Let's Talk GUT HEALTH & TUMMY TROUBLES

Almost everyone has experienced a tummy ache or digestive discomfort, but there is a lot more to know about gut health than just the soothing solutions you eagerly seek when trouble arises. That’s why Maria Despres, NP, of WakeMed Children’s – Pediatric Gastroenterology, wants to teach families more about gut health and help adults and kids understand why it is so important. 

“The gut does so much more than it often gets credit for — it’s the unsung, unglamorous hero of the body,” says Despres. “Beyond digestion, it supports neurodevelopment, strengthens the immune system, produces essential vitamins and helps absorb the nutrients we need.”

Despres says the gut is in constant communication with the brain and central nervous system through something called
the gut-brain axis, and that means it can directly influence mood, focus and stress levels.

Fueling Up to Feel Better

For older children and adolescents, the basics for a healthy gut make a big difference. 

“Regular meals, plenty of fiber, good hydration, and daily physical activity go a long way,” says Despres. “Once kids are more on-the-go, it’s helpful to continue to reframe food as energy.” 

She recommends reminding teens that just like a phone or tablet needs to be charged, or a car needs gas, their bodies need to be fed – ideally with regular, nutritious meals. Despres says too many teens skip breakfast, which isn’t good for the gut and can negatively impact brain power for academics and overall mental health.  Because the gut and brain are so connected, Despres says parents should know (and will likely notice) that when a child’s digestion is off, their mood, sleep and energy levels can be off, too. 

Changes with Ages & Stages 

Kids are more sensitive to changes in diet, illness, and medications, so building a healthy gut early on can lay the foundation for strong immunity, steady growth, and a healthy brain and nervous system. Newborns start out with a simple gut microbiome that begins to diversify in infancy. Until 12 months, most of a baby’s daily nutrition should still come from breast milk or formula.

“When initial solid foods are typically introduced around four to six months, they are mainly for sensory development and exploration at first, so think of them as extras rather than replacements for milk feeds,” says Despres. “Start with single ingredient purees and gradually expand to different fruits, vegetables, and whole grains to build a diverse gut microbiome and broaden taste preferences. The only food off-limits before age 1 is honey.” 

Variety & Consistency 

Once you begin to transition a baby to solids, Despres says one of the best things you can do to support gut diversity is consistently introduce a wide variety of foods in the toddler years. She explains that this can also help prevent food allergies and aversions for young children. For toddlers, preschoolers and beyond, keep offering colorful fruits and vegetables, even if they don’t eat them the first (or fifth) time. Don’t underestimate how perceptive children are — be mindful of your own routine and what is on your plate at family meals to model healthy eating habits!

The Balancing Act of Bacteria 

The gut is home to billions of tiny bacteria, which are called the gut microbiota, and Despres says they keep everything running smoothly. She likes to tell families to think of it like the movie “Inside Out”— only instead of little emotions behind the scenes, you’ve got little bacteria running the show. 

“When bacteria in the gut is balanced and working together, everything functions well,” says Despres. “But if the balance is off it can throw the whole system out of whack, leading to gastrointestinal (GI) symptoms such as bloating or abdominal pain and other things you might not expect, including allergies and autoimmune conditions.”

Hydration for A Healthy Gut

• Water is the best!
• Sugary drinks, sodas and energy drinks can harm gut bacteria and disrupt hydration.  
• Sports drinks should only be used for prolonged, intense activity.
• Caffeinated drinks can worsen reflux and sleep problems so it’s best to limit them and avoid too close to bedtime.
• Whole fruits & veggies can be hydrating while also providing fiber.
• If you offer juice, stick to 4 oz./day or less; choose 100% fruit juice without added sugar. 

After Antibiotics 

Antibiotics can upset the delicate balance of bacteria in the gut, and it can take a while for things to get
back to normal. When a child is sick and prescribed antibiotics, follow these four steps for healthy recovery. 

• Don’t rush kids back to their normal diet – take things slow; follow your child’s cues.
• Offer gentle, bland, easy-to-digest foods (like the BRAT diet) until symptoms subside.
• Prioritize fluids for hydration – this is extra important in the first few days.
• Talk to your pediatrician about giving probiotics during or after antibiotics treatment.

“It’s usually a good idea to add in a solid multi-strain (10+) probiotic during the recovery period,” says Despres. “Go ahead and ask about adding in probiotics when an antibiotic is prescribed.” 

Common Concerns and Complaints

Constipation Frustration

“While many may avoid talking about it, constipation is a common issue across all age groups,” says Despres. “Almost every child will deal with it at some point.” 

