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Abdominal pain - children under age 12

Definition

Abdominal pain is pain that you feel anywhere between the chest and groin. This is often called the stomach area or belly.

This article discusses abdominal pain in children under age 12.

Alternative Names

Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children

Considerations

Almost all children experience pain in the abdomen at one time or another. Most of the time, it is not caused by a serious medical problem.

Severe abdominal pain can sometimes be from mild conditions, such as gas or the cramping of stomach flu. On the other hand, mild pain or no pain may be present with life-threatening conditions, such as cancer or early appendicitis.

Ways of describing the pain include:

  • Generalized pain may be present in more than half of the belly. This is more typical for a stomach virus, indigestion, or gas.
  • Pain may be localized, or found in only one area of the belly. This type of pain is more likely to be a sign of a problem in one organ, such as the appendix, gallbladder, or stomach (ulcers).
  • Cramp-like pain is usually not serious, and is more likely to be due to gas and bloating. It is often followed by diarrhea. More worrisome signs include pain that occurs more often, lasts longer (more than 24 hours), or has a fever with it.
  • Colicky pain is pain that comes in waves, usually starts and ends suddenly, and is often severe.

Infants and toddlers cannot describe their pain. Signs of belly pain may be:

  • An increase in fussiness
  • Drawing their legs up toward the belly
  • Poor eating

Common Causes

Many different conditions can cause abdominal pain in a child. The key is to know when you must seek medical care right away. In many cases you can simply wait, use home care remedies, and call your doctor at a later time only if the symptoms don't go away.

In infants, prlonged unexplained crying (often called "colic") may be caused by abdominal pain. It may end with the passage of gas or stool. Colic is often worse in the evening. Cuddling and rocking the child may bring some relief.

Less serious causes of abdominal pain include:

  • Constipation in irritable bowel syndrome
  • Food allergies or intolerance
  • Heartburn or acid reflux
  • Stomach flu or food poisoning (salmonella, shigella)
  • Strep throat and mono can cause abdominal pain in children

Other possible causes include:

  • Appendicitis (inflammation of the appendix)
  • Bowel blockage or obstruction
  • Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
  • Intussusception, caused by part of the intestine being pulled inward into itself
  • Tumors or cancers
  • Urinary tract infections

Sickle cell disease crisis may cause abdominal pain. It sometimes may be mistaken for the pain of appendicitis or conditions of other abdominal organs.

Home Care

When milder pain begins, ask your child to lie quietly to see if it goes away. Sometimes sips of water or other clear fluids may help. You may also ask your child to try to pass stool.

Avoid solid foods for the first few hours. Then try small amounts of mild foods such as rice, applesauce, or crackers.

Avoid:

  • Caffeine
  • Carbonated beverages
  • Citrus
  • Dairy products
  • Fried or greasy foods
  • High-fat foods
  • Tomato products

Do not give aspirin, ibuprofen, acetaminophen (Tylenol), or similar medicines without first asking your child's health care provider.

To prevent many types of abdominal pain:

  • Avoid fatty or greasy foods.
  • Drink plenty of water each day.
  • Eat small meals more often.
  • Exercise regularly.
  • Limit foods that produce gas.
  • Make sure that meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.

Call your health care provider if

Seek immediate medical help or call your local emergency number (such as 911) if your child:

  • Is a baby younger than 3 months and has diarrhea or vomiting
  • Is currently being treated for cancer
  • Is unable to pass stool, especially if the child is also vomiting
  • Is vomiting blood or has blood in the stool (especially if the blood is maroon or dark, tarry black)
  • Has sudden, sharp abdominal pain
  • Has a rigid, hard belly
  • Has had a recent injury to the abdomen
  • Is having trouble breathing

Call your doctor if your child has:

  • Any abdominal discomfort that lasts 1 week or longer
  • Abdominal pain that does not improve in 24 hours, or is becoming more severe and frequent
  • A burning sensation during urination
  • Diarrhea for more than 2 days or vomiting for more than 12 hours in an infant or child -- call right away
  • Fever over 100.4 degrees F
  • Prolonged poor appetite
  • Unexplained weight loss

What to expect at your health care provider's office

Knowing the location of pain and its time pattern will help. Also let the doctor know if there are other symptoms like fever, fatigue, general ill feeling, nausea, vomiting, or changes in stool.

Your doctor may ask the following questions about the abdominal pain:

  • What part of the abdomen is affected? All over? Lower or upper? Right, left, or middle? Around the navel?
  • Is the pain severe, sharp or cramping, constant, coming and going, or changing in intensity over minutes?
  • Does the pain wake your up child at night?
  • Have your child had similar pain in the past? How long has each episode lasted? How often has it occurred?
  • Is the pain getting more severe?
  • Does the pain get worse after eating or drinking? After eating greasy foods, milk products, or alcohol?
  • Does the pain get better after eating or having a bowel movement?
  • Does the pain get worse after stress?
  • Has there been a recent injury?
  • What other symptoms are occurring at the same time?

During the physical examination, the doctor will test to see if the pain is in a single area (point tenderness) or whether it is spread out.

Diagnostic tests that may be performed include:

  • Blood, urine, and stool tests
  • CT scan
  • Ultrasound of the abdomen
  • X-rays of the abdomen

References

Ebell MH. Diagnosis of appendicitis: part 1. History and physical examination. Am Fam Physician. 2008;77:828-830.

Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;25:438-451.

Rimon, N, Bengiamin RN, Budhram GR, King KE, Wightman JM. Abdominal pain. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 21.

Sreedharan R, Liacouras CA. Major Symptoms and Signs of Digestive Tract Disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 298.


Review Date: 9/19/2011
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine.
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