My Tummy Hurts: Pediatric Abdominal Pain

Abdominal pain is one of the most common symptoms of illness during childhood. It’s not always easy for parents to deal with. Younger children cry continuously due to the pain, and are unable to describe the location and severity, often causing parents to have no idea what to do. Sometimes they think their child is just having a temper tantrum and delay seeing a doctor. Armed with some basics about pediatric abdominal pain, parents can not only provide more information to help with diagnosis and treatment, but also to seek medical attention in time to avoid serious complications.

Pediatric abdominal pain by location

1. Center of the upper abdomen: mostly caused by peptic ulcer, acute or chronic gastritis, acute pancreatitis, pleurisy, lobar pneumonia, and roundworms in biliary tract

2. Right upper abdomen: mostly caused by hepatitis, cholecystitis, cholelithiasis, parasitic intestinal roundworms, and roundworms in biliary tract

3. Left upper abdomen: mostly caused by spleen trauma

4. Around the umbilicus: mostly caused by parasitic intestinal roundworms, intestinal cramps, acute or chronic enteritis, and Henoch–Schönlein purpura

5. Right lower abdomen: mostly caused by acute appendicitis, mesenteric lymphadenitis, and intestinal tuberculosis

6. Left lower abdomen: mostly caused by dysentery, fecal impaction, and sigmoid volvulus

7. Belly button: mostly caused by pyelonephritis and ureteral calculi

Identifying the underlying causes of abdominal pain based on age

The underlying causes of abdominal pain can differ based on a child’s age. For children under 3 years old, especially infants, language skills are still developing so they cannot fully express themselves. Sometimes crying is the only way to communicate their discomfort. Parents must pay special attention, observe symptoms closely, and describe them to a physician to facilitate proper diagnosis. For this age group, intussusception, colic syndrome, incarcerated hernia, and intestinal infection are all common causes of abdominal pain.

Intussusception: if infants and young children (especially under 2 years of age) cry intermittently, display irritability, cry for about 10 to 15 minutes every 15 minutes to every one to two hours, vomit, and have dark red-colored stool, intussusception needs to be considered. Take your child to see a doctor immediately.

Infant colic: when healthy babies with adequate nutrition cry at least three hours a day, at least three days a week for more than three weeks, the baby probably has colic. For a 3-4 month-old baby, factors such as neurodevelopmental immaturity of the intestinal wall and irregular bowel movements with slow or fast peristalsis can contribute to spasms and colic discomfort. In addition, there are fewer digestive fluids and enzymes within infant’s digestive tract, which result in more gas production when digesting the protein in breast milk or formula. This will cause stomachache and flatulence. Finally, while babies cry, they swallow a good deal of air, which can make bloating and colic worse.

Incarcerated hernia: infants and young children are at risk for this. Children with an incarcerated hernia generally have a history of hernias. Inform your doctor if this is the case. Parents also need to pay attention to skin color changes around the hernia area. When your child cries more frequently and the surrounding skin of the hernia turns purple, the possibility of incarcerated hernia should be considered.

Intestinal infections: if pediatric abdominal pain is present along with fever, diarrhea, mucus, and pus or blood in the stool, it may be caused by intestinal bacteria. Please take your child to see a doctor. Don’t give your child antidiarrheal medicine without a doctor’s order.

If urine output becomes low, no tears are present when crying, or the child becomes lethargic, there is a danger of dehydration. Please take the child to the hospital immediately.

Acute appendicitis: If teenagers complain of pain in the upper abdomen or around the belly button that moves to the right lower abdomen later, along with fever, vomiting, possible diarrhea, abdominal tension, or tenderness in the right lower quadrant, acute appendicitis should be highly suspected. Immediate medical attention is necessary to prevent appendix perforation.

Gastritis: this can happen in all ages. There may be abdominal pain, bloating, poor appetite, or nausea and vomiting. The symptoms are often recurrent without any clear pattern. The pain often appears during or after a meal, located mostly in the upper abdomen and around the belly button. Some patients experience pain all over the abdomen. Some children have intermittent dull pain, while other may complain of severe cramps.

Children with chronic abdominal pain should be assessed to rule out Helicobacter pylori (H. pylori) bacterial infections. H. pylori are highly contagious, with humans being the only source of infection. An infected family member, once diagnosed, must start regular antibiotic treatment immediately to eliminate the source of infection. First, the existence of H. pylori infection must be determined, then effective treatment can be carried out to completely rid a person of recurrent stomach problems and prevent complications. Children should avoid food that may irritate their system (e.g., sour, spicy, overly cold, and fried food, as well as carbonated beverages) to decrease the damage to the gastric mucosal membranes and reduce the incidence of gastritis.

