Abdominal pain is one of the most common reasons for a parent to bring his or her child to a health care professional. Evaluation of a “tummy ache” can challenge both parents and the doctor.
Causes of abdominal pain in children
Possible causes for a child’s abdominal pain range from trivial to life-threatening with little difference in the child’s complaints and symptoms. Fortunately, abdominal pain in a child usually improves quickly. Parents or caregivers face the difficult decision of whether a complaint needs emergency care or not.
Below are some of the most common causes of abdominal pain in children:
Viruses or bacteria can cause abdominal pain, typically from stomach flu or gut flu (called gastroenteritis). Often these infections are associated with other gastrointestinal symptoms such as cramps, nausea, and diarrhea. Viral infections tend to resolve quickly, while bacterial infections may need an antibiotic to improve.
Food poisoning (which has symptoms like those of stomach/gut flu), food allergies, eating excessive amounts of food – any of these can cause temporary discomfort.
Poisoning: This can range from simple problems, such as eating soap, to more serious issues like swallowing iron pills or an overdose of medications (such as acetaminophen poisoning [Tylenol]).
Surgical problems & medical causes
Surgical problems for abdominal pain include appendicitis and blockage of the bowels. In addition, things outside the abdomen can cause abdominal pain. For example, a child can have abdominal pain from complications of diabetes or from a black widow spider bite.
Symptoms of abdominal pain in children
A parent or caregiver usually can notice pain in a child’s abdomen. Infants and very young toddlers may cry, express pain facially, and curl up. Young children are usually quick to tell you what is wrong. Some teenagers may be reluctant to report pain, and you must try to get a clear explanation of what they are feeling. Ask about these conditions:
•Duration of the pain: Most simple causes of abdominal pain do not last long. Most of us have experienced gas pains or the stomach/gut flu, and recall that the pain was usually gone within 24 hours. Any abdominal pain that continues longer than 24 hours should be evaluated by a physician.
•Location of the pain: Most simple pains are located in the center of the abdomen. The child will rub around his or her belly button. Pain felt in other areas is more concerning. This is especially true of pain located low and down on the right side of the abdomen. Pain in that area should be considered as appendicitis until proven otherwise.
•Appearance of the child: As a general rule, if the child looks very ill in addition to being in pain, medical help should be sought. Often, the caregiver “just knows” the child is very sick. When abdominal pain occurs, key things to look for include pale appearance, sweating , sleepiness or listlessness. It is most concerning when a child cannot be distracted from the pain with play, or refuses to drink or eat for several hours.
•Vomiting: Children vomit quite frequently with abdominal pain, butvomiting does not always indicate a serious problem. However, as with the duration of the pain, most simple causes of vomiting go away very quickly. The rule again is that vomiting for longer than 24 hours is a legitimate reason to call the physician.
•Nature of the vomiting: In infants and very young children, vomiting that is green or yellow is a reason to call the doctor. At any age, vomiting that appears to contain blood or darker material is a reason to seek emergency care.
•Diarrhea: Diarrhea is also common with abdominal pain and usually indicates that a virus is the cause. This can continue for several days but usually only lasts less than 72 hours (three days). Any blood in the stool is a reason to seek medical care.
•Fever: The presence of fever does not always indicate a serious problem. Indeed, a normal temperature can be seen with the more serious causes of abdominal pain.
•Groin pain: One serious problem that a boy may describe as abdominal pain actually comes from somewhere else. It is testicular torsion, a condition in which a testicle twists on itself and cuts off its own blood supply. The child may be embarrassed to mention the location, so you should ask if there is any pain “down there.” A testicular problem is usually easy to fix if treated early enough. So, if a child complains of pain in the groin area or testicles, seek medical emergency care.
•Urinary problems: Abdominal pain associated with any trouble urinating, such as painful or frequent urination, could indicate an infection and is a reason to seek medical care.
•Rash: Certain serious causes of abdominal pain also occur with a newrash. The combination of skin rash with abdominal pain is a reason to contact your doctor
A parent or caregiver must be observant and should contact appropriate help at the appropriate time. Monitor a child especially closely during recovery until the child is better. A teenager may not want to be bothered but still should be monitored.
•Rest: A child with active abdominal pain often will benefit from resting. Lying face down may help relieve gas pain, but the optimal position is that which feels best to the child.
•Diet: People can survive a long time without solid food but need to keep up on liquids. Dehydration takes time to develop, so forcing fluids is not always necessary. A child who is actively vomiting will not be able to hold down a large amount of liquid. Doctors recommend giving small amounts (1-2 ounces) at a time (every 15-20 minutes typically) until the child can handle more. Avoid tinted, carbonated, caffeinated, fatty, or excessively salty or sugary liquids (such as colas, tea, coffee, milk, sports drinks, and fruit juices).
•Fluids to give: Do not give water or boiled milk to infants, because it can cause serious problems with the salt content of their bodies. Also, milk is harder for a sick stomach to digest. Doctors recommend various dehydration liquids. For example, Pedialyte can be bought over-the-counter without a prescription. Try to get the infant back on the usual feedings as soon as possible. Good choices for older children include ginger. Avoid milk, fruit juices, heavily carbonated beverages, coffee, and sports drinks (such as Gatorade) in patients with diarrhea, since the stomach may not tolerate these fluids. If an older child asks for soft drinks, avoid those with caffeine. Shaking the fizz out of carbonated beverages may make them more tolerable for an ill child.
•Solid foods: The child will let you know when it is time to get back on solid food. Start them slowly, first try toast or crackers then advance to regular foods as they tolerate the feedings. Banana, apple sauce, plain toast, or cooked rice are also suitable foods for introduction after a full liquid diet.
•Medications: You can use acetaminophen (Aspirin Free, Children’s Silapap, Panadol, Liquiprin, or Tylenol) to control fever. Most doctors still avoid aspirin in children. Avoid antibiotics unless prescribed by a doctor. Physicians do not recommend herbal medicines or other home remedies. If you use them and later see a physician, be sure to tell the physician exactly what you gave the child, because such material could affect the treatment recommendations.