Common Causes For Stomach Pain In Children And When To Worry

What it could be

Sudden abdominal pain that comes and goes for a few hours is usually a sign of one of two things: gas or an abrupt attack of constipation (which is more likely to cause chronic belly pain and can occur as the bowel squeezes to expel hardened poop). Crampy pain that occurs an hour or two after eating points to constipation.

What parents can do

If constipation seems likely, fluids, fibre and regular toilet habits may help. Some children may also need a stool-softening treatment, but it’s best to check with your doctor or pharmacist before giving a laxative, since the right product and dose depend on your child’s age and symptoms.

If constipation becomes persistent, try boosting fibre intake. Choose whole-grain breads and cereals containing at least four grams of fibre per serving, and veggies like baked sweet potatoes.

Pain relieved by impolite bodily noises implicates gas. There’s little you can do once the wind is underway, but figuring out which foods upset your child’s stomach may prevent future blow-ups (see Uncomfortable bouts of bloating and gas).

When to worry

Call your doctor if the pain lasts more than 24 hours, keeps getting worse, or comes with vomiting, fever, bloating, bloody stools or trouble peeing.

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What it could be

Fever usually signals that the body’s anti-infection forces are battling bacteria or viruses. If the tummy ache quickly leads to vomiting and diarrhea, the prime suspects are organisms like Norovirus and rotavirus, passed between children via the “bums to gums” route, or food-borne illnesses such as Salmonella, says Robert Issenman, chief of paediatric gastroenterology at McMaster Children’s Hospital in Hamilton and president-elect of the Canadian Paediatric Society.

“About 90 percent of gastroenteritis or ‘stomach flu’ is caused by viral infections that get better on their own,” he reassures. Similarly, most cases of food poisoning don’t require special treatment. The exceptions—including those caused by E. coli-contaminated water or hamburgers—are relatively uncommon and tend to trigger scarier symptoms like bloody diarrhea (see Red Flags).

What parents can do

The biggest concern with vomiting and diarrhea is dehydration. Offer small, frequent sips of an oral rehydration solution such as Pedialyte or Gastrolyte, which replace both fluids and electrolytes. Juice and other sugary drinks can make diarrhea worse. If your child can keep fluids down and is peeing normally, most stomach bugs improve on their own — but signs of dehydration mean it’s time to call your doctor.

Don’t give anti-diarrhea or anti-nausea medicines unless your doctor recommends them, since some products aren’t appropriate for children.

Again, fever indicates the immune system is mobilizing its foot soldiers. Soreness in the lower abdomen could be due to a urinary tract infection (UTI), which is more likely to affect a girl than a boy because of her shorter urethra (the tube that empties urine out of the bladder).

Burning or pain while peeing are dead giveaways, but not all kids experience these symptoms, and toddlers may not be able to tell you exactly where it hurts. Also, some kids are prone to puking when their temperatures rise, so vomiting doesn’t rule out a UTI.

If you suspect your child has a UTI, a simple urine test by your doctor can confirm the diagnosis, and she’ll receive antibiotics so the infection doesn’t spread to the kidneys. Avoiding bubble baths, encouraging good bathroom hygiene and wiping front to back may help lower the risk of future UTIs. Some research suggests cranberry products may help prevent some infections in some children, but the evidence is mixed, and cranberry juice won’t treat an active UTI.

When to worry

Get medical advice if your child shows signs of dehydration, can’t keep fluids down, has bloody diarrhea, severe pain, unusual sleepiness, or symptoms that are getting worse instead of better.

What it could be

Appendicitis can mimic a garden-variety stomach virus, with loss of appetite, vomiting and soreness starting near the belly button, then moving to the lower right side. According to David Sigalet, Chief of Surgery at Sidra Medical and Research Center in Doha, Qatar, appendicitis occurs when the appendix, a hollow tube, becomes blocked or swollen and mucous and bacteria build up, eventually creating an abscess.

It typically takes about 48 hours after noticing the first symptoms for a serious infection to develop and four to five days for an abscess to form.

What parents can do

Seek medical care promptly if appendicitis seems possible. Until your child is assessed, avoid giving food, drink or pain medicine unless a clinician tells you otherwise.

Making the call can be tough, so here’s a hint: Movement makes the pain worse, so your child may walk hunched over or grimace if her bed is bumped. If all signs point to appendicitis, seek medical attention early; appendicitis requires surgery to remove the organ. Meanwhile, avoid giving pain medication, but a warm water bottle and lying in a fetal position will make your child more comfortable.

