“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 them
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 they have 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, they continue 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.
Originally published: 11-01-18
Updated: 11-08-22
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