Children often complain of stomach pain. It is one of the most common reasons parents take children to their doctor or the hospital emergency department. Stomach pain can be hard to diagnose. The doctor will ask you questions then examine your child. Sometimes a problem may be quite obvious, so no tests are needed.
Many children with stomach pain get better in hours or days without special treatment and often no cause can be found. Sometimes the cause becomes more obvious with time and treatment can be started. If pain or other problems persist, see your doctor.
Causes of abdominal pain in children
There are many health problems that can cause stomach pain for children, including:
bowel (gut) problems – constipation, colic or irritable bowel
infections – gastroenteritis, kidney or bladder infections, or infections in other parts of the body like the ear or chest
food-related problems – too much food, food poisoning or food allergies
problems outside the abdomen – muscle strain or migraine
surgical problems – appendicitis, bowel obstruction or intussusception (telescoping of part of the gut)
period pain – some girls can have pain before their periods start
poisoning – such as spider bites, eating soap or smoking.
Repeat attacks of stomach pain
Some children suffer repeat attacks of stomach pain, which can be worrying for parents. Often, no health problem can be found.
Children may feel stomach pain when they are worried about themselves or people around them. Think about whether there is anything that is upsetting your child at home, school or kindergarten, or with friends. See your local doctor for advice. A referral may be needed to a paediatrician (a doctor who specialises in children).
Appendicitis explained
Appendicitis is one of the more common reasons your child may need surgery. The appendix is a small, dead-end tube leading from a part of the bowel. If this tube gets blocked, it can cause an infection. Appendicitis can happen at any age, but is rare in young children.
The pain often starts in the middle of the tummy and moves down low on the right side. The tummy becomes sore to touch. This is often worse with coughing and walking around. A child with appendicitis often shows signs of being unwell such as fever, refusing food, vomiting or (sometimes) diarrhoea.
If you are concerned your child may be developing appendicitis, visit your local doctor or go to the emergency department of your nearest hospital. An operation is often needed to remove the appendix, although in some cases the problem will settle without surgery.
Gastroenteritis
May be due to acute or chronic viral (especially rotavirus), bacterial, or parasitic GI infection.
Eosinophilic gastroenteritis, defined as a condition affecting the GI tract with eosinophil-rich inflammation without a known cause for the eosinophilia, can result in significant abdominal pain.
Haemolytic uraemic syndrome, characterised by microangiopathic haemolytic anaemia, thrombocytopenia, and nephropathy, can occur as a complication of gastroenteritis caused by verotoxin-producing Escherichia coli . Abdominal pain is a common presenting symptom.
Intestinal obstruction
Small or large bowel obstruction may be the result of various aetiologies and can occur at any age. Abdominal pain may not occur until the obstruction has progressed to include extensive abdominal distension or intestinal ischaemia. Intestinal obstruction may mimic intestinal ileus, which usually does not require surgical intervention.
The aetiology of intestinal obstruction can be congenital or acquired. Congenital causes include atresias or stenosis, which present in the newborn period.
Duodenal atresia or stenosis may cause complete or partial obstruction of the duodenum as a result of failed re-canalisation during development. This results in either stenosis with incomplete obstruction of the duodenal lumen (allowing some but not all gas and liquid to pass) or an atresia where the duodenum ends blindly causing a true complete obstruction.
Jejuno-ileal atresia or stenosis is a complete or partial obstruction of any part of the jejunum or ileum. Although uncertain, it is believed to result from a vascular accident during development. Jejunal stenosis may still have bowel lumen continuity with a narrowed lumen and thickened muscular layer. There are 4 types of atretic bowel, and all result in a complete obstruction due to a blind-ending lumen.
Colonic atresia is an extremely rare complete obstruction of any part of the colon, although it usually occurs near the splenic flexure. Like jejuno-ileal atresia, it is thought to occur as a result of a vascular event.
Viral hepatitis
The viral hepatitides include A, B, C, D, and E.
Hepatitis A virus remains a significant aetiology of acute viral hepatitis and jaundice, particularly in developing countries, in travellers to those countries, and in sporadic food-borne outbreaks in the Western world.
Hepatitis B virus (HBV) frequently causes acute hepatitis and is the most common cause of chronic hepatitis in Africa and the Far East.
Hepatitis C virus (HCV) represents the leading cause of chronic viral hepatitis in the Western world.
Hepatitis D virus is a defective virus that needs the presence of hepatitis B to cause clinically recognisable disease.
Hepatitis E virus represents a major cause of mortality in developing countries, especially among pregnant females.
Abdominal trauma
The third leading cause of death in paediatric trauma patients. It is generally classified as penetrating or blunt. Occult blunt abdominal trauma should always be considered in the setting of vague or inconsistent history. Additionally, it is important to consider child abuse/non-accidental trauma in this patient population (e.g., a kick to the abdomen). The liver, spleen, and kidneys are the most commonly injured intra-abdominal organs in blunt trauma. Most cases of blunt injury to the liver and spleen are managed non-operatively.
It is important to exclude duodenal and/or pancreatic injuries with bicycle handlebar injuries and/or direct blows to the abdomen. Hollow viscous injuries (e.g., stomach and intestines) are more common with penetrating trauma.
Diagnosis of abdominal pain in children
When a problem is quite obvious, no tests are needed. If tests are needed, they may include:
blood tests
urine test
stool (poo) sample
x-rays
other special tests
review by a specialist doctor.
If your child does undergo tests, the doctor should explain the results to you. Some results may take a number of days to come back and these results will be sent to your local doctor.
Treatment for abdominal pain in children
Your child’s treatment will depend on what the doctor thinks is causing their pain. Treatment may be as simple as sending your child home with advice to rest, take fluids and eat a bland diet. Other treatment options include hospital admission and surgery.