When to worry

Don’t wait if the pain is getting worse, your child is hunched over, movement makes the pain sharper, or the abdomen becomes very tender.

What it could be

When a mixture of food and acid flows back through a weak valve at the top of the stomach (gastroesophageal reflux or GER), it causes heartburn and a “barfy” taste in the back of the throat. Heartburn typically doesn’t affect young kids, but becomes more common as puberty approaches, notes John Howard, a paediatric gastroenterologist and professor at the University of Western Ontario. GER is common in babies under a year old, but it usually causes spitting up rather than heartburn.

What parents can do

If your child has recurring burning pain after eating, check in with your doctor before using over-the-counter antacids or reflux medicines, since not all products are appropriate for children. Smaller meals, avoiding trigger foods, and not lying down right after eating may help in the meantime. Rather than subjecting kids to invasive tests, Howard usually prescribes a medication to suppress stomach acid production—if it works within two or three days, that proves the problem is heartburn.

When to worry

Call your doctor if the burning pain keeps happening, is getting worse, or starts interfering with meals, sleep or daily activities. Get medical advice sooner if your child has trouble swallowing, vomits repeatedly, loses weight, refuses food or has vomiting, black stools or severe pain, since those symptoms can point to something more serious than simple reflux.

What it could be

During a period, there’s a surge of prostaglandins (hormone-like substances that help control pain and inflammation), which can trigger uncomfortable muscle spasms or cramps in the uterus. (Some girls start getting them before ever having a period, as early as age nine.)

What parents can do

So how do you help your daughter cope? “Cramps respond marvellously to over-the-counter ibuprofen,” says Issenman, adding that the medication blocks the action of prostaglandins. Many parents also seek natural remedies—from boosting dairy intake before a period is due to giving (with professional advice) herbs like black haw or cramp bark.

When to worry

Call your doctor if the cramps are severe, keep getting worse, start between periods, or regularly cause your child to miss school or normal activities. Get medical advice sooner if the pain comes with fever, vomiting, heavy bleeding, dizziness, fainting, pain on one side, or symptoms that don’t seem to match a typical period, since those signs may point to something other than menstrual cramps

What it could be

Do certain foods seem to set off your child’s digestive disturbances? Too much sugar from fruit juice is one possibility: Normal gut bacteria gobble up the sweet stuff and give off gas. Or an inability to digest certain simple carbohydrates could be to blame, for instance, lactose intolerance is caused by a lack of the enzyme needed to break down milk sugar.

This condition usually doesn’t strike until after age two and particularly affects children of Asian, African, First Nations, Mediterranean and Hispanic descent. Some kids also have difficulty digesting complex starches in beans and vegetables.

What parents can do

If you suspect your child is lactose intolerant, consider substituting lactose-reduced milk for regular moo juice, but check with your doctor before eliminating nutrient-packed dairy from her diet. Also, a few drops of Beano on starchy foods may make them easier to stomach.

When to worry

Call your doctor if the bloating and gas keep happening, seem to be getting worse, or are causing ongoing pain, diarrhea, constipation or missed meals. Get medical advice sooner if your child also has weight loss, vomiting, bloody stools, persistent diarrhea, poor growth, or symptoms after many different foods, since that may point to something more than simple gas, such as a food intolerance or another digestive issue.

What it could be

Although rare before adolescence, irritable bowel syndrome can crop up afterwards. What causes it is unclear, but somehow, the bowel becomes oversensitive to normal digestive action.

What parents can do

Treatment includes increasing fibre intake and avoiding caffeine beverages and fatty foods like French fries. Cheryl Mutch, a paediatrician in Burnaby, BC, also suggests kids don’t miss meals. “If they’re skipping breakfast and lunch and not eating until they get home from school, that overloads the [digestive] system, and they get a stomachache.”

When to worry

Call your doctor if the constipation and diarrhea keep alternating, are getting more frequent, or are causing ongoing pain, missed school or changes in appetite. Get medical advice sooner if your child has weight loss, bloody stools, vomiting, pain that wakes them at night, persistent diarrhea, or symptoms that are affecting growth or daily life, since those signs may point to something more serious than a sensitive bowel.

What it could be

A child can strain abdominal wall muscles in the wake of prolonged bouts of vomiting or coughing, or after a sport like tennis or softball. The pain is relatively constant but will often worsen when he tenses his tummy muscles.

What parents can do

Have your child lie down and try lifting his legs. If the pain intensifies, it’s probably a simple muscle strain that will eventually subside. In the meantime, ibuprofen and ice or heat packs can ease the ache.

