Abdominal Pain

ABDOMINAL PAIN

Symptom Definition

  • Pain or discomfort located between the bottom of the rib cage and the groin crease.
  • The older child complains of a stomachache.
  • The younger child should at least point to or hold the abdomen

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Causes

  • Indigestion: Indigestion or overeating causes many mild stomachaches 
  • Gastroenteritis: A viral infection of the intestines causes stomach cramps as well as vomiting and/or diarrhea
  • Food Poisoning: Severe vomiting and/or diarrhea lasting less than 12 hours is often due to bacterial overgrowth in unrefrigerated foods
  • Constipation: The need to pass a BM causes lower abdominal cramps
  • Strep: A strep throat causes up to 10% of acute abdominal pain
  • Serious Causes: These include appendicitis, kidney infections and intussusception

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WHEN TO CALL YOUR DOCTOR FOR ABDOMINAL PAIN

Call 911 Now (your child may need an ambulance) If:

  • Not moving or too weak to stand

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • You suspect poisoning with a plant, medicine, or chemical
  • Unable to walk or walks bent over holding the abdomen
  • Pain mainly low on the right side
  • Pain or swelling in the scrotum or testicle (Male)
  • Could be pregnant (Female)
  • Severe pain anywhere
  • Pain (or crying) present > 2 hours
  • Blood in the bowel movements or vomiting blood
  • Vomiting bile (bright yellow or green)
  • Recent injury to the abdomen
  • Age under 2 years
  • Fever over 104°F (40°C)and not improved after 2 hours after fever medicine

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

  • You think your child needs to be seen
  • Mild pain that comes and goes (cramps) lasts over 24 hours

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Abdominal pains are a recurrent chronic problem

Parent Care at Home If

  • Mild abdominal pain and you don't think your child needs to be seen
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HOME CARE ADVICE FOR MILD ABDOMINAL PAIN

  1. Reassurance:
  2. A mild stomachache can be caused by something as simple as gas pains or overeating.
  3. Sometimes a stomachache signals the onset of a vomiting or diarrhea illness from a virus (gastroenteritis).
  4. Watching your child for 2 hours will usually tell you the cause.
  5. Rest: Encourage lying down and rest until feeling better.
  6. Clear Fluids: Offer clear fluids only (e.g., water, flat soft drinks or 1/2 strength fruit juice). For mild pain, offer a regular diet.
  7. Prepare for Vomiting: Keep a vomiting pan handy. Younger children often refer to nausea as a "stomachache."
  8. Pass a BM: Encourage sitting on the toilet and trying to pass a bowel movement (BM). This may relieve pain if it is due to constipation or impending diarrhea.
  9. Avoid Medicines: Any drug could irritate the stomach lining and make the pain worse. Do not give any pain medicines or laxatives for stomach cramps. For fever over 102F (39C), acetaminophen (Tylenol) can be given.
  10. Expected Course: With harmless causes, the pain is usually better or resolved in 2 hours. With gastroenteritis (stomach flu), belly cramps may precede each bout of vomiting or diarrhea and last several days. With serious causes (such as appendicitis), the pain worsens and becomes constant.
  11. Call Your Doctor If:
    • Pain becomes severe
    • Pain present over 2 hours
    • Mild pain present over 48 hours
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. Ashcraft KW. Acute abdominal pain. Pediatr Rev. 2000;21:363-367.
  2. Gremse DA and Sacks AI. Evaluation of dyspepsia. Pediatr Ann. 1997;26:251-259.
  3. Klein EJ, Paris CA. Appendicitis. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health. London, England: BMJ Publishing Group; 2000. p.287-297.
  4. Kuppermann N, O’Dea T, Pinckney L, Hoecker C. Predictors of intussusception in young children. Arch Pediatr Adolesc Med. 2000;154:250-255.
  5. Mason JD. The evaluation of acute abdominal pain in children. Emerg Med Clin North Am. 1996;14:629-643.
  6. McCollough M, Sharieff G. Abdominal pain in children. Pediatr Clin North Am. 2006;53(1):107-120.
  7. Pena BM, Taylor GA, Lund DP. Appendicitis revisited: New insights into an age-old problem. Contemp Pediatr. 1999;16(9):122-131.
  8. Pollack E. Pediatric abdominal surgical emergencies. Pediatr Ann. 1996;25:448-457.
  9. Scholer SJ, et al. Clinical outcome of children with acute abdominal pain. Pediatrics. 1996;98:680-685.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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