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Abdominal pain - children under age 12

Almost all children have abdominal pain at one time or another. Abdominal pain is pain in the stomach or belly area. It can be anywhere between the chest and groin.

Most of the time, it is not caused by a serious medical problem. But sometimes abdominal pain can be a sign of something serious. Learn when you should seek medical care right away for your child with abdominal pain.

Alternative Names

Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children

Considerations

When your child complains of abdominal pain, see if s/he can describe it to you. Here are different kinds of pain:

  • Generalized pain or pain over more than half of the belly. Your child can have this kind of pain when they have a stomach virus, indigestion, or gas, or when they become constipated.
  • Cramp-like pain is likely to be due to gas and bloating. It is often followed by diarrhea. It is usually not serious.
  • Colicky pain is pain that comes in waves, usually starts and ends suddenly, and is often severe.
  • Localized pain is pain in only one area of the belly. Your child may be having problems with his/her appendix, gallbladder, or stomach (ulcers).

If you have an infant or toddler, s/he depends on your seeing that s/he is in pain. Suspect abdominal pain if s/he is:

  • More fussy than usual
  • Drawing his/her legs up toward the belly
  • Eating poorly

Causes

Your child could have abdominal pain for many reasons. It can be hard to know what is going on when your child has abdominal pain. Most of the time, there is nothing seriously wrong. But sometimes it can be a sign that there is something serious and your child needs medical care.

Your child mostly likely is having abdominal pain from something that is not life threatening. For example, your child may have:

  • Constipation
  • Gas
  • Food allergy or intolerance
  • Heartburn or acid reflux
  • Stomach flu or food poisoning
  • Strep throat or mononucleosis ("mono")
  • Colic
  • Air swallowing
  • Abdominal migraine
  • Pain caused by anxiety or depression

Your child may have something more serious if the pain does not get better in 24 hours, gets worse or gets more frequent. Abdominal pain can be a sign of:

  • Appendicitis
  • Gallstones
  • Stomach ulcers
  • Hernia or other bowel twisting, blockage or obstruction
  • Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
  • Intussusception, caused by part of the intestine being pulled inward into itself
  • Tumors or cancers
  • Urinary tract infections
  • Sickle cell disease crisis

Home Care

Most of the time, you can wait for your child to get betteranduse home care remedies. If you are worried or your child’s pain is getting worse or lasts longer than 24 hours, call your health care provider.

Have your child lie quietly to see if the abdominal pain goes away.

Offer sips of water or other clear fluids.

Suggest that your child try to pass stool.

Avoid solid foods for a few hours. Then try small amounts of mild foods such as rice, applesauce, or crackers.

Do not give your child foods or drinks that are irritating to the stomach. Avoid:

  • Caffeine
  • Carbonated beverages
  • Citrus
  • Dairy products
  • Fried or greasy foods
  • High-fat foods
  • Tomato products

Do not give aspirin, ibuprofen, acetaminophen (Tylenol), or similar medicines without first asking your child's health care provider.

To prevent many types of abdominal pain:

  • Avoid fatty or greasy foods.
  • Drink plenty of water each day.
  • Eat small meals more often.
  • Exercise regularly.
  • Limit foods that produce gas.
  • Make sure that meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.

When to Contact a Medical Professional

Call your doctor if the abdominal pain does not go away in 24 hours.

Seek immediate medical help or call your local emergency number (such as 911) if your child:

  • Is a baby younger than 3 months and has diarrhea or vomiting
  • Is currently being treated for cancer
  • Is unable to pass stool, especially if the child is also vomiting
  • Is vomiting blood or has blood in the stool (especially if the blood is maroon or dark, tarry black)
  • Has sudden, sharp abdominal pain
  • Has a rigid, hard belly
  • Has had a recent injury to the abdomen
  • Is having trouble breathing

Call your doctor if your child has:

  • Abdominal pain that lasts 1 week or longer, even if it comes and goes
  • Abdominal pain that does not improve in 24 hours. Call if it is getting more severe and frequent, or if your child is nauseous and vomiting with it.
  • A burning sensation during urination
  • Diarrhea for more than 2 days
  • Vomiting for more than 12 hours
  • Fever over 100.4 degrees F
  • Poor appetite for more than 2 days
  • Unexplained weight loss

What to Expect at Your Office Visit

Talk to the provider about the location of the pain and its time pattern. Let the provider know if there are other symptoms like fever, fatigue, general ill feeling, change in behavior, nausea, vomiting, or changes in stool.

Your provider may ask the questions about the abdominal pain:

  • What part of the stomach hurts? All over? Lower or upper? Right, left, or middle? Around the navel?
  • Is the pain sharp or cramping, constant or comes and goes, or changes in intensity over minutes?
  • Does the pain wake your child up at night?
  • Has your child had similar pain in the past? How long has each episode lasted? How often has it occurred?
  • Is the pain getting more severe?
  • Does the pain get worse after eating or drinking? After eating greasy foods, milk products, or carbonated drinks? Has your child started eating something new?
  • Does the pain get better after eating or having a bowel movement?
  • Does the pain get worse after stress?
  • Has there been a recent injury?
  • What other symptoms are occurring at the same time?

During the physical examination, the doctor will test to see if the pain is in a single area (point tenderness) or whether it is spread out.

They may do some tests to check on the pain. The tests could be:

  • Blood, urine, and stool tests
  • CT scan
  • Ultrasound of the abdomen
  • X-rays of the abdomen

References

Ebell MH. Diagnosis of appendicitis: part 1. History and physical examination. Am Fam Physician. 2008;77:828-830.

Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;25:438-451.

Rimon, N, Bengiamin RN, Budhram GR, King KE, Wightman JM. Abdominal pain. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 21.

Sreedharan R, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 298.

Weydert JA. Recurring abdominal pain in pediatrics. In Rakel D, ed. Integrative Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 44.

Updated: 8/4/2013

Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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