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The most common cause of chronic stomach pain in children isn’t anything you can find on a test or cure with a medicine. And that can make it very challenging to diagnose — and treat.

You may not have ever heard of functional abdominal pain. Yet it ranks as the most common cause of stomach pain lasting two months or more in children and teens.

What is functional abdominal pain?

The mind and the body are tightly connected in ways that we are still working to understand, and this is particularly true of the mind and the gastrointestinal tract. Stress — particularly chronic stress, depression, and anxiety — can lead to pain that is very real. Sometimes the pain is the only symptom of stress, especially in children who are high-achieving or tend to hide their emotions.

Sometimes the pain doesn’t start from stress but from an infection or other illness, and stays once the illness is gone or adds additional pain to the illness while it is being treated. Worry about the pain and its possible cause can make things worse. The nervous system of the gut can go into overdrive.

What are common symptoms of functional abdominal pain?

Children with functional abdominal pain can have mild symptoms that just show up occasionally, or they can have more severe symptoms that interfere with daily life. Along with stomachaches, they can have nausea, vomiting, constipation, or diarrhea — or some combination of all of them. They may have a poor appetite or complain of feeling full very quickly.

When should you contact your child’s doctor?

It’s important to check in with your doctor if your child is having chronic stomachaches. They should have a physical examination, and your doctor may want to do some testing, such as blood or stool tests, as there are many medical conditions that can cause chronic stomachaches.

It’s particularly important to call your doctor if your child

• is losing weight
• has blood in their stool
• has severe pain
• has fever, rashes, sore joints, or other signs of illness.

If your doctor finds that your child’s examination and tests are normal, and they aren’t losing weight, chances are that your child has functional abdominal pain.

For some families, getting this diagnosis sounds like the doctors are saying that it is all in the child’s head. But nothing could be further from the truth. It is very real pain — but it is not being caused by something dangerous, which is very good news.

How can you help a child diagnosed with functional abdominal pain?

There are many ways to help a child who has functional abdominal pain once the diagnosis is made. They include:

• Understanding and managing stressors in the child’s life, if there are any
• Medications recommended by your health care team can help with symptoms, such as laxatives for constipation
• Cognitive behavioral therapy, which is a kind of therapy that teaches strategies for managing pain, as well as managing any stress or sadness that can be contributing
• Meditation, yoga, and other ways for a child to relax and regulate how they react to their world
• For some children, a low-FODMAP diet can be helpful
• Probiotics, peppermint oil preparations, and some other supplements are sometimes used to help soothe and prevent pain.

Most children with functional abdominal pain can receive care from their pediatrician. Regular visits are a good idea, to check in to see how things are going and adjust any treatments. If things aren’t getting better, a referral to a gastroenterologist can be helpful.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

When was the last time you had your blood pressure checked? All adults should have this simple test at least once a year.

If a blood pressure reading at your doctor’s office is elevated — that is, higher than a healthy range — current guidelines from the US Preventive Services Task Force recommend repeating the measurement outside of a clinic setting before starting treatment. But that’s not the only reason why your doctor may suggest regularly tracking your blood pressure at home.

Why monitor blood pressure at home?

“Some people have blood pressure elevations only at the doctor’s office, which is known as white-coat hypertension,” says Dr. Stephen Juraschek, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. One of the best ways to know if your blood pressure is truly higher than normal is to measure it multiple times at home.

Home monitoring is also a good idea:

• if your doctor asks you to track readings to help decide if you need to start taking medication to lower blood pressure
• if you’ve been diagnosed with high blood pressure and need to adjust your medications to make sure you’re reaching your blood pressure target
• if you’re pregnant or had a baby in recent months and your health team is concerned about preeclampsia. This condition is a severe form of high blood pressure that can harm vital organs like the kidneys. When not promptly treated, it sometimes leads to seizures, stroke, or even death.

Which home blood pressure monitor should I buy?

