A frightened 10-year old tugs at your sheets as tears stream down her face. "My tummy hurts and I can't get back to sleep."

It's going to be a long night.

Actually, it's happened before - many times in fact, and tonight is no exception. Unfortunately there doesn't seem to be a workable solution either. Despite a battery of negative tests and multiple medications, the pain, tears and the anxiety persist.

This condition is called "recurrent abdominal pain" (RAP) and it typically affects approximately 5% of children. Actually this may represent a gross underestimation. Extraordinarily difficult to treat, the condition often evolves into an ongoing source of frustration for kids, their parents and physicians. Frequently associated with cramps and bloating, symptoms can increase in frequency to the point of daily occurrence. While lactose intolerance, gastroesophageal reflux (heartburn in adults) and constipation are known causes, the underlying basis for these symptoms is unknown in approximately 50% of sufferers. Many experts agree, however, that stress may play a significant role as one elusive factor.

This is not surprising for as RAP worsens, heightened stress typically ensues and everything seems to fall apart - schoolwork, homework, extracurricular activities and social interactions. After multiple sleepless nights, parental frustration approaches the breaking point. When trial after trial of medication fails, and each new consultation leads to a dead end, a depressing sense of hopelessness sets in.

Yet there is promising news!

Research in progress is suggesting a rational solution that works for many children - without side effects! A medical team at the University of Arizona is currently studying this problem. Funded by a $5 million grant from the National Institutes of Health (NIH), investigators at the Children’s Research Center are testing the use of guided imagery and visualization techniques for the treatment of RAP.

Their initial success isn’t surprising considering the fact that imagery techniques have been clearly shown to help people cope with and reduce pain. A number of research investigations have already validated this approach in various patient populations including children with postoperative pain (Journal of Developmental and Behavioral Pediatrics – October 1996), and adults with pain associated with cancer (Pain – November 1995).

The Arizona research team provides each child with 4 instructional sessions covering deep-breathing relaxation techniques or guided imagery with muscle relaxation. With the primary goal of preventing pain, children are instructed to practice twice daily. They also learn to utilize these techniques during painful or stressful periods. Each child maintains a log which is carefully reviewed by the investigators.

Many clinicians have discovered that the majority of children tend to accept this approach without resistance. To a child, guided imagery is simply a natural extension of play or story telling. Since one's ability to exercise his/her imagination is key, kids are actually more likely to achieve better results than adults.

As a neurologist, I've referred a number of children with RAP to our counselors for guided imagery and relaxation training. Coupled with appropriate counseling, kids and their parents learn to reestablish a needed sense of control while taking an active role in the healing process. Their results are often extraordinary and I'm not aware of any reported side effects.

So the next time your child awakens with RAP, forget the Pepto Bismol - you know it doesn't work. Consider beginning instead with a hug and encourage your child to close his/her eyes while imagining a colorful hot air balloon floating within and pressing against the walls of the stomach. As you focus on and begin to practice slow, deep and relaxed breathing, suggest the air is slowly escaping from the balloon as it progressively shrinks and eases the pressure in the tummy. Continue in a calm voice and an even tempo while you describe the balloon gradually shrinking until it is barely visible and no longer exerting any pressure or discomfort. Do not be surprised if your child quickly falls asleep.

Prior to beginning any treatment strategy, remember to consult your physician for a comprehensive exam, workup and diagnosis. Yet don't be afraid to try guided imagery or deep-breathing relaxation techniques even when medications are prescribed. And sleep well, knowing that your child might never have to awaken again with a bout of RAP--Mind Over Matter!