Abdominal Pain in Children

As parents, we often worry about our little ones' health, especially when they complain of tummy troubles. Upper or lower Abdominal pain in children is a common complaint and can emerge due to various causes, ranging from minor issues to more serious conditions. 

Children may have difficulty describing their pain, making diagnosis challenging. Understanding the symptoms, causes & treatment options is crucial to ensure prompt and correct care for our children.

Symptoms of Abdominal Pain in Children

Abdominal pain in children is a common occurrence that can manifest in various ways. 

The pain can occur anywhere from the chest to the groin area, and its characteristics can vary. Children might experience pain that comes on quickly or slowly, remains steady or worsens over time, changes location, or comes and goes. The intensity can be mild to severe, and the duration can be short-lived or persistent.

Children experiencing abdominal pain may also show other discomfort symptoms or behaviours, such as:

• Crying or increased fussiness
• Difficulty getting comfortable
• Wanting to stay still or refusing to play
• Loss of appetite or refusing food and drinks
• Becoming grumpy or irritable
• Displaying certain facial expressions indicative of pain

Sometimes, other symptoms may accompany abdominal pain, such as:

• Nausea and vomiting
• Change in bowel habits, such as constipation or diarrhoea
• Swollen or distended belly
• Cramps or sharp abdominal pain

Localised pain, concentrated in one specific area of the belly, may suggest problems with organs such as the appendix, gallbladder, or stomach. In some cases, it might indicate issues with the ovaries in girls or testicles in boys.

Causes of Abdominal Pain in Children

Functional abdominal pain in children has an impact on many aspects of their daily lives. 

Common abdominal pain causes in children include:

• Digestive Issues: Indigestion, constipation, intestinal obstruction, and irritable bowel syndrome often lead to stomach discomfort.
• Infections: Gastroenteritis, commonly known as stomach flu, causes pain with other symptoms like vomiting and diarrhoea. Kidney or bladder infections &  infections in other body parts, such as the chest, can also result in abdominal pain.
• Food-related Problems: Overeating or food poisoning may trigger stomach pain.
• Food Intolerances: Reactions to lactose, gluten, or other food items often result in abdominal symptoms.
• Stress and Anxiety: Children may experience stomach pain when worried about themselves or people around them.
• Appendicitis: This condition causes pain that often starts in the middle of the tummy and radiates to the lower right side. It requires immediate medical attention and often surgery.
• Pre-menstrual pain: In girls, menstrual cramps can cause abdominal pain even before their periods start. 
• Other Causes: These include muscle strain, migraine, bowel obstruction, and, in some cases, poisoning from sources like spider bites or ingestion of harmful substances.

Diagnosis of abdominal pain in children

Diagnosing abdominal pain in children can be challenging and often requires time to determine the underlying cause. Doctors use a step-by-step approach to investigate the issue, relying heavily on the history provided by the parent and child.

The diagnostic process typically involves:

• Medical History: The doctor asks about the pain, other symptoms, and the child's general health. They will also inquire about food allergies and family history of conditions such as peptic disease and irritable bowel syndrome. Doctors may speak with adolescents alone to address concerns and elicit honest answers about sensitive issues.
• Physical Examination: The doctor carefully examines the child, putting them at ease first.
• Laboratory Testing: This may include blood, urine, and stool tests.
• Imaging Studies: Ultrasound scans and X-rays may be necessary in some cases.

It's important to note that most children with abdominal pain don't need extensive tests. The diagnosis often relies on the information from the history and physical examination.

Treatment for Abdominal Pain in Children

The treatment for abdominal pain in children depends on the underlying cause. In many cases, the pain resolves on its own with simple home remedies and rest. However, some situations may require medical intervention.

For mild cases, doctors often recommend the following approaches:

• Rest: Encourage the child to rest & avoid physical activity, especially after eating.
• Hydration: To prevent dehydration, offer plenty of clear fluids such as water, broth, or diluted fruit juice.
• Bland Diet: Serve easily digestible foods like plain bread, rice, or applesauce. Avoid spicy or greasy foods & caffeinated or carbonated drinks until 48 hours after symptoms subside.
• Pain Relief: Use a heating pad or warm bath to ease cramps. Doctors may recommend medicine for pain relief.
• Probiotics: Mixing a probiotic in the child's water may help stop diarrhoea.
• Medications: Sometimes, doctors prescribe medication to address specific symptoms or underlying conditions. For instance, they might recommend stool softeners for constipation.

Remember, never give aspirin to children, and always consult a doctor before administering any medication for abdominal pain. 

When to See a Doctor

Parents should seek medical attention for their child if abdominal pain persists or worsens. It's crucial to contact a doctor if the pain doesn't improve within 24 hours or becomes more severe and frequent, especially if accompanied by nausea and vomiting.

Immediate medical help is necessary if a child:

• Is under three months with diarrhoea or vomiting
• Has sudden, sharp abdominal pain
• Shows signs of a rigid, hard belly
• Is unable to pass stool, particularly if vomiting
• Vomits blood or has blood in the stool
• Has difficulty breathing
• Has had a recent abdominal injury
• Pain confined to one area, especially the right side
• Fever exceeding 100.4°F (38°C)
• A burning sensation during urination
• Poor appetite for more than two days
• Unexplained weight loss

If in doubt, it's always better to contact the paediatrician. Parents should be vigilant if the pain is in the lower right part of the stomach, as this could indicate appendicitis. In such cases, taking the child to the emergency room is advisable.

Home Remedies for Abdominal Pain in Children

Parents can try several home remedies to help ease their child's abdominal pain. These simple techniques often provide quick relief and comfort:

• A warm compress has an impact on stomach aches. The warmth relaxes the muscles and helps minimise acidity. 
• Certain foods and herbs have soothing properties. Yoghurt, a probiotic food, helps relieve nausea and diarrhoea by restoring beneficial gut bacteria. Parents can mix crushed fenugreek seeds into yoghurt for added benefits. 
• Hydration plays a crucial role in alleviating stomach pain. Parents should offer small sips of water or unsweetened tea to keep the child hydrated. 
• Herbal teas, such as mint or ginger, can ease stomach pain. 
• Applying ginger juice to the belly button may help children under two.
• Gentle massage has a positive effect on gas and indigestion. 
• Parents can apply light pressure to specific points on the child's feet, which connects to different body areas. For instance, they can hold the child's left foot with the right hand and use the left thumb to press under the ball of the foot.
• It's advisable to avoid dairy and oily foods until the child feels better.
• For recurring stomach aches, keeping a food diary helps identify potential triggers. 
• Use conversation, games, or television to shift attention away from the pain.

Conclusion

Abdominal pain in children is a common complaint that can stem from various issues, ranging from minor digestive problems to more serious conditions. Understanding the symptoms, causes, and treatment options impacts ensuring prompt and appropriate care for our little ones. 

While many cases of abdominal pain in children can be managed at home with rest and simple remedies, it's crucial to know when to see a doctor. Parents can help their children navigate tummy troubles and ensure their overall well-being by staying informed and attentive. 

FAQ's

1. What is the most common cause of chronic abdominal pain in children?

Functional abdominal pain disorders (FAPDs) are the most common reason for chronic abdominal pain in children and adolescents. These disorders affect 9 to 15% of children and result from abnormal gut and brain interactions. Children with FAPDs may experience nausea, vomiting, constipation, or diarrhoea, along with stomach aches. They may also have a poor appetite or feel full very quickly.

2. What are the red flags for abdominal pain in children?

Parents should watch for several red flags that may indicate a more serious condition:

• Pain that awakens the child or adolescent
• Significant vomiting, constipation, diarrhoea, bloating, or gas
• Blood in the vomit or stool
• Changes in bowel or bladder function
• Pain or bleeding with urination
• Abdominal tenderness (pain when the abdomen is pressed)
• Unexplained fever 

3. When to worry about abdominal pain in a child?

Parents should seek immediate medical guidance if their child experiences:

• Bloody stools, severe diarrhoea, or recurrent or bloody vomiting
• Severe abdominal pain lasting more than one hour or severe pain that comes and goes for more than 24 hours
• Refusing to drink or eat for a prolonged period
• Fever higher than 101°F (38.4°C) for more than three days
• Pain in the right lower side of the belly, which could indicate appendicitis
• Unusual sleepiness
• Difficulty breathing or chest pain
• Hives, paleness, dizziness, or swelling of the face

4. How to relieve stomach pain in kids?

Several home remedies and techniques can help alleviate stomach pain in children:

• Relaxation techniques: Teach older children and adolescents brief muscle relaxation techniques like deep breathing exercises.
• Warm compresses: Apply a heating pad or warm water bottle wrapped in cloth to the child's abdomen.
• Dietary adjustments: Consider a lactose-free diet for two weeks if lactose intolerance is suspected. Increase fibre intake for constipation-related pain.
• Herbal remedies: Try peppermint oil or ginger tea to soothe the stomach.
• Probiotics: Offer yoghurt to help restore beneficial gut bacteria.
• Hydration: Provide small sips of water or unsweetened tea to keep the child hydrated.
• Gentle massage: Apply light pressure to specific points on the child's feet to relieve gas and indigestion.

Dr. Shalini

CARE Medical Team

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