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.

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, diarrhea 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 feces (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 diarrhea and vomiting. The best treatment is bed rest and sips of water; hospitalization is only required if your child has been persistently vomiting and has become dehydrated. Hand washing 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 hospitalization, 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

• Urinary tract infections;
• Infantile colic, and;
• Period pain in girls.

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 fiber 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 diarrhea, 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 diarrhea, 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, diarrhea 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

• Lactose intolerance;
• Food allergy, and;
• Gastrointestinal worms.

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.

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 recognizable 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:

• Stool and urine samples - these tests will check for parasites, bacteria and urinary tract infections;
• Blood tests - to check for infection, anemia and antibodies produced in coeliac disease, and;
• X-rays - these are often used to check for bowel obstruction and any abnormality in the digestive system.

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.

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 localized bleeding - but children tend to bounce back from surgery much more quickly than adults.

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.

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.