“My Tummy Hurts” – An Overview of Abdominal Pain in Children
Abdominal pain is a frequent complaint in the pediatric office. Children of nearly all ages will complain at some point of tummy aches, and the number of potential diagnoses for these visits is just as broad. Stomach pain in children can range from mild and easily treated to a severe “acute abdomen” that is a surgical emergency. It takes a lot of discussion with parents and patients, along with a physical exam and sometimes laboratory or radiology procedures to determine the cause. Today we will discuss the most frequent reasons children complain of abdominal pain.
Constipation
Blame it on the questionable nutrition in the typical American diet, on lack of proper water consumption, or on genetics, but constipation is probably the most common reason for abdominal pain in children. Constipation is the infrequent passage of large bowel movements and causes pain from cramping of the intestines as well as the actual passage of the stool. I have evaluated children in the emergency room in severe cramping pain that was determined to be constipation. As an outpatient Pediatrician I discuss it at least once per week and I have written previously about constipation here. Treatment involves softening the stool to promote easier bowel movements and can be done in a variety of ways.
Gastroenteritis
Commonly known as a “stomach bug” or “the stomach flu,” gastroenteritis is a viral infection of the gastrointestinal tract, including the stomach, small intestine, and large intestine (colon). It is usually accompanied by significant abdominal pain, nausea, vomiting, and diarrhea. It is highly contagious and tends to sweep through families and friend groups. It will spontaneously resolve over time, and we generally worry most about keeping the child hydrated throughout.
Dietary Intolerance
There is a difference between dietary intolerance and food allergy. Most dietary intolerances cause bloating, nausea, crampy abdominal pain, and discomfort rather than the frank vomiting, facial swelling, hives, and difficulty breathing associated with allergy. The most common food intolerances are dairy and gluten, though some people are affected by soy as well. Diagnosis and treatment of dietary intolerances involve food group restriction and reintroduction with close symptom monitoring throughout.
Urinary Tract Infection
Bacterial infection of the bladder is a common cause of lower abdominal pain, though most of the time children will complain of pain with urinating first.
Strep Throat
Many parents are surprised to learn that strep throat – an infection of the throat caused by a streptococal bacteria – is often accompanied by abdominal pain and vomiting along with sore throat and fever. If your child is exposed to strep or is complaining of sore throat and abdominal pain, he or she should be checked with a throat swab. Streptococcal throat infections always need to be treated with antibiotics to remove the risk of developing rheumatic heart fever, which is a late complication that involves one of the heart valves.
Appendicitis
The appendix is a small pouch of tissue at the very beginning of the large intestine. At times, this pouch can become significantly swollen and inflamed and will cause severe pain. This is usually caused by a blockage of the pouch from stool within the colon. The pain from appendicitis starts around the belly button and then moves to the right lower abdomen. The pain continues to worsen over time and may be accompanied by vomiting and fever, and an unwillingness to move around much. If you are concerned your child may have appendicitis, take him or her to the emergency room for evaluation, as surgery is required for treatment.
Bowel Obstruction
Blockages that prevent normal passage of material can occur in other areas of the small and large intestines as well. While this is a rare cause of abdominal pain, it is worth mentioning because it is more common in certain populations. Any child who has had a prior abdominal surgery has an increased risk of bowel obstruction due to the potential for scar tissue to form in the abdomen. Similar to appendicitis, the pain from a bowel obstruction will be severe, worsening. It can occur in any part of the abdomen. It is often accompanied by a lack of bowel movements, very poor appetite and/or vomiting, and an unwillingness to move around much. These children should be evaluated promptly at the emergency room as well.
Anxiety and Stress
Children internalize stress and anxiety and it often presents as abdominal pain. Rarely will a child come to the office and say, “I am anxious about going to school” or “I am worried about my parents’ divorce.” What they will say is, “My stomach hurts.” Through discussion with these patients and their parents, there is no obvious cause for the pain – bowel movements are normal, no signs of urinary tract infections, no severe pain prompting an emergency room visit, no troubles with appetite or any notable foods that bother them. Just a diffuse, persistent, waxing and waning abdominal pain that is complained of frequently. Unfortunately there is not an easy fix for this type of abdominal pain. Getting to the root of the issue and helping the child to work through the anxiety and stress via therapy is really the best chance of improving this pain.
Final thoughts
There are several types of visits that Pediatricians can expect to encounter on any given day. Abdominal pain is certainly one of them. It is a visit that can either be fairly quick if the pain is due to something simple such as constipation or gastroenteritis, or one that can be prolonged and extended if the cause is more difficult to uncover. Abdominal pain can be frustrating for the patient, parents, and the Pediatrician with its frequency and ability to completely affect a child’s life. Hopefully today’s article has shed some light on some of the more common causes of abdominal pain in children.
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