Constipation can cause stomach pain, decreased appetite and even behavior changes so it’s important to address it right away. It will not go away on its own, and untreated constipation can lead to stool withholding, discomfort, and long-term bowel issues, including resistance to potty training and soiling accidents.  Families should reach out to their child’s primary care physician for medical advice and support early on when a child seems constipated.

“Gentle laxatives, along with diet and lifestyle changes, are often needed to resolve the issue,” says Despres. “Consistency is key, and treatment may require weeks to months of steady support.”

Reflux Reality

Many times, the first run in with reflux is during infancy, which is often a normal process that happens because the esophagus is still immature. Once it resolves, most kids don’t experience reflux again until they are in school, but Despres says it can come back with a vengeance and is frequently related to stress or specific dietary habits. 

Anxiety & Abdominal Pain 

Recurrent abdominal pain is common in school-age children and teens. In many cases, the pain is linked to stress, anxiety, or irregular bowel habits rather than a serious medical issue. 

Serious Symptoms

Pay attention to what’s going on with kids when they complain about their stomach. The symptoms below warrant a call and likely a visit to their pediatrician. 

• Blood in vomit
• Stools with blood or mucous or is greasy looking
• Persistent vomiting or diarrhea
• Unexplained weight loss or poor growth
• GI complaints accompanied by frequent fevers, night sweats, or unusual fatigue
• Ongoing severe pain that limits routine activities or interferes with daily life. 

A trip to the Emergency Department is warranted if your child’s belly pain is sudden and severe — especially if it’s on the lower right side, which can be a sign of appendicitis. If a child’s pain is paired with other concerning symptoms, such as a fever, blood in stool or vomit, persistent vomiting, a swollen belly or an inability to stay awake, these are red flags that require emergency evaluation. 

THE STRESS CONNECTION 

Children today face increasing pressures — socially, academically, in family life and in sports. For the developing brain, this can sometimes feel overwhelming. And since the gut and brain are connected, many kids Despres sees with functional GI disorders are experiencing symptoms that stem from or are worsened by stress. 

“Unfortunately, children may not have the awareness or language to grasp the stress-gut connection or explain how their body is internalizing stress,” says Despres. “Parents and caretakers should prioritize letting kids be kids with time for fun along with open dialogue and relaxation because those things are just as important for gut health and overall well-being as the food children eat — it takes a holistic approach.” 

“Always trust your parent gut! If something feels off, it’s worth a conversation with your child’s pediatrician.” 

PROBIOTICS & PREBIOTICS

You’ve probably heard about both probiotics and prebiotics, but what is the difference and what are good sources? Despres breaks it down to the basics of what we need to know and shares what foods to eat for both. Probiotics are live, “good” bacteria that help keep the gut balanced. You can get them through supplements or by eating fermented foods like yogurt and kefir.

Prebiotics on the other hand, are the non-digestible fibers that feed those good bacteria and help them grow. Foods like bananas, onions, garlic, oats and whole grains are excellent sources of prebiotics.

Probiotics are the healthy bacteria; prebiotics are the food and nourishment they need to thrive. Both work together to support a strong, diverse gut microbiome.

Probiotics can be helpful for some kids, but they’re not necessary for everyone. Despres says the main job of probiotics is to help replenish and rebalance the gut microbiota, so they tend to be most beneficial for children in the following situations: 

• Recent condition caused vomiting and/or diarrhea (like a stomach bug)
• Taking or recently taken prescribed antibiotics
• Struggling with allergies and/or eczema
• Dealing with a chronic condition like constipation or functional abdominal pain

If things seem out of balance, talk to your child’s doctor for advice regarding their specific condition and needs.

MEET THE EXPERT

Maria Despres, NP, WakeMed Children’s – Pediatric Gastroenterology

Maria Despres is a nurse practitioner with clinical interests in the gut–brain axis, functional gastrointestinal disorders and the role of nutrition and mental health in supporting overall well-being. She completed her undergraduate degree at Southern New Hampshire University in Manchester, NH and received her master’s at Duke University in Durham, NC. Despres believes in building strong partnerships with families and exploring the full story behind a condition. Her goal is to create a safe space where kids and families feel heard, valued, and supported throughout their care journey. 

When not helping patients, Despres is drawn to creative, hands-on leisure activities. She especially enjoys gardening, home improvement projects and spending time with her husband and two kids

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This article is adapted from Families First. Subscribe here.