"My tummy hurts" is a complaint most parents hear from their child from time to time. As a pediatrician, I also know that it's one of the most common reasons parents bring their children to my office. Fortunately, abdominal pain in children usually is not serious. Sometimes it's caused by something as simple as overeating and will go away on its own. When a child's stomach pain is chronic, however - meaning it occurs over and over - it's important to seek medical help to find the cause and help your child feel better. Sometimes stomach pain can even indicate a serious condition requiring treatment.

Because it can be difficult to know when to seek medical care, let me first list some red flags that should alert you to contact your doctor:

  • Weight loss

  • Blood in the stool

  • Blood or bile in vomit

  • Severe or debilitating abdominal pain

  • Signs of dehydration, such as decreased urination, dry mouth or skin, lethargy or drowsiness

  • A fever that lasts longer than two days

  • If your child is too weak to stand

  • If the stomachache is accompanied by a burning sensation while urinating

  • If the stomach pain moves from the center of the abdominal area to the right side

  • For babies under three months, if there is diarrhea, vomiting or fever

Most importantly, as I often tell parents, if you are just really worried about your child, that alone is a good enough reason to have him or her seen by a doctor. Even if it turns out there is no problem, at least you will feel reassured and have learned something about your child's body and health.

It helps to have some basic knowledge about what can cause a tummy ache in kids. Stomachaches have many causes. Here are some of the most common:

Constipation is probably the most common cause of abdominal pain that I see. The child has stomach pain and is having difficulty passing stools because the stools become hard. The problem is usually due to a lack of fiber and enough liquids in the diet. Kids tend to like foods that can be constipating, such as processed starches including white rice and pasta (bananas and cheese can also be constipating). Toddlers love their macaroni and cheese! I talk to parents a lot about the importance of a healthy diet and how diet can affect the stomach. Children should get plenty of fluids - including water and three to four servings of items with vitamin D and calcium per day - and at least five daily servings of fruits and vegetables. Some kids with constipation will require medication, but usually correcting the diet by increasing fluid intake and fiber intake through fruits, vegetables and whole grains will correct the constipation.

Small children going through potty training sometimes experience constipation as they adjust to using the toilet. At other times, they just are too busy playing and don't want to stop to go to the bathroom, and they withhold. When the child finally does try to have a bowel movement, his or her stomach starts to hurt and there is discomfort. This can then lead to a repetitive cycle of withholding followed by stomach pain. For these children, it helps to schedule toilet time and have them sit on the toilet for 10 minutes. A good time to schedule toilet time is after meals, when there is a natural reflex to eliminate.

At the other end of the spectrum is diarrhea (not accompanied by fever). Loose stools can also be caused by diet. Kids who drink a lot of juice or eat sugary foods have this problem because their bodies cannot absorb all that sugar. A healthy diet can correct the problem, just as it does for constipation. Eating regularly, without skipping meals, is also good for the digestive process.

Some children can experience heartburn, also known as acid reflux. The food goes down and hits the stomach, and during that process there's a backup of stomach acid into the esophagus. This may be triggered by eating certain foods, such as spicy or heavy foods. This condition can usually be managed at home. The important thing is to be sure your child stays hydrated, but be cautious. If your child is also vomiting, wait an hour after they vomit before offering fluid, and then give small amounts of water or Pedialyte frequently. For older kids, diluted Gatorade can help. Once they are keeping the liquids down, reintroduce food by following the BRAT diet: banana, rice, applesauce and toast. Do not feed your child dairy products during this time - and obviously no spice. If the symptoms of heartburn are not subsiding with home care and adjusting the diet, you should call your doctor.

Milk allergies can cause stomach cramping as well as vomiting, diarrhea and sometimes a rash.

Celiac disease is a less common cause of recurrent abdominal pain and is caused by intolerance to gluten. Gluten is present in foods such as pasta and bread. If you suspect your child has a problem with tolerating gluten, contact your doctor to determine if any diagnostic tests need to be ordered.

Stress or anxiety can result in an upset stomach for kids. If your child has pain that comes and goes and is accompanied by no other physical symptoms, then emotional problems could be the culprit. It's important, however, to rule out other conditions prior to blaming stomach pains on stress or anxiety.

All the above causes of stomachache are chronic conditions that happen repeatedly. To diagnose conditions like these, it can be helpful to keep a log of when your child has these complaints and bring it to your doctor's appointment. You might even discover a pattern on your own, such as the problem happening after your child eats a certain food, or in the case of stress-related stomach problems, every time he or she has a test at school. This information can be very helpful in guiding your doctor to a diagnosis and determining if any tests should be performed to help with the evaluation.

Other common stomach issues aren't persistent problems, but instead come on suddenly and can warrant medical attention. Here are some examples:

Appendicitis is the condition many parents fear when their child has significant abdominal pain. It typically begins with pain in the center of the abdomen, and then the pain shifts downward and over to the right side. The pain may become so severe the child cannot walk. Appendicitis may also be accompanied by symptoms common to a stomach virus - such as fever, diarrhea and nausea or vomiting - and abdominal swelling. Appendicitis is rare in kids under three. If your child exhibits these symptoms, seek medical help immediately.

A stomach virus (viral gastroenteritis) is one of the most common problems I see. It includes low-grade fever, diarrhea, nausea and vomiting, and sometimes crampy stomach pain. It typically lasts 24 hours or from three to five days. The vomiting usually goes away first, and the diarrhea can last up to a couple of weeks. It's important to keep your child hydrated by giving small amounts of water or Pedialyte frequently, and when vomiting subsides, follow the BRAT diet. The virus will usually resolve itself. Dehydration is the most common complication of a stomach virus. If your child cannot hold down fluids, is having decreased urination or is becoming more lethargic, you should seek medical care. In addition, if the stomach pain is severe, there is persistent fever or if there is any blood in the diarrhea or vomit, it's time to see a doctor. Sometimes stomach viruses are followed by gastritis, inflammation of the stomach lining that also can cause an upset stomach. If, after your child's virus is better, he or she continues to complain of stomach pain, you should call your doctor.

A urinary tract infection (UTI) is often accompanied by discomfort in the abdominal area in addition to more frequent urination and pain during urination. Your child may also have a fever. If your child is diagnosed with a UTI, a doctor can prescribe an antibiotic.

Stomach pain, along with fever and a sore throat, is one of the symptoms of strep throat. Sometimes kids with strep throat vomit as well. Your pediatrician can diagnose strep with a throat culture and treat it with an antibiotic.

Even with encyclopedic knowledge of abdominal issues, it still can be hard to know what to do because kids cannot always explain their pain very well. Remember that if you're unsure or worried about your child's health, it never hurts to call your doctor.


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Pemmaraju Dakin, MD, is a board-certified pediatrician with the Mid-Atlantic Permanente Medical Group and a fellow of the American Academy of Pediatrics. She sees patients at the Kaiser Permanente Falls Church Medical Center.