Pediatric Chronic Abdominal Pain

It is not unusual for children to have stomach pain. But pain that lasts is miserable for kids and concerning for parents. Is something more going on? When should your child see a doctor?

This page will help you:

  • Know when to call a doctor for stomach pain.
  • Find ways to help your child feel better.
  • Learn about chronic (long-lasting) abdominal pain.
Learn about types of abdominal pain, how pain signals can go wrong, and what you can do about it.

Understanding pediatric chronic abdominal pain

Abdominal pain is rarely serious and often goes away on its own. But chronic stomach pain can keep your child from having a normal life.

Functional abdominal pain

Functional abdominal pain is the most common cause for chronic belly pain in kids. It happens when the nerves in your child’s gut send pain signals to their brain, even though there’s no damage to their GI tract.

Functional abdominal pain has many different causes, including: 

  • A previous infection 
  • Genes 
  • Diet 
  • Stress 
  • The gut microbiome (bacteria living in the intestines) 

Common types of functional abdominal pain include dyspepsia (pain, burning or bloating), irritable bowel syndrome, or stomach migraines (occasional, intense mid-stomach pain).

Other causes of abdominal pain

Many conditions can cause chronic stomach pain, from constipation to Crohn’s disease. The pain may be caused by another condition if your child: 

  • Wakes up from the pain. 
  • Feels pain when you press on their stomach. 
  • Vomits or has constipation, bloating or diarrhea, especially if there’s blood in vomit or stool. 
  • Loses weight or stops growing normally. 
  • Has changes in bowel or bladder function, or pain or bleeding with urination. 

When to call a doctor

Contact your child’s primary care provider if:

  • The pain lasts 24 hours or more.
  • Your child can’t do normal daily activities because of the pain.
  • There are other serious symptoms, like bleeding.
  • Your child’s stomach is bloated and severely tender.
  • Your child won’t eat or can’t keep food and fluids down.

Our gastroenterology experts are available to consult with your child’s primary care provider if needed.

Diagnosing pediatric chronic abdominal pain

Your child’s primary care provider will do an exam and ask questions about when the pain started and how often it returns. They may recommend:

  • Pain diary: You track your child’s pain, usually for one week. You should include possible triggers (such as food) and whether anything made the pain go away.
  • Blood, urine, stool or lactose-intolerance tests: These tests can check for an underlying disorder.

If needed, additional tests may include:

  • pH monitoring: This test measures how much acid flows from your child’s stomach to their food pipe (esophagus). To do this test, a tiny probe is either swallowed or placed through a nostril. The probe keeps track of the acid flow for as long as two days.
  • Imaging: An X-ray, ultrasound, CT (computed tomography) or MRI (magnetic resonance imaging) scan shows the inside of the body.
  • Upper GI series: Your child drinks a liquid called contrast. A continuous X-ray beam shows the liquid moving through the digestive system.
  • Endoscopy/colonoscopy: Your child may swallow a capsule with a tiny camera. Or, a doctor can guide a thin, flexible tube with a camera into the body through the throat or anus.

Treating pediatric chronic abdominal pain

  • Relaxation and behavioral therapy: Stress and anxiety can make the pain worse. Physical therapy, biofeedback or acupuncture may help. A pediatric psychologist can offer support.
  • Diet: Your child’s doctor may recommend changes depending on symptoms. For example, avoiding spicy foods and carbonated drinks, or adding high-fiber foods. If needed, our dietitians can create a nutrition plan.
  • Medications: Your child’s doctor may prescribe medication if the pain is disrupting your child’s daily routine.

Treatment depends on the cause of the stomach pain. Your child’s doctor may recommend diet changes and/or medication. Surgery may be needed for serious conditions.

Tips for parents

Sometimes your child’s belly nerves become hypersensitive to pain. The stomach can keep sending pain signals even if tissue or nerve damage has healed.

We believe pain loves an audience. Asking your child about their pain can make the pain cycle worse. Your child will scan their body looking for pain and find it. Distract your child from the pain instead.

Children with chronic abdominal pain often stop doing normal activities and miss school. Encourage your child to return to normal routines. Pain can subside when children return to living as they normally do.

Moderate exercise can also help by strengthening the immune system and reducing pain signals.

A healthy, balanced diet is important for any child, especially those with chronic abdominal pain. Avoid spicy foods or drinks high in sugar. Help your child:

  • Develop a sleep routine.
  • Engage in relaxing activities, with no screens for at least an hour before bedtime.
  • Avoid afternoon naps.
  • Avoid caffeine drinks, such as soda, especially in the afternoon.
  • Use their bed only for sleep. Use a chair instead for homework or reading.

When your child’s belly hurts, nerves tell the brain something is wrong. If your child’s brain doesn’t feel well, it may signal the belly that something is wrong and cause pain.

Depression and anxiety don’t directly cause pain, but they can make pain worse. If your child has symptoms of depression or anxiety, seek treatment. Our pediatric psychologists can help.

Medication can reduce pain and calm belly nerves. But coping skills, positive thinking and other strategies can be even more helpful to children with chronic pain. You also may consider stress management, physical therapy, biofeedback and acupuncture.

Develop skills to manage pain and cope with stress. See below to learn about belly breathing and guided imagery. Reward or praise your child when they practice good coping skills.

Practice positive thinking to help your child avoid spiraling into negative thoughts. Here are examples of how to turn a negative thought into a positive one.

Negative Positive
The pain will never stop. This will pass.
My life is over. I can get through this.
Pain controls my life. I have the power to help myself.