When to worry

Call your doctor if the pain doesn’t start to improve after a few days, keeps getting worse, or makes it hard for your child to walk, play or move normally. Get medical advice sooner if the pain comes with fever, vomiting, swelling, bruising, trouble breathing, or belly pain, even when the muscles are relaxed, since that may point to something more than a simple muscle strain.

What it could be

Sometimes, not even a doctor can pinpoint the cause of a child’s recurring bellyache. “Marek started complaining his tummy hurt at about 16 months,” recalls Laura Chutny of St. Albert, Alta. Almost two years later, he still occasionally suffers with a sore tummy. After conducting simple tests to exclude the usual suspects like a bladder infection or parasites, the paediatrician assured the Chutnys that Marek was perfectly healthy.

Unexplained stomach pain in children is relatively common, according to Howard. About one in six kids suffers from recurrent abdominal pain (RAP) of childhood, usually after age five. The ache generally affects the middle of the tummy during the day, seemingly without a specific cause.

The pain is real; scientists just haven’t figured out why it occurs. However, normal growth and development aren’t affected. So while it’s prudent to let your doctor examine your child, avoid the impulse to push for lots of tests. Research shows that children with RAP were less likely to improve within a year if their parents pushed for a diagnosis, rather than sending them to counselling.

What parents can do

For treatment, Howard recommends letting your child decide if the pain warrants sitting out regular activities (however, don’t be hoodwinked; no school means no TV or video games). Like any pain, RAP can be heightened by anxiety or stress, so yoga and relaxation exercises may help. It usually disappears around puberty.

When to worry

Call your doctor if the pain becomes more frequent, more severe, or starts interfering with school, sleep, eating or normal activities. Get medical advice sooner if your child has weight loss, vomiting, bloody stools, persistent diarrhea, fever, pain that wakes them at night, or any other new symptoms.

Some conditions, like ulcers, rarely strike kids before puberty, while others, like celiac disease (an immune system reaction to a protein in some grains), often cause hard-to-miss symptoms like prolonged diarrhea and weight loss. Dial your doctor if your child has any of the following symptoms:

Under six months old

• fever
• diarrhea (abnormally frequent, watery stools that may contain mucous or blood)
• extreme fussiness
• sunken fontanelle (soft spot)

All ages

•  weight loss
• bloody or black stools
• abdominal pain that awakens child at night
• difficulty swallowing
• pain when urinating
• belly pain lasting longer than 24 hours
• vomiting that continues for four to six hours or longer
• vomiting dark green material
• symptoms of dehydration: decreased urination; dry skin, mouth and tongue (look for stickiness under the tongue); no tears; sunken eyes; greyish complexion; extreme drowsiness or lethargy

How long is too long for a child’s stomach pain to last?

Many mild stomach aches get better within a few hours. Call your doctor if your child’s belly pain lasts longer than 24 hours, keeps coming back, or is getting worse instead of better.

What does dehydration look like in a child?

Signs of dehydration can include peeing less than usual, a dry mouth, no tears when crying, sunken eyes, unusual sleepiness or low energy. If your child is vomiting or has diarrhea and you notice these signs, call your doctor.

When is belly pain more likely to be constipation?

Constipation is more likely if the pain is crampy, comes and goes, happens around bowel movements, or your child is having hard, infrequent stools. Bloating and relief after pooping or passing gas can also point to constipation.

When could belly pain be appendicitis?

Appendicitis often starts as pain near the belly button and then shifts to the lower right side. The pain usually gets worse over time and may come with vomiting, loss of appetite, fever, or pain that gets sharper with movement.

When should I worry about vomiting and diarrhea with stomach pain?

The biggest concern is dehydration. Get medical advice if your child can’t keep fluids down, has signs of dehydration, has bloody diarrhea, is unusually drowsy, or seems to be getting sicker instead of improving.

Should I give my child medicine for stomach pain?

It depends on the cause. Avoid giving over-the-counter medicines unless you’re confident what’s causing the pain and the product is appropriate for your child’s age. If the pain is severe, worsening, or you’re worried about appendicitis, get medical advice before giving medicine.

Experts

• Robert Issenman is a paediatric gastroenterologist; cited in the story as chief of paediatric gastroenterology at McMaster Children’s Hospital in Hamilton and president-elect of the Canadian Paediatric Society.
• David Sigalet is Chief of Surgery at Sidra Medical and Research Center in Doha, Qatar.
• John Howard is a paediatric gastroenterologist and professor at the University of Western Ontario.
• Cheryl Mutch is a paediatrician in Burnaby, BC.