Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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 will usually be 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: An important thing to remember is that most simple causes of abdominal pain do not last very long. Most of us have experienced gas pains or the stomach/gut flu, and remember 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 is considered to be 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. Key things to look for when abdominal pain occurs include pale appearance, sweating, or a child who is sleepy or listless. 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, but
vomiting 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: This is also very 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 new
rash. The combination of skin rash with abdominal pain is a reason to contact your doctor.