ABDOMINAL PAIN
Abdominal pain, known also to parents as tummy aches or belly aches, are very common issues for parents to deal with during their child’s life. The causes of abdominal pain are many and varied. The majority of the cases of mild abdominal pain are not serious and will usually resolve on their own. However, because serious conditions can cause abdominal pain, we will address the subject here in some detail here. We classify abdominal pain into three types: chronic abdominal pain, abdominal pain associated with infections that cause vomiting and diarrhea, and acute abdominal pain.
Chronic Abdominal Pain
Some common causes of chronic abdominal pain (long-standing pain) in
infants and children are:
- anxiety conditions
- constipation (by far the most common cause of abdominal pain)
- functional abdominal pain (no cause can be found)
- gastroesophageal reflux disease (GERD)
- infections (viral, bacterial, parasitic)
- inflammation (Crohn’s disease, Ulcerative Colitis, Celiac disease)
- irritable bowel disease (IBS)
- lactose intolerance
- milk allergy
- non-specific abdominal pain of childhood
- peptic ulcer disease
Chronic abdominal pain can last for quite some time, depending on its cause and how it is treated. Although treatment is important to begin as soon as possible, this is not an emergency and can wait until the office is open during our regular office hours. By far, the most common cause of a tummy ache in a child is constipation. Please refer to the section on constipation for more information on this topic. Other causes of chronic abdominal pain listed above are also covered in this handbook. See the appropriate sections.
Abdominal pain associated with infections
Abdominal pain can be associated with infections that cause vomiting with or without diarrhea. Many times this type of abdominal pain will precede the vomiting and or diarrhea.
Abdominal pain associated with vomiting and/or diarrhea may be due to:
- a stomach virus
- parasites
- bacterial infection of the GI tract, such as those due to food poisoning
- food allergy
- Inflammatory bowel diseases and other causes
Please see the
vomiting and diarrhea section for management advice of this type of abdominal pain.
Acute abdominal pain
Acute abdominal pain is moderate to severe pain that occurs quickly in the abdomen without warning. This type of pain is more worrisome. It typically appears over a few hours to a few days and may require urgent medical evaluation due to its potential to indicate a wide variety of potentially serious medical conditions.
Causes of acute abdominal pain can include appendicitis, gallstones, pancreatitis, intestinal obstruction, urinary tract infections, sexually transmitted infections, kidney stones, and more. The nature of the pain, along with other symptoms and a physical examination, helps us determine the underlying cause and appropriate treatment.
Although acute abdominal pain may be due to constipation, some causes of acute abdominal pain require immediate medical attention. These include:
Appendicitis:
The appendix is a pouch-like tubular structure that is attached to the cecum, the initial part of the large intestine. It is located in the right lower side of the abdomen.
No one knows for sure what the function of the appendix is, although it is believed to play a role in the immune system and may act as a reservoir for beneficial gut bacteria. We do know that you can live without it.
Rarely, this structure may become blocked by stool or a foreign body and become inflamed and infected. This is called appendicitis. This infection can lead to an abdominal abscess and infection in the peritoneal cavity, a condition called peritonitis. Blockage and infection of the appendix are serious and should be treated as a medical emergency. Appendicitis affects individuals of all age groups but is most common in children and young adults.
Appendicitis usually begins with mild to moderate dull abdominal pain, which is located in the umbilical area. The pain then generally moves to the right lower quadrant over a few hours. As the pain moves to the right lower quadrant, it generally becomes much more severe. Fever can be low-grade in the early stages but may increase as the condition worsens.
Most people lose their appetite with appendicitis. Nausea, vomiting, a bloated feeling, and an inability to pass gas can all happen. Appendicitis causes the abdomen to be very tender and hurt if touched or prodded. A good test to see if your child has appendicitis is to have them jump up and down. If your child can jump up and down without pain, appendicitis is unlikely.