Belly breathing can reduce pain and stress. Watch this video or read the directions below to learn how.

  1. Lie on the floor or sit up straight with your feet supported.
  2. Put one hand on your chest and the other over your belly. You want the hand on your belly to move while the hand on your chest stays still.
  3. Imagine you have a balloon under your belly button that inflates as you inhale and deflates as you exhale.
  4. Breathe in through your nose for three seconds, like you are smelling freshly baked cookies. Pull the air deep into your lungs. Feel your belly expand, like a balloon blowing up. Notice that the hand on your belly is moving but the hand on your chest is not.
  5. Exhale slowly through your mouth, like you are blowing out candles on a birthday cake. Feel your belly go back in, like a balloon deflating. Again, make sure the hand on your belly is the one moving.
  6. Breathe in slowly again through your nose for three seconds, then exhale for six seconds.

Continue this pattern for five to 10 minutes, keeping an eye on your hands to make sure the air is going into your belly, not your chest. You may have a parent or a friend do this with you to help you perfect the technique together.

Taking a “journey” with your child can help lower stress and pain. Read this script to your child:

Find a comfortable position, sitting or lying down. Allow your body to relax as you create a picture in your mind.

Imagine yourself walking on a path through a forest. The path is soft beneath your shoes, a mixture of soil, fallen leaves, pine needles and moss. As you walk, your body relaxes and your mind clears, more and more with each step.

Breathe in the fresh mountain air, filling your lungs. Exhale. Breathe out all the air. Feel refreshed. Take another deep breath in and breathe out completely, letting your body relax further.

Continue to breathe slowly and deeply as you walk through the forest.

The air is cool but comfortable. Sun filters through the trees, making a moving pattern on the ground in front of you.

Listen to the sounds of the forest: Birds singing. A gentle breeze blowing. The leaves on the trees swaying in the soft wind.

Your body relaxes more and more as you walk. Count your steps and breathe in unison with your strides.

Continue to breathe like this, slowly and deeply, as you become more and more relaxed.

As you walk through the forest, feel your muscles relaxing and lengthening. As your arms swing in rhythm with your walking, they become loose and relaxed.

Feel your back relaxing as your spine lengthens and the muscles loosen. Feel the tension leaving your body as you admire the scenery around you. Your legs and lower body relax as well, feeling free and loose.

As you walk through the forest, you begin to climb up a slight incline. You easily tread along smooth rocks on the path.

The breeze continues to blow through the treetops, but you are sheltered on the path, and the air around you is calm.

Small saplings grow at the sides of the path. You are surrounded by green. Some leaves on the trees are a delicate, light green. Some are deep, dark forest green. Many trees have needles that look soft and deep green. The forest floor is thick, green moss.

Tall trees grow on either side of the path. Picture the variety of trees around you. Some have smooth, white bark. Others are darker, with coarse, heavy, deeply grooved bark. Enjoy the colors of the bark on the trees — white, tan, brown, red, black and many combinations of color. You admire the rough, brown bark of pine trees and enjoy the fresh pine scent.

Smell the forest around you. The air is fresh and filled with the scent of trees, soil and mountain streams.

You can hear the sound of water faintly in the distance. The gentle burbling of a creek.

As you walk through the forest, you are gaining elevation and getting closer to the sound of a stream.

Continue to enjoy the forest around you.

As you near the top of the mountain, you hear the stream very close. The path curves up ahead. You can see sunlight streaming onto the path. As you round the corner, you hear the water and see a clearing in the trees up ahead.

You are growing tired from your journey. Your body feels pleasantly tired and heavy.

Imagine yourself walking toward the clearing and the stream. Stepping stones make an easy path across the stream and toward the edge of the mountain. Step on each large flat stone to easily cross the small, shallow stream.

Up ahead is a large, smooth rock, like a chair, waiting for you to rest. The rock is placed perfectly, high up on a beautiful lookout. Sit or lie down on the rock if you wish. It is very comfortable. You feel comfortable and at ease. The sun shines on you.

Looking around, you see mountains in the distance. Faint and blue. You can look down from your viewpoint into a valley with trees and a blue lake. Across from you is another mountain.

Feel the sun warming your body as you relax on the rock. Enjoy the majestic landscape around you and feel your body relaxing even more. Your body becomes warm and heavy.

Continue to breathe the clean, fresh air.

You feel so relaxed.


At peace.

When you are ready to leave this peaceful place, slowly begin to reawaken your body. Know that you can return to this forest in your imagination whenever you like.

As you reawaken, keep with you the feeling of calm, peace and relaxation.

Wiggle your fingers and toes to wake up your muscles. Shrug your shoulders. Stretch if you want to.

When you are ready, open your eyes and return to full wakefulness, feeling alert and refreshed.

There are many programs and resources that help kids feel better and more in control of their symptoms. Here are a few we recommend:

  • Self-hypnosis – Information about hypnosis and audio recordings you can use.
  • The Comfortability – Guided imagery to help with pain.
  • Imaginaction – Audio guides to help kids gain more control over how they feel.
  • KidEvolve – Many mindfulness programs for kids, including course 8 for pain management.
  • Yoga Videos – Some of the best yoga videos for kids.
  • Muscle Relaxation – Video guide for kids.

For families

Call 503-346-0640 to:

  • Request an appointment
  • Seek a second opinion
  • Ask a question


Parking is free for patients and their visitors.

Doernbecher Children’s Hospital
700 S.W. Campus Drive
Portland, OR 97239
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