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. We classify abdominal pain into three types: chronic abdominal pain, abdominal pain associated with infections that cause vomiting and diarrhea, and acute abdominal pain.
Some common causes of chronic abdominal pain (long standing pain) in infants and children are:
- constipation
- lactose intolerance
- milk allergy
- acid reflux disease (GERD)
- Celiac disease
- peptic ulcer disease
- irritable bowel disease
- Crohn’s disease
- non specific abdominal pain of childhood
- anxiety conditions and many others
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. The most common cause of a tummy ache in a child is constipation. Please refer to the section on constipation in this handbook for more information on this topic. Other causes of chronic abdominal pain are also covered in this website. See the appropriate sections.
Abdominal pain can also be associated with infections that cause vomiting with or without diarrhea. Many times, the abdominal pain will precede the vomiting and or diarrhea. Abdominal pain associated with 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
See the vomiting and diarrhea section of this website for management advice.
Acute abdominal pain is pain that occurs quickly and severely in the abdomen without warning. This type of pain is more worrisome. Although acute abdominal can be due to constipation, there are some causes of acute abdominal pain that require immediate medical attention. These are:
- Appendicitis: The appendix is a long tubular structure that is attached to the large intestine. No one knows for sure the function of the appendix. We do know that you can live without it. Rarely this structure can get blocked by stool or a foreign body and become infected. This infection can lead to an abscess and even infection in the peritoneal cavity, a condition called peritonitis. Blockage and infection of the appendix is serious and should be treated as a medical emergency. 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 time. As the pain moves to the right lower quadrant, it generally becomes much more severe. 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. Appendicitis can affect any age. If you suspect this, give your child nothing to eat or drink and seek medical attention immediately. Surgery may be needed. Delays in treatment of appendicitis can be serious.
- Intussusception: This is a condition that occurs when one portion of the large intestine slides into the next, much like the moving of the pieces of a telescope. 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, with leakage of intestinal bacteria into the abdominal cavity, a very harmful development. Intussusception needs immediate treatment. It occurs most often in babies between the ages of 5 and 10 months of age. Older children over the age of two years rarely get intussusception. Babies with intussusception can have intense abdominal pain, which often begins very suddenly and causes loud crying and screaming. The pain is usually intermittent, but 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 distention 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 is diagnostic and usually curative. Surgery is sometimes needed. Ultrasound can be done to diagnose intussusception.
- Sometimes infections in other areas of the body can cause abdominal pain. These conditions may include: strep throat, pneumonia, mononucleosis and urinary tract infections among others. 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.
- In menstruating girls ovulation pain and dysmenorrhea (pain from menses) are common. Try naproxen (Aleve) for this. See the package for dosing information. Consult us if this is severe as there are other treatment options.
- Sometimes migraine headaches can cause abdominal pain. 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.
- There is a very long list of more rare causes of abdominal pain. Consult us for this information. This can be a very complicated problem.