• Look for a monitor that’s been validated, which means the device has been independently reviewed for accuracy.
• Avoid monitors that feature cuffs used on the wrist or fingertip. These aren’t as accurate as upper-arm cuffs.
• Choose and use the right size cuff. Measure the circumference of your upper arm midway between your elbow and shoulder. Most home monitor cuffs can accommodate arm circumferences of 9 to 17 inches, but smaller and larger cuffs are available. A too-small cuff can lead to an artificially high reading, while a loose cuff can give a falsely low reading. For example, a 2023 randomized study of automated blood pressure monitors tested a regular size cuff on adults who need a different size cuff. The researchers found systolic blood pressure readings increased 19.5 mm Hg for participants who should have used an extra-large cuff, and by 4.8 mm Hg for participants who should have used a large cuff.

Very basic models cost as little as $25. But more expensive models, which range from about $50 to $100, may be more convenient to use. They can store multiple readings and send the data to your computer or smartphone — or even directly to the patient portal at your doctor’s office.

Three key points about blood pressure readings

Home blood pressure monitoring is a bit more involved than some people assume. “It’s not something you just do sporadically or whenever you have time,” says Dr. Juraschek.

• Blood pressure fluctuates throughout the day, which means one isolated reading doesn’t provide accurate information.
• If you check your blood pressure when you’re upset or stressed, it’s likely to be high. If you take it again right away, you may get another high reading, which feeds a cycle of anxiety and elevated readings, he says.
• Consistent, repeated measurements provide a far more useful assessment than occasional measurements.

How often should you take your blood pressure at home?

Ask your doctor how often and what time of day to take your blood pressure.

“The gold standard for home monitoring is to take 28 separate measurements, which you can then average to get a representative reading,” says Dr. Juraschek.

That means taking your blood pressure four times a day — twice in the morning and twice in the evening — for seven days in a row. However, even 12 measurements over three days is reasonable, especially if you include one weekend day, Dr. Juraschek says. Your doctor can advise you about what makes the most sense for your situation.

How can you get an accurate blood pressure reading?

Common mistakes can raise your blood pressure reading by a few points, or as much as 10 or even up to 25 points in some cases. Here’s what to do or avoid — and why — for an accurate blood pressure reading.

Wait at least 30 minutes after smoking, consuming caffeine or alcohol, or exercising before taking blood pressure.

Why? Caffeine and nicotine constrict blood vessels and boost your heart rate, which can raise blood pressure. Alcohol dilates blood vessels, possibly lowering blood pressure. And exercise increases heart rate and blood pressure.

Empty your bladder.

Why? A full bladder can put pressure on and reduce blood flow to your kidneys. Your body’s natural response is to raise your blood pressure to make sure your kidneys are getting enough blood.

Sit comfortably, supporting your arm near heart height.

Sit back in your chair with your feet flat on the floor, legs and ankles uncrossed, and your arm extended, palm up, on a table so that your elbow is positioned roughly at heart height.

Why? Crossing your legs, especially at the knee, temporarily raises blood pressure. If your feet or your arm are not supported, your muscles will contract. Even this small amount of isometric exercise can raise your blood pressure. Also, supporting your arm below or above the level of your heart may affect the accuracy of the reading.

Wait a few quiet minutes before taking a reading.

First, wrap the proper size cuff around your bare arm about an inch above the crook of your elbow. Sit quietly for a few minutes without distractions like TV, reading, phone scrolling, or talking. Then start the machine to take your blood pressure.

Why? Putting the cuff over clothes — or pushing up your sleeve so that it’s tight around your upper arm — may interfere with an accurate reading, though evidence on this is mixed. Ideally, you want to record blood pressure while feeling relaxed, not distracted, because even minor stress or tension can raise your blood pressure.

This video from the American Heart Association demonstrates the correct technique.

Why is diagnosing high blood pressure so important?

Nearly half of all adults have high blood pressure, but about a third of these people aren’t even aware they have the problem. An accurate diagnosis and treatment is vital, says Dr. Juraschek. Few things in medicine have shown such consistent results as the harms of high blood pressure, which is a major cause of heart attacks, strokes, kidney disease, and cognitive decline.