If present, appendicitis requires immediate evaluation by a pediatric general surgeon. Appendicitis can affect any age. If you suspect this, give your child nothing to eat or drink and seek medical attention immediately at the Arkansas Children’s Hospital emergency room. Surgery may be needed. Long delays in the treatment of appendicitis can have serious complications.
Intussuception:
Intussuception occurs most often in babies between the ages of 3 months and 12 months of age, up to three years of age. Older children over the age of two years rarely get intussusception.
This condition occurs when one segment of the intestine slides into the next, much like the moving of the pieces of an old telescope. Most often, this occurs in the small intestine, specifically the ileum, into the colon. When this happens, it can create a blockage in the intestines, with the walls of the intestines pressing against one another. This, in turn, leads to swelling, inflammation, and decreased blood flow to the affected part of the intestine. This can cause part of the intestine to die due to the lack of blood flow, with leakage of intestinal bacteria into the abdominal cavity, a very harmful, life-threatening development.
Babies with intussusception can have intense abdominal pain, which of ten begins very suddenly and causes loud crying and screaming. The pain is usually intermittent, but it recurs and may become stronger. As the pain eases, the child may stop crying for a while and seem to be feeling better, only to recur again.
As the disease worsens, the following can happen: abdominal distension and swelling, vomiting, the passing of dark, bloody stools (known as currant jelly stools), and grunting due to the pain. This is an emergency that requires immediate attention. A contrast enema done by a pediatric radiologist is diagnostic and usually curative. Surgery is sometimes needed. Ultrasound can be used to diagnose intussusception.
Symptoms: Intussusception presents with several clinical features:
- Classic Triad of Symptoms: Severe abdominal pain, vomiting, and bloody stools (described as currant jelly-like stools).
- Abdominal Distension: Gradual enlargement of the abdomen due to bowel obstruction.
- Intermittent Symptoms: Fluctuating periods of normality alternating with episodes of severe symptoms: abdominal pain, crying, and screaming.
Diagnosis: The diagnosis of intussusception involves the following steps:
- History and Physical Examination: Evaluating for classic symptoms and signs while taking a detailed medical history.
- Imaging Studies: Ultrasound is the imaging modality of choice, providing visualization of the intussuception and aiding in diagnosis.
Treatment: Treatment options for intussusception include:
- Non-operative Reduction: This involves using an air or barium enema under radiological guidance to forcibly reduce the intussuception.
- Continued Observation: After successful reduction, monitoring for recurrent intussuception or complications is necessary.
- Surgical Intervention: Surgery becomes necessary if non-operative reduction is ineffective or associated with complications, or in cases of bowel perforation, peritonitis, or suspected necrosis.
Complications: Possible complications of intussuception include:
- Bowel Perforation: Prolonged obstruction or inadequate reduction can lead to bowel wall necrosis and subsequent perforation.
- Peritonitis: Infection of the peritoneal cavity resulting from bowel perforation, requiring urgent surgical management and antibiotic therapy.
- Recurrent Intussuception: Despite successful reduction, intussuception can recur, necessitating careful monitoring and potentially further interventions.
Infections in other areas of the body:
Sometimes infections in other areas of the body can cause abdominal pain. These conditions may include: strep throat, pneumonia, mononucleosis and urinary tract infections. Usually, the pain is not too severe, and the other symptoms of these infections are the aspects of the illness that get the majority of the attention. See the appropriate sections of this handbook for management advice. These types of problems can usually wait until regular office hours.
Menstrual abdominal pain:
In menstruating women, ovulation pain and dysmenorrhea (pain from menstruation) are common. Try naproxen (Aleve) for this. See the package for dosing information. Consult us if this is severe, as there are treatment options.
Migraine:
Sometimes migraine headaches can cause abdominal pain. See our section on migraine in the handbook. Consult us about this.
Kidney stones:
The pain of kidney stones is typically felt in the flank area (side), although it can be felt in the abdomen. It is typically quite severe. Consult us for this.
Other:
There is a very long list of rarer causes of abdominal pain. Consult us for this information. This can be a very complicated problem.
