Abdominal Pain

November 22, 2009

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Abdominal Pain

by Robert Needlman, M.D., F.A.A.P.
reviewed by Lynn Cates, M.D., F.A.A.P.

Every child has abdominal pain, or stomachaches, at some time. Pain that lasts a short time and only occurs once in a while is probably not serious. The most common causes are hunger or needing to have a bowel movement. If your child complains that her stomach hurts from time to time, offering a snack or suggesting time sitting on the toilet usually does the trick. Sometimes having a child slow down while eating may help. Even too-tight pants sometimes cause abdominal pain, which is easy to "cure" once you figure out the cause.

Severe abdominal pain
Abdominal pain that is severe enough to cause a child to double over or to look very weak and pale can be a sign of a serious medical problem, such as appendicitis. As you probably know, a child with appendicitis needs an operation--the sooner the better. There are other serious medical problems that can cause severe abdominal pain as well, and you should bring your child in to see her doctor as soon as possible.

Persistent or recurrent abdominal pain
Sometimes a child may experience chronic abdominal pain that lasts for days or weeks at a time, or recurrent pain that occurs every day or two. There is a long list of illnesses that can cause these symptoms--too long to list here. But there are only a few causes that occur frequently, and if you know about these, you may be able to take care of your child's problem on your own:

Constipation. This problem tops the list for chronic abdominal pain. In constipation, the waste matter in the intestines becomes dried out and overly firm. The intestines have to work extra hard to try to push this thick material along. All that work causes the muscles of the intestines to cramp, which can be very uncomfortable. The discomfort centers in the middle of the belly. If your child has hard, painful bowel movements or goes more than a couple of days between BMs, it's a good bet that she's constipated. Bowel movements that are so large they plug up the toilet are a sure sign of constipation, but the same problem can also result in small, hard BMs. (If you suspect constipation, you may have to ask your child directly, because even young children sometimes keep quiet about their toilet habits.) A high-fiber, high-fluid diet, and perhaps a short course of laxatives prescribed by the doctor, usually can solve this problem. Initial relief often comes quickly, but the diet and medical supervision may need to continue for months. See our articles on constipation for more on how to take care of this common problem.

Sensitivity to milk products. Some children are unable to digest lactose, a form of sugar present in cow's milk. The undigested sugar ferments in the intestines, causing gas, bloating, and discomfort. The problem is more common in people of African or Asian descent than in those of northern European backgrounds. Sometimes a weeklong trial diet free of milk and all other dairy products cures the stomachaches and solves the mystery.

Medications. Almost any medication can cause stomachaches as a side effect. Asthma medications, such as Albuterol, are notorious for this. (But note that asthma attacks themselves also can cause stomachaches, as the hard work of breathing makes the diaphragm muscle sore.)

Psychological causes. Tension and worry can cause stress-related stomachaches in children. There are many causes, including problems in school, at home, or with kids in the neighborhood. Some parents think that this pain is "all in the head," but it really does hurt in the child's stomach! Sometimes a hug and your loving reassurance that she is really OK is all that's needed to stop your child's stomachaches. But often a child needs the help of a doctor to help determine whether or not the cause of the abdominal pain is psychological. In these cases, a wise doctor will involve a psychologist or other mental health professional early on, even if there is more medical testing to be done.

Red flags
If your child has abdominal pain that's severe or lasts for more than a few days (the usual length of a simple intestinal infection), you'll need to call the doctor. Other signs that the problem might be serious include:

Weight loss

Bloating

Fever

Overseas travel, living in a shelter or group situation, or group child care. These all increase chances that a child might have contracted a intestinal parasite.

Pain in a child younger than three or four years. Since it's harder for very young children to tell you what's bothering them, it's best to involve a doctor early on.


RELATED INFORMATION

			When Worry Causes a Stomachache
			Symptoms & Conditions
			GI Problems: Miscellaneous

Created February 25, 2002
Reviewed February 26, 2002

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