“It’s called the silent killer for a reason. We don’t feel or experience any of high blood pressure’s effects until it’s too late,” he says.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

The first two weeks of July were the Earth’s hottest on human record, and people across the country continue to suffer from lingering, suffocating heat waves. The US Centers for Disease Control and Prevention has issued repeated warnings and tips about recognizing and preventing heat-related illnesses, like heat stroke, heat exhaustion, and heat cramps.

But one heat-related illness that people do not always recognize is heat rash.

“Heat rash can indicate that your exposure to excessive heat could lead to other serious heat-related issues, if not addressed,” says Dr. Abigail Waldman, a dermatologist with Harvard-affiliated Brigham and Women’s Hospital. "While heat rash is not dangerous in itself, sustained exposure to high heat can lead to heat exhaustion and heat stroke, so it's important to note any early signs that your body is struggling with the heat.”

What are the signs of heat rash?

Heat rash is also known as miliaria or prickly heat. It is caused when ducts from eccrine sweat glands that lead to the skin's surface are blocked or inflamed.

Eccrine sweat glands help your body maintain a steady temperature. When your internal temperature rises, these glands release water that rises to the surface of your skin through tiny ducts. There, it quickly evaporates, cooling your skin and the blood beneath.

However, sweat ducts may get blocked when you sweat excessively in hot temperatures, particularly if skin folds or tight-fitting clothes hinder their function.

Sweat is then trapped beneath the skin. This triggers inflammation, which leads to the appearance of small, itchy red bumps, similar to tiny pimples or blisters. In people with darker skin tones, these small, itchy bumps may not appear red, but will look slightly darker than surrounding skin.

Where and when is heat rash likely to occur?

Heat rash can appear on the neck, scalp, chest, groin, or elbow creases.

“Heat rash can occur any time the body sweats, so it is common in hot, humid climates, during hospitalizations, from fever, and during exercise,” says Dr. Waldman.

Heat rash also can occur in newborns, as their eccrine sweat glands are not fully developed. In newborns, heat rash looks like very thin blisters or water drops widely distributed on the face, trunk, arms, and legs. Call your pediatrician for advice if you notice a rash like this.

How can you treat heat rash?

Heat rash in adults is easy to treat with home remedies. “The techniques to relieve symptoms also can help prevent heat rash for adults and babies,” says Dr. Waldman.

• Cool down. The first step is to get out of the heat and cool and dry your skin. Use a fan or air conditioner, take a cool shower, or apply cool compresses to the affected areas. It's important to know that some people are more vulnerable to heat, and to make plans to help stay safe when temperatures are dangerously high.
• Prevent irritation. To prevent skin irritation, avoid wearing clothes made from synthetic materials, which can trap heat. (While dry-fit clothing helps to wicks away moisture from the skin, it often can be too tight fitting.) Instead, wear light, loose-fitting cotton clothing that allows airflow over your skin. If a heat rash occurs around your groin area, avoid wearing undergarments until it clears up.
• Try anti-itch products. Use an over-the-counter topical corticosteroid cream or calamine lotion for itching. However, avoid baby powder, oily or greasy moisturizers, and sunscreen, as they can further block sweat ducts.

Heat rash typically goes away within one to two days once you cool down your body. More severe heat rashes can last a week or longer. See your doctor (or follow up with your pediatrician) if a heat rash has not cleared up after a week. Also seek immediate care if you experience pain, intense itching, or the rash appears infected.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

The media uproar that swirled a few weeks ago around leprosy in the US drew attention away from ongoing heat and extreme weather that pose far more danger to most of us. But does a single case of a man diagnosed with leprosy in central Florida suggest that anyone anywhere in the US could get leprosy? Might this become the next pandemic? Just how worried should we be?

Read on to set the record straight about leprosy. (Spoiler alert: there will be mention of armadillos.)

Why did leprosy make the news?

In August, one case of leprosy in central Florida was described in the journal Emerging Infectious Diseases. This report was widely covered by the news media, with headlines like “CDC confirms leprosy outbreak in Florida: What to know if you’re traveling to the state” (WKYC) and “Central Florida is a hot spot for leprosy, report says” (CNN).

