- Identify pathophysiology changes related to the age range and topic/disease.
The etiology of recurrent abdominal pain (RAP) in children is unclear. The diagnosis is established by presenting clinical features based on the Rome III criteria. Many pathophysiologic pathways have been suggested including altered gastrointestinal microbiota, mucosa or motility, altered immune system or central nervous system function, or visceral hypersensitivity (Newlove-Delgado et al., 2017). Psychosocial factors have also been implicated in the symptom cluster. The criteria for RAP is abdominal pain that occurs at least once per week for the last two months without indication of another condition which would explain the symptoms. Other symptoms are also associated with RAP in children including headache, anxiety and emotional disorders, trouble sleeping and limb pain. The abdominal pain may cause “some loss of daily functioning” and many children loose time spent in schooling or other activities (Rasquin et al., 2006).
- Identify how the changes might be affected by the integrative therapy you have chosen (research article).
Due to the implication of gastrointestinal microbiota in the pathophysiology of recurrent abdominal pain (RAP) in children, probiotics have been suggested as a dietary intervention that may improve pain symptoms. Probiotics contain living micro-organisms which alter the normal microbiota of the intestinal tract and may help manage a healthier gut. A systematic review found that there was an improvement in pain, a reduction in pain frequency and decrease in pain intensity in children who were taking probiotics (Newlove-Delgado et al., 2017).
- Identify the possible ethical and legal issues with the chosen integrative therapy specifically for this population.
Children are a vulnerable population and must be protected. They are unable to give informed consent and their guardian is consenting to the intervention on their behalf. In the case of probiotics, this is mitigated by there being minimal risks to the participants as “no major adverse events were reported” in any of the studies evaluated in the systematic review (Newlove-Delgado et al., 2017). Probiotics are also not controlled by the Food and Drug Administration (FDA) and are not regulated in formulation or dosage. Guardians who buy probiotics for their children also incur the full cost of the supplement as many times probiotics are not covered by health insurance.
Newlove-Delgado, T. V., Martin, A. E., Abbott, R. A., Bethel, A., Thompson-Coon, J., Whear, R., & Logan, S. (2017). Dietary interventions for recurrent abdominal pain in childhood. The Cochrane Database of Systematic Reviews, 3, CD010972. https://doi.org/10.1002/14651858.CD010972.pub2
Rasquin, A., Di Lorenzo, C., Forbes, D., Guiraldes, E., Hyams, J. S., Staiano, A., & Walker, L. S. (2006). Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology, 130(5), 1527–1537. https://doi.org/10.1053/j.gastro.2005.08.063