Not So Yummy in My Tummy

It was the common wisdom to think of abdominal pain in children as similar to headaches in adults – essentially a common symptom that resolves on its own and generally has no underlying worrisome cause. However, like headaches, it is important to be aware of the red flags that might indicate a need for further investigation and treatment.

Most children who have abdominal pain will get better in hours, but persistent or severe pain requires further investigation. The most common causes are constipation, irritable bowel syndrome, food intolerance or food borne infections. Appendicitis is the most common emergency associated with abdominal pain in children. In appendicitis, the pain often begins centrally and gradually worsens and shifts to the right lower abdomen. Immediate medical attention is required.

More rare causes may be a twisting of the bowel called torsion or another telescoping of the bowel called intussusception. Clues to these conditions may be blood in the stools and intermittent severe pain. In boys, a twisting of the testicles may present as abdominal pain. In young girls, pain in the lower abdomen cyclically may be a premonition of periods to come.

Fever, escalating pain, and severe pain that persists are all red flags that would make you seek attention more readily for your child.

In the case of lower level or recurrent pain, paying attention to timing of the pain and associated clues might give invaluable clues to help your