Identifying the causes of abdominal pain based on pain characteristics

Intermittent pain or cramps: this often indicates obstructive diseases. If the pain is relieved by localized compression or hot compress, then it is likely caused by spasms of the stomach, intestines, or bile ducts.

Persistent pain: deteriorating pain often indicates gastrointestinal perforation. If it is persistent dull pain, becomes worse with position change, is tender to touch, this pain is often caused by abdominal viscera inflammation, tumor, and peritoneal irritation.

Dull ache: mostly caused by peptic ulcer.

Characteristics of abdominal pain due to non-functional organic disease:

1. Continuous cramping that deteriorates intermittently

2. Area is tender to the touch

3. Abdominal muscle tension

4. Abnormal bowel sounds

Characteristics of abdominal pain due to functional reasons:

1. Recurrent dull pain

2. Tenderness to touch not significant or not severe

4. Soft abdomen

4. No bowel sound change

Identifying the causes of abdominal pain based on disease progress

Acute abdominal pain: when a child develops severe acute abdominal pain accompanied by other symptoms such as vomiting, bloody stool, or becomes pale, or experiences altered consciousness, acute abdominal illness may be suspected. These conditions include acute intussusception, intestinal obstruction, intestinal perforation, Henoch–Schönlein purpura, volvulus, and pancreatitis – all of which can require immediate surgical intervention.

If faced with this condition, please don’t use any analgesics, as they may result in severe complications. In addition, refrain from giving hot compress or abdomenal massage in this situation. Parents should take their child to see a doctor immediately, while at the same time the child should begin fasting (both food and drink, including water).

Chronic recurrent abdominal pain: this is for a mostly tolerable, dull ache. The pain may be associated with sympathetic nervous response symptoms, which include paleness and tachycardia. This type of pain is often seen in recurrent abdominal pain, including chronic gastritis, peptic ulcer, chronic enteritis, lead poisoning, sickle cell anemia, migraine headache with abdominal manifestations, abdominal epilepsy, irritable bowel syndrome, and functional dyspepsia. Children with functional disorders such as irritable bowel syndrome and functional dyspepsia should be encouraged to eat regularly and have regular bowel movement patterns.

Recurrent abdominal pain: the patient will complain of spasmodic or colicky pain, which normally occurs around the umbilicus. It can also occur in other areas of the abdomen. The pain may occur daily, weekly, monthly, or once every several months. It will last no more than one to three hours and will stop on its own without treatment. Patients will often experience the pain in the morning or at 3 to 4 pm in the afternoon. The pain usually gets worse when the patient is hungry or eating. 90% of recurrent abdominal pain is not related to physical illness. Autonomic nerve disorder, sensitive visceral sensation, gastrointestinal dysfunction, and psychological factors like anxiety, depression and school phobia may be related to the abdominal pain.

Abdominal pain that has an acute onset or deteriorates intermittently is often caused by diseases which require surgical intervention, such as acute appendicitis, bowel obstruction, gastrointestinal perforation, intussusception, and incarcerated inguinal hernia. If the abdominal pain is consistent and occurs slowly, diseases which do not require surgical intervention, including intestinal roundworm disease, gastric and duodenal ulcer, enteritis, and viral hepatitis are all common causes.

However, sometimes the cause of acute and chronic abdominal pain can be the same due to different stages of a disease. For example, a gastric ulcer is normally a chronic disease. When the ulcer perforates, it will cause acute abdominal pain. Parents of children with chronic abdominal pain should be aware of the possibility of an acute episode if their child’s pain becomes sharp and persistent. Urgent medical attention is needed if this is the case.

In addition, the incidence of abdominal pain from allergies is on the rise. If abdominal pain occurs right after drinking milk, eating eggs, fish, or shrimp, it might indicate an allergic reaction. As long as the allergy-causing food is discontinued, the abdominal pain will improve. The incidence of pediatric abdominal pain will also decrease if children refrain from overeating or drinking an abundance of cold beverages.

Abdominal pain is one of the most common symptoms in childhood. The causes can be attributed to a variety of different problems. Parents needn’t be overanxious about abdominal pain, but should be vigilant nonetheless.

I advise parents to help young children develop and maintain a healthy lifestyle while avoiding risk factors to decrease the occurrence of abdominal pain. If abdominal pain does occur, and parents are unsure of the severity, I recommend taking their child to see a physician immediately to prevent any possible complications from occurring.