One reason for concern raised by experts was the fact that the man diagnosed had no identifiable risk factors for the disease. That is, he had not traveled to a place where leprosy is common and had no contact with anyone who had the disease. Past research has suggested the organism that causes leprosy can survive in soil. And that raised the possibility that this man’s work as a landscaper put him at risk for leprosy.

What is leprosy?

Leprosy, or Hansen’s disease, is a chronic infection caused by Mycobacterium leprae bacteria. (That’s a close relative of the organism that causes tuberculosis.) This ancient disease, which affects skin, nerves, and linings of the eyes and upper respiratory tract, is described in some of the earliest human writings (including the Old Testament), and genetically identified in archeological remains dating back to 2000 BC.

Common symptoms of leprosy include:

• red and/or thickened patches on the skin
• reduced sensation, numbness, or weakness in the hands or feet
• nonhealing wounds, blisters, and cracks in the skin of the hands or feet.

Left untreated, this may lead to skin deformities. Surgical amputations may be necessary to control skin ulcers that fail to heal or are chronically infected.

How does leprosy spread?

Usually, the infection spreads from person to person through respiratory droplets shared during prolonged, close contact. Coughing or sneezing, for example, can release respiratory droplets, which can be breathed in by people who are nearby.

Some cases of leprosy have been linked to animal contact, such as the nine-banded armadillo and Eurasian red squirrels.

However, in about a third of cases, no clear risk factor can be identified.

How common is leprosy?

For most people in the US, leprosy is not a major health concern. In recent years, about 180 cases of leprosy have been diagnosed annually. Though this represents an uptick from fewer than 100 cases in 1999 and 2000, the disease remains rare in the US.

Worldwide, it’s a different story: according to the World Health Organization, more than 200,000 cases in 120 countries are diagnosed each year. The highest numbers of cases are in Brazil, India, and Indonesia.

Has leprosy become common in Florida?

No. There have been about 20 cases per year in Florida since 2015. As is true nationally, this represents an increase from prior years.

But some experts speculate that leprosy may be endemic now in central Florida, where about 80% of the state’s cases are diagnosed. Endemic means there are enough sources of infection (such as infected people or animals) in a particular area to allow the disease to spread, even if no new cases are brought in from elsewhere.

Since some people with infection have no risk factors for the disease, it’s possible leprosy has become endemic there. But that remains unproven.

Myth versus truth: Common misconceptions about leprosy

Misunderstanding fuels stigma and discrimination against people who have leprosy. Maybe you’ve heard some of these falsehoods.

The myth: Leprosy is extremely easy to spread. In the past, this myth led to isolation of people with leprosy in “leper colonies” that quarantined entire communities of people with the infection.

The facts: About 95% of people are naturally immune to leprosy. And, because spread of infection between people requires close and prolonged contact, it’s not nearly as contagious as many other infections. So it’s not readily spread by being in a room with an infected person, or by touch. And, within one week of treatment (see below), a person with leprosy is no longer contagious. As a result, isolation from others is unnecessary.

The myth: Leprosy causes parts of the body, such as fingers or ears or the nose, to fall off.

The facts: Body parts do not fall off. Sometimes surgical amputations are needed to treat nonhealing wounds and infections, two complications of longstanding nerve damage related to leprosy.

The myth: There are no treatments for leprosy.

The facts: There are effective antibiotics for leprosy. To cure the infection, people may need to take a combination of different antibiotics for a year or more.

The bottom line

Some of the news coverage on the case of leprosy in Florida seems more dire than necessary. In fact, the risk of developing leprosy in central Florida, or elsewhere in the US, remains exceedingly low.

And it’s highly unlikely leprosy will become the next pandemic. However, some experts predict that vulnerable populations in the US, such as homeless people living in close contact with poor hygiene and inadequate medical care, could experience outbreaks of leprosy in the future.

While risk seems low now, it’s a good idea to keep leprosy in mind if you have unexplained rashes or nerve damage, especially if you live in a place where the disease is common or have had contact with an infected person. Otherwise, there’s little reason to have leprosy on your short list of health concerns.

Follow me on Twitter @RobShmerling

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD