Just A 'Tummy Ache,' or More?
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. We'll look at some of the most common causes of abdominal pain in children the following slides.
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 abdominal 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 tell when a child has abdominal pain. Infants and very young toddlers may cry, have painful facial expressions, and curl up. Young children usually will 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. Symptoms to ask about are discussed on the following slides.
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 usually was 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 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.
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
At any age, vomiting that appears to contain blood or darker material is a reason to seek emergency care. Prolonged vomiting and the inability to keep down liquids can lead to dehydration. Signs of dehydration such as a dry mouth and no urine is another reason to seek emergency care.
This is also very common with abdominal pain and often indicates that a virus is the cause. This can continue for several days but usually lasts less than 72 hours (three days). Diarrhea, especially when associated with vomiting, can lead to dehydration. Any blood in the stool is a reason to seek medical care.
The presence of fever does not always indicate a serious problem. Moreover, a normal temperature can be seen with the more serious causes of abdominal 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. So, if a child complains of pain in the groin area or testicles, seek emergency medical care.
Abdominal pain associated with any trouble urinating, such as painful or frequent urination, could indicate a bladder infection and is a reason to seek medical care.
Certain serious causes of abdominal pain also occur with a new rash. The combination of a skin rash with abdominal pain is a reason to contact your doctor.
Exams and Tests
Abdominal pain in children has several potential causes that may affect multiple organ systems, each requiring a unique set of diagnostic tests. The doctor will obtain a thorough history and examine the child, which likely will include a rectal exam to evaluate the presence of blood in the stool. From this information the doctor may order additional tests.
Blood tests, stool samples, imaging studies (including X-rays, ultrasound, and CT scans), as well as other special tests (barium enema/swallow, or pelvic exam) may be done. In some cases a specialist such as a gastroenterologist or pediatric surgeon may be consulted.
Several conditions in the abdominal region may be associated with tummy pain including constipation, gallstones, bowel disease, irritable bowel syndrome (IBS), ulcers, acid reflux, celiac disease, indigestion, heartburn, cholecystitis, gastroenteritis, or other conditions. Testing helps diagnose the cause of the symptoms.
Self-Care at Home
A parent or caregiver must be observant and should contact appropriate help at the appropriate time. A child should especially be monitored closely when he or she is recovering. A teenager may not want to be bothered, but still should be monitored. The following slides offer tips for self-care at home.
A child with active abdominal pain often will benefit from resting. Lying face down may help relieve gas pain, but the optimal position is the one that feels best to the child.
People can survive a long time without solid food, but need to keep up on liquids. Dehydration takes time to develop unless vomiting or diarrhea is severe, 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.
Fluids to Give
Do not give water or boiled milk to infants in large quantities, because it can cause serious problems with the salt content of their bodies. Doctors recommend various liquids for preventing and treating dehydration. 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 ale or simple soup broth. Avoid any liquids that aggravate the abdominal pain. If an older child asks for soft drinks, it may be better to avoid those with caffeine. Shaking the fizz out of carbonated beverages may make them more tolerable for an ill child.
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, or cooked rice also are suitable foods for introduction after a full liquid diet.
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 it could affect the treatment recommendations.
Treatment will be prescribed according to the history, physical examination, and test results. Treatment may be as simple as sending the child home with instructions for rest, encouraging fluids, and eating a bland diet. The doctor may recommend antacids for acid reflux, indigestion, or similar tummy concerns. Conditions like IBS or ulcers may require dietary changes and more extensive interventions. Stomach pain arising from celiac disease is associated with inflammation in the intestines. The primary treatment for celiac disease is the adoption of a strict gluten-free diet. For more serious conditions, treatment can be as extensive as hospital admission and surgery.
When to Call a Doctor
Call your child’s doctor immediately if your child is experiencing any of the symptoms listed in this slide.
The prognosis for abdominal pain in children is as diverse as the causes themselves. Abdominal pain identified and treated early carries a good prognosis overall; however, pain undiagnosed and untreated can be life-threatening. Simple constipation or minor problems with the stomach or bowels are usually easily treatable. However, sometimes symptoms may be associated with something more serious. Consequently, early in the child's illness, a parent or caregiver should work with the pediatrician and hospital to ensure the child receives appropriate care.
Uncommon Causes of Abdominal Pain
Less common causes of abdominal pain include kidney infections, kidney stones, hepatitis, gallstones, cardiac conditions, parasitic infections, hiatal hernia, cancer, cysts, and infections of the organs. A doctor can evaluate your child and determine the underlying cause of his or her stomach pain.