Common causes for stomach pain in children and when to worry

Your kid says her tummy aches, but you're not sure what's wrong. Here are a few common causes of stomach pain in children, and symptoms to look out for.

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Maybe it’s the fact that most of the body’s major organs are crammed into a couple of cubic feet which makes every child vulnerable to abdominal ailments. Whatever the reason, tender tummies can prompt parental anxiety. However, it’s relatively simple to determine if the culprit is a bug the body can fight on its own or something more serious. Here’s what you need to know about stomach pain in children, and when to worry.

Sudden stomach pain

Tummy ache without other symptoms
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 a meal points to constipation. In this case, a mild laxative such as milk of magnesia may help by softening the stool. 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 tummy may prevent future blow-ups (see Uncomfortable bouts of bloating and gas).

Sore tummy with fever, vomiting and diarrhea
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 Norwalk virus 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).

Preventing dehydration is crucial to your child’s recovery. Give small doses of mineral-balanced solutions like Pedialyte or Gastrolyte. “You want to avoid juices, in particular, because their sugar content is so high, they tend to make the diarrhea worse,” Issenman stresses. Hold the Kaopectate or Gravol — all that barfing and pooping is nature’s way of flushing out the infection.

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. Cranberry juice is also a useful remedy, and avoiding bubble baths and wiping front to back, especially after bowel movements, may foil future flare-ups.

Pain on the right side with a low-grade fever, and sometimes vomiting
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, a professor of paediatric surgery at the University of Calgary, 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 serious infection to develop and four to five days for an abscess to form. 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.

Recurring stomach pain

Burning in upper abdomen that worsens after eating
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.)

For occasional attacks, try a glass of milk or an antacid like Tums, but if they occur once a week or more, consult your doctor. Avoiding big meals, cutting out carbonated drinks and not lying down immediately after eating may also help. 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.

Cramps in lower abdomen (girls)
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.)

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’s due to giving (with professional advice) herbs like black haw or cramp bark.

Uncomfortable bouts of bloating and gas
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.

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.

Alternating constipation and diarrhea
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.

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 stomach ache.”

Pain that’s aggravated when abdominal muscles are tightened
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. 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.

Intermittent pain behind the belly button that’s unaffected by eating or bowel movements
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 abdominal pain is relatively common in childhood, 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. According to recent research, children with RAP were less likely to improve within a year if their parents pushed for a diagnosis, rather than sending them to counselling.

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.

Red flags
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 letharg

Read more:
What may be causing your kid’s stomach pain
The ultimate guide to kid puke
What to do when your kid is afraid to go poo

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