What is abdominal pain in children?

Abdominal pain, also known as stomach ache, is very common in children. It can be due to a variety of causes, including constipation, stress, food poisoning and a number of other medical reasons.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Types and causes

Abdominal pain can be divided into two types:

  • Acute pain, which tends to start suddenly without warning and is severe, and;
  • Chronic or recurrent abdominal pain, which is when your child experiences at least three distinct episodes of pain over three months or more. There may be a cause found, but in many cases it resolves without a diagnosis.

 

Causes of acute abdominal pain

Underlying causes of acute abdominal pain can include:

Mesenteric adenitis

This is often confused with appendicitis due to the presentation of symptoms and location of the pain - usually in the lower right-hand quarter of the abdomen, or near the bellybutton. This condition is usually caused by a viral infection. Your child may develop a high temperature, a flushed face and refuse to eat or drink anything; vomiting and general malaise are often noted. This usually passes within a week, with fluids and pain-relief medications being the best treatment. Your child may be admitted to hospital to undergo further testing, to rule out appendicitis.

Acute appendicitis

Appendicitis is more common in adolescents and children between 5-15 years of age, but can occur at any time. Symptoms are usually vomiting, diarrhoea and pain that worsens with walking, coughing or vigorous movement. The pain usually starts in the middle of the child's abdomen near their bellybutton, but then moves to their lower-right abdomen.

Appendicitis is a medical emergency because without treatment, the appendix can rupture, releasing bacteria and faeces (stool) into the abdomen, which can potentially be life-threatening.

Gastroenteritis ('gastro')

Gastroenteritis, or stomach flu, is a highly contagious condition that often affects whole communities. Symptoms include acute stomach pain accompanied by diarrhoea and vomiting. The best treatment is bed rest and sips of water; hospitalisation is only required if your child has been persistently vomiting and has become dehydrated. Handwashing is very important, as 'gastro' can spread to the whole family very quickly.

Intussusception

Intussusception is a form of bowel obstruction, in which one part of the intestine 'telescopes' inside another. This usually occurs in very young children, between three months and two years of age. Pain is usually sudden and occurs in waves. Your child can have a swollen abdomen, vomit, become weak and may draw their legs upwards. They will often pass blood in the stool, which looks like redcurrant jelly. Intussusception is a medical emergency, requiring immediate treatment.

Bowel obstruction

Bowel obstruction occurs when something stops the normal movement of food, liquids and gas through the digestive system. Symptoms are persistent vomiting, swollen abdomen, lack of bowel movements or ability to pass gas and increasing pain. It is a medical emergency and warrants immediate treatment, as lengthy delays in seeking treatment can be life-threatening.

Accidental poisoning

Young children are at great risk of poisoning as they may not understand warning labels, nor being told 'not' to drink or eat something. Adult medications, contaminated food, berries, plants, household products, batteries and soap are all common causes of poisoning. Magnets are also a common reason for hospitalisation, as they can cause bowel obstruction by sticking together through the intestinal wall. Symptoms will depend on what they have eaten, but paleness, vomiting and severe abdominal pain are commonly seen.

If you think your child has swallowed something inedible or poisonous, take them straight to hospital or call the Poisons Information Line on 13 11 26.

Trauma

If your child experiences abdominal pain after falling from a bicycle or from a height, take them straight to the emergency room to rule out internal trauma. If your boy reports pain or swelling in his testes, this needs immediate medical attention as he may have a testicular torsion, a condition requiring immediate surgery.

Other causes

Causes of chronic and recurrent abdominal pain

Underlying causes of chronic abdominal pain can include:

Constipation

Many young children have constipation, often due to not wanting to use the toilet in an unfamiliar place, or ignoring the body's signals to open their bowels. Encourage your child to drink plenty of water throughout the day, to get lots of exercise and ensure they have enough fibre in their diet in the form of fresh fruit and vegetables. Prompt them to go to the bathroom after eating and watch out for signs of pain when they pass a bowel movement.

Irritable bowel syndrome

If your child is experiencing abdominal pain alongside constipation or diarrhoea, bloating and passing mucus in their stool, they may have irritable bowel syndrome (IBS). If this has been happening for more than two months at least once a week, your doctor may suggest seeing a specialist to confirm a diagnosis.

Coeliac disease

Coeliac disease is the inability to digest gluten, a protein found in rye, wheat, barley and many prepared foods. Common symptoms are diarrhoea, abdominal pain with bloating, reduced appetite, skin conditions and weight loss. There is often a genetic link with a close relative also having the condition. Diagnosis is made via a blood test or biopsy.

Crohn's disease

Crohn's disease is a type of inflammatory bowel disease (IBD) that can affect children as young as seven years old. It presents as colicky abdominal pain, diarrhoea with blood in the stool and tiredness. Crohn's disease causes severe inflammation in your child's bowel, leading to malabsorption (the intestine's inability to fully absorb nutrients) and weight loss. Crohn's disease is diagnosed by a specialist know as a gastroenterologist. This condition responds well to medication.

Emotional reasons

Children are prone to tummy upsets if they are worried about something. If your child is having recurring tummy trouble, try and find out if there is something troubling them at school or home.

Other causes

Signs and symptoms requiring immediate medical attention

If your child displays any of the following symptoms, take them to your doctor or emergency department immediately:

  • Vomiting for more than 24 hours;
  • Developing a skin rash with headache or pain;
  • Becoming weak and listless;
  • Becoming pale, sweaty and unresponsive;
  • Having pain in their groin or pain and swelling in their testicle;
  • Having blood in their urine or stool, or having pain when passing either;
  • Not passing urine (for young children, having less than four wet nappies in a day);
  • Having severe pain that moves, or that gets worse, and;
  • Continuous pain in the right-hand side of their abdomen.

Bacteria

Microscopic, single-celled organisms with DNA but no definite nucleus. Bacteria are the cause of many human diseases.

Biopsy

The removal of a tissue sample for microscopic laboratory examination. It is used to determine the presence, cause and type of the disease.

Blood test

During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analysed to help diagnose and monitor a wide range of health conditions.

Dehydrated

The state of insufficient hydration; excessive loss of water; requiring more water in order to function normally.

Digestive system

The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.

Faeces

Waste or excrement that is discharged from the bowels after digestion.

fibre

Ingredients in food that are not digestible. They pass through the digestive system relatively unchanged and help to keep the digestive system healthy.

Genetic

Related to genes, the body's units of inheritance or origin.

Gluten

A mixture of proteins that occur in wheat, barley, rye and similar grains.

Headache

Pain across the face, eye, ears and other head or neck areas. Can be a dull ache, stabbing or throbbing pain.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Inflammatory bowel disease

A group of conditions characterised by chronic, episodic inflammation of the bowels, including Crohn's disease and ulcerative colitis.

Intestine

The part of the digestive system from the stomach to the anus.

Intussusception

An intestinal obstruction in which one part of the intestine is inverted into another.

Mucus

A thick, viscous liquid that is secreted for lubrication and to form a protective lining over certain tissues.

Nutrients

Substances in foods that are necessary for the body to function and grow. They include macronutrients, which provide energy and micronutrients, which are substances needed in small amounts such as vitamins, minerals and trace elements.

Testes

The male sex organs located in the scrotum that produce sperm.

Testicle

The male reproductive organs that produce sperm and the hormone testosterone.

Testicular torsion

This condition occurs when a testicle rotates, twisting the spermatic cord and reducing blood flow to the scrotum. Symptoms such as severe pain and swelling can develop suddenly.

Trauma

1. Physical injury to the body caused by force or a toxic substance. 2. Psychological damage caused by a severely disturbing experience.

Urine

The yellowish fluid made by the kidneys and moved via the urinary tract out of the body. It contains waste products, excess water and electrolytes.

Viral

Pertaining to an illness caused by a virus.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Bowel

The part of the digestive tract that comprises the small and large intestines.

Groin

The area where the abdomen joins the thighs.

Methods for diagnosis

Medical history

Your family doctor will take a medical history before examining your child, to see if there is an obvious cause for their discomfort. As children are often frightened or shy when they visit the doctor, it will help if you have written down all their signs and symptoms to include:

  • The timescale of when the child's pain started and how often it occurs (if recurrent);
  • What they had just eaten and how soon after the pain started;
  • If the child was emotionally upset about anything;  
  • What makes the pain better or worse, and;
  • Whether bowel movement or urination affects the pain.

Physical examination

Your doctor will want to physically examine your child to see if there is an obvious cause for their pain. Physical complaints such as appendicitis and constipation tend to have recognisable signs, so your doctor will want to gently examine your child's abdomen.

Other tests

If your doctor can find no obvious reason for your child's pain, they may suggest further testing such as:

Anaemia

A deficiency in red blood cells or haemoglobin in the body.

Antibodies

A protein molecule produced by the immune system. Antibodies bind specifically to foreign substances to neutralise them or target them for destruction.

Bacteria

Microscopic, single-celled organisms with DNA but no definite nucleus. Bacteria are the cause of many human diseases.

Blood tests

During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analysed to help diagnose and monitor a wide range of health conditions.

Digestive system

The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.

Infections

Entry into the body of microorganisms that can reproduce and cause disease.

Urine

The yellowish fluid made by the kidneys and moved via the urinary tract out of the body. It contains waste products, excess water and electrolytes.

X-rays

A scan that uses ionising radiation beams to create an image of the body’s internal structures.

Bowel

The part of the digestive tract that comprises the small and large intestines.

Types of treatment

The type of treatment offered will depend on what is causing your child's abdominal pain, but the most common options are:

Lifestyle changes

If your child's abdominal pain is due to constipation or overindulgence in unhealthy foods, you may be referred to a dietitian. Including at least five portions of fresh fruit, vegetables and whole grains in their daily intake can promote healthier bowel movements. Drinking lots of water and getting plenty of exercise is also important in keeping their bowels moving.

Medication

Most doctors prefer not to give children medication, though in some cases it will be necessary, such as in the following situations:

  • Antibiotics will usually be prescribed for bacterial infections;
  • Antiemetics may be prescribed if your child has uncontrollable vomiting;
  • Antivirals may be prescribed for viral infections;
  • Parasitic infestation will be treated with antiparasitic drugs, and;
  • Severe cases of constipation may warrant laxative use.

Surgery

If your child has appendicitis, bowel obstruction, intussusception, or eaten something that has perforated or become stuck in their bowel, they will be admitted for surgery. The type of surgery required will depend on their circumstances.

Antibiotics

Chemical substances that kill or suppress the growth of bacteria.

Dietitian

A health professional who specialises in diet and nutrition.

Infections

Entry into the body of microorganisms that can reproduce and cause disease.

Intussusception

An intestinal obstruction in which one part of the intestine is inverted into another.

Laxative

Any substance that causes or encourages bowel movements.

Viral

Pertaining to an illness caused by a virus.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Bowel

The part of the digestive tract that comprises the small and large intestines.

Bacterial

Relating to bacteria, which are microscopic organisms with DNA, but no definite nucleus. They are capable of causing many diseases in humans.

Potential complications

The majority of causes for abdominal pain in children tend to pass without any complications. There is always a slight risk involved with any surgery - mainly infection or localised bleeding - but children tend to bounce back from surgery much more quickly than adults.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Prognosis

The outlook for most cases of abdominal pain in children is good, with most cases passing with simple bed rest, sips of water and mild pain-relief medication. If your child has a medical reason for their pain, they will be referred to a specialist or treated in hospital where recovery is usually quick and uneventful. Your doctor will advise you if a referral to a specialist is required.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Prevention

There is no fail-safe way to stop your child having abdominal pain, but keeping an eye on what they eat will help. Monitor their consumption and limit the amount of snack foods, fizzy sodas and sweets they eat, as children often do not know when to stop. Keeping a food diary will help pinpoint any foods that cause problems, as children will not always remember.

Young children sometimes eat non-food items (e.g., coins); usually these will pass through their digestive system without trouble. Ingestion of medicines and poisons are much more worrisome; these products must be kept in lockable cupboards away from children. Keep a close watch on any signs your child is stressed or worried and see if these have any correlation to their abdominal pain.

Digestive system

The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.