child's life when we're diagnosing this.
Host: Now children, as well as adults are facing many unknowns due to COVID-19, how does this worry and anxiety translate to abdominal pain in kids? And what advice do you have for providers during this time?
Dr. Sanghavi: I certainly think that these are unusual times and our children, even though they outwardly might seem like they're coping very well, are anxious. And there are children who are anxious, both ways. Some of them are very anxious about going back to school because of the whole unknown of am I going to get COVID and they've all heard that COVID is something really bad. Some children on the other hand are very anxious because they are worried that they will not be able to go back to school and they miss their friends and their social gatherings, and that in itself causes anxiety in them. So I think it's very important for adults and whether it is the parent, the teacher, or the physician, to be aware of what kind of personality the child has? And try and specifically tease out what is it about COVID that the child is anxious about?
Is it not being able to see their friends, or is it the fear of getting really sick? A lot of times it would be both, but you've got to figure out which one is the dominant one and then addressing that fear, which means you don't minimize it. You don't say, yeah, that's nothing nothing's going to happen to you, validate it, address it and talk through all the possible scenarios. Usually something that helps the child a whole lot. And then again, from the gut standpoint, a lot of children who have been home during quarantine have not had the chance to really be physically active or have really fallen off the tracks, so to say, in terms of their good diet, and these children may be constipated. So keeping that in mind as well, making sure that they have regular bowel movements is something else that had like physicians and parents to be aware of.
Host: Dr. Sanghavi, is there anything else that you would like to share with other providers when it comes to the mind gut connection and abdominal pain in pediatric patients?
Dr. Sanghavi: I would say that it is very, very under-recognized, but it's also somehow become a taboo topic, which means a lot of parents will immediately say, well, it's not in his head or it's not in her head. And I think it's important for the parent, as well as the physician to realize that we're not saying that the pain is made up, the pain is absolutely real. It's almost like having a migraine headache. You can have a migraine headache and do an MRI on your head. And by all means, it's going to be normal because it's not a change in the structure. It's a change in the sort of subtle functioning in the body. So, so I think I'd like both parents and physicians to be aware that this anxiety and or stress of different situations, usually plays a big role in the mind gut connection and plays a big role in longstanding abdominal pain. And that's the one subject I see that most physician and parents are least excited about talking about. So everybody tries to avoid this topic, but I think thinking about this, talking about this and addressing it is really the key to helping the child move on.
And by addressing it, I want to make sure I also emphasize we don't want them to avoid it. So a lot of parents will come to me and say, well, my child is worried about going to school. Some just not going to let them go to school and that's not what we want to teach our children. So the second thing I want our parents and physicians to know is if you find out what it is that's stressing them out, help the children work through it and move forward with continuing to do the activity they need to do, rather than helping them avoid the activity. We have a clinic at Children's Health, Children's Medical Center of Dallas, where we deal with second and third opinions of children who have had long-standing abdominal pain. And we have a multidisciplinary team of physicians and healthcare practitioners who really get down to the bottom of what is it that's causing the pain, and help our children feel better.
Host: Well, thank you so much for your time, Dr. Sanghavi it's always a great reminder to remember just how in tune and connected our bodies are. And thank you for listening to Pediatric Insights, Advances and Innovations with Children's Health. Find more information about everything we discussed today at children's.com/GI. I'm your host, Caitlin Whyte, stay well.