Abdominal Pain

 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

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 stool 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. Suspect appendicitis if pain low on the right side, won't hop or jump, and prefers to lie still.

See More Appropriate Topic (instead of this one) If

• CONSTIPATION present and is the main symptom
• DIARRHEA present and is the main symptom
• URINATION PAIN present and abdominal pain is mild
• VOMITING (or child feels like needs to vomit) is the main symptom
• Crying and not sure what's causing it, see CRYING

WHEN TO CALL YOUR DOCTOR

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
• Constant pain (or crying) present over 2 hours
• Blood in the stool 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 2 hours after fever medicine
• You think your child needs to be seen urgently.

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

• You think your child needs to be seen, but not urgently.
• 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

HOME CARE ADVICE FOR MILD ABDOMINAL PAIN

Reassurance:

• A mild stomachache can be caused by something as simple as gas pains or overeating.
• Sometimes a stomachache signals the onset of a vomiting or diarrhea illness from a virus (gastroenteritis).
• Watching your child for 2 hours will usually tell you the cause.

Rest: Encourage your child to lie down and rest until feeling better.

Clear Fluids: Offer clear fluids only (e.g., water, flat soft drinks or half-strength Gatorade). For mild pain, offer a regular diet.

Prepare for Vomiting: Keep a vomiting pan handy. Younger children often refer to nausea as a "stomachache".

Pass a Stool: Encourage sitting on the toilet and trying to pass a stool. This may relieve pain if it is due to constipation or impending diarrhea. (Note: For constipation, applying a warm, wet cotton ball may relax the anus and help release a stool.)

Avoid Medicines: Any drug (especially ibuprofen) could irritate the stomach lining and make the pain worse. Do not give any pain medicines or laxatives for stomach cramps. For fever over 102° F (39° C), acetaminophen (Tylenol) can be given.

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.

Call Your Doctor If:

Extra Care Advice: Worried Stomach

• Help your child talk about events that trigger the abdominal pain and how to cope with these triggers next time.
• Help your child worry less about things he or she can't control.
• Teach your child to use relaxation exercises (relaxing every muscle in the body) to treat the pain. Lie down in a quiet place; take deep-slow breaths; and think about something pleasant. Listening to CDs or audiotapes that teach relaxation might help.
• Teach your child the importance of getting adequate sleep.
• Make sure that your child doesn't miss any school because of stomachaches. Stressed children have a tendency to want to stay home when the going gets rough.
• Caution: Your child should have a complete medical checkup before you conclude that recurrent stomachaches are due to worrying too much.

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

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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. 

Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Review Date: 6/1/2011
Last Revised: 8/1/2011 2:46:37 PM
Content Set: Pediatric HouseCalls Symptom Checker
Version Year: 2012
Copyright 1994-2012 Barton D. Schmitt, M.D.