How To Keep A Symptom Diary

Nutritional and gastrointestinal disorders are often mysteries in the beginning.  Not a whodunit, but awfully close as doctors try to put the symptoms together and figure out the cause and then the best treatment plan.  Sometimes we'd rather have a simple ear infection, where we can look into the ear, see the infected area and decide on the best antibiotic.  However, even ear infections can be more complex if there have been multiple ear infections because immune problems or even reflux can be contributing to the problem and the hearing deficits that can result if the underlying cause isn't identified.

It's often important to enlist you as Mom and / or Dad to help us solve the mystery of GI disorders.  If the child is old enough and thoughtful, we can have your child tell us more as well.  What you need to do is pay attention and record your impressions.  Parents usually do the first part automatically, remembering when and how their child's problem began, but we can benefit from pieces of information that sometimes go unnoticed.

The Child With a Tummy Ache

Let's say your daughter has abdominal pain, not just once, but several times, as an example. What should you notice? 


Where was the pain?  Top, where the stomach sits?  On her lower right side, near the appendix?  Or her left?  Is it always the same place?  Does it start one place and move?


How long does it last?  Seconds, minutes, hours?


How often is the pain?  Has it changed (was it once a month and now every day)?


How bad was it?  Enough to cause tears?  Wake her at night?  Cause her to stop eating or playing? 


Does it get better or worse over that time?


Does anything trigger the pain or that change?  Eating, drinking, pooping, peeing, movement, stress?  Any particular foods (if so, write them down--it may not be the same food, but there could be a pattern.  Can the child eat those same foods other times without developing symptoms?).


Does anything happen along with the pain (nausea, diarrhea or a headache--if so does it have the same pattern or a different one)?  If she's vomiting, what's coming up (food, fluid, bile, blood)?  Change in appetite, weight, bowel movements?


Anything else you notice?  Joint pains, fever, a rash?

I like to have parents chart the symptoms, whatever they are, pain, diarrhea, fever, nausea, etc. Use the chart below, if it helps or keep your notes on a calendar. Do so for each episode until you see your doctor or primary provider.





Time over




Sept 1


1 pm


Nausea at home

Vanilla milk shake 4 ounces, after church

15 minutes before




Pain at belly button, gradual






Vomited all it seemed



Sept 7


3: 05


Nausea, gradually got better after lying down, normal BM

 ? Lunch (pizza, water)


Sept 9

6 am


Woke vomiting yellow fluid

No nausea or pain

Went to school after

 None, slept well  (fried fish, peas, water, cupcake at 7 pm last night


Sept 12

4 PM


Fell on playground, hurt L knee, vomited a little when cried

Hit by swing in stomach

Right then

Obviously, all of these problems aren't related--or at least, the incident on the playground isn't, but the others might be and probably are.  Milk allergy, fat intolerance/ absorption, gallbladder disease or stomach issues could be present, but that depends on the child's age, family history, body size and a host of other factors that your provider can sort through, but that chart presents a clear picture to help that happen.  So keep your own chart and also give your provider a list of

  • child's current allergies, medications and diet
  • child's past medical history (other illnesses, surgery, testing, special needs)
  • family medical history   
  • social history (school and how doing there, activities, pets, recent travel, exposures like swimming in a nearby lake,  stress factors, illnesses among family or friends)
  • any other concerns

 Hopefully, that precision will lead the way to a full understanding so that any testing that's needed can help establish the diagnosis and its cause, so that you can begin to do what is needed to effectively treat or stop the problem.

Bailey Koch, RD, CSP, LD 10 March 2016

Bailey Koch is the President of Atlanta Pediatric Nutrition, Inc., which provides nutrition services to pediatric physicians’ practices and provides consulting services to food companies and researchers. Bailey serves on our Read More

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