Clinical Hypnosis for Pediatric Gastrointestinal Disorders: A Practical Guide for Clinicians.

Functional abdominal pain disorders (FAPDs) are common in the pediatric population and are associated with a significant reduction in quality of life. Bidirectional communication of the brain-gut axis plays an important role in pain generation and perception in FAPDs. There is a paucity of data on the best approach to treat this group of disorders, with no Food and Drug Administration (FDA)-approved drugs and scarce research to substantiate the use of most medications. Use of hypnosis in pediatric FAPDs is supported by evidence and has long-term benefits of up to at least 5 years beyond completion of treatment, highlighting the importance of incorporating this therapy into the care of these patients. The mechanisms by which clinical hypnosis is beneficial in the treatment of FAPDs is not completely understood, but there is growing evidence that it impacts functioning of the brain-gut axis, potentially through influence on central pain processing, visceral sensitivity, and motility. The lack of side effects or potential for significant harm and low cost makes it an attractive option compared to pharmacologic therapies. This review addresses current barriers to clinical hypnosis including misconceptions among patients and families, lack of trained clinicians, and questions around insurance reimbursement. The recent use of telemedicine and delivery of hypnosis via audio-visual modalities allow more patients to benefit from this treatment. As the evidence base for hypnosis grows, acceptance and training will likely increase as well. Further research is needed to understand how hypnosis works and to develop tools that predict who is most likely to respond to hypnosis. Studies on cost-effectiveness in comparing hypnosis to other therapies for FAPDs will increase evidence for appropriate healthcare utilization. Because hypnosis has applications beyond pain and is child-friendly with minimal to no risk, hypnosis could be an important therapeutic tool in the wider pediatric gastrointestinal population.

Electrodermal Activity of Auricular Acupoints in Pediatric Patients With Functional Abdominal Pain Disorders.

OBJECTIVES: Functional abdominal pain disorders (FAPD) affect approximately 13.5% of children. Pharmacotherapy is often ineffective, leaving providers, and families seeking adjunctive therapies. Auriculotherapy provides treatment for pain and other symptoms, without a defined protocol for FAPD. A handheld point-finder device measuring transdermal electrical current determines active acupoints, with a higher current indicating a more active acupoint. Our objectives were to determine auricular acupoint (AA) activity in FAPD and to assess participants' attitudes towards auriculotherapy. METHODS: This is a prospective double-blind study evaluating the electrodermal activity of AAs in pediatric-aged female participants with FAPD compared to healthy controls (HC). Participants completed surveys regarding demographics and interest in auriculotherapy. The electrodermal assessment evaluated 20 AAs per ear using a point-finder device. Each AA current measurement was analyzed by average relative rank and median, with a median current measurement ≥50 µA considered active. RESULTS: We enrolled 46 female participants, 22 FAPD (mean age 15.8 years) and 24 HC (mean age 15.4 years). In FAPD, 12 of 40 AAs were active, of which only six were also active in HC. Comparison of median current and average ranking between participants demonstrated consistency. In the post-assessment survey, 86.4% of FAPD expressed interest in receiving auricular acupressure and 68.2% would travel to the clinic solely for treatment. CONCLUSIONS: Based on electrodermal measurements, we propose a treatment protocol using auriculotherapy for FAPD symptom-management. We demonstrated there is considerable patient interest in auriculotherapy. Further studies are needed to confirm the findings in a larger sample size and validate the efficacy of this treatment protocol.

A Case Series of New-Onset Ulcerative Colitis Following Recent Diagnosis of COVID-19.

There have been only 2 reported cases of new-onset ulcerative colitis in pediatrics following acute coronavirus disease 2019 (COVID-19). We are reporting a case series of 3 adolescent female patients, 2 of whom were vaccinated against COVID-19, who developed new-onset ulcerative colitis following a recent diagnosis of COVID-19 infections at a singular pediatric hospital. This case series should be an impetus to clinicians who have pediatric patients with persistent symptoms of hematochezia, diarrhea, and abdominal pain following acute COVID-19 infection to consider further workup for inflammatory bowel disease.

Non-pharmacologic approach to pediatric constipation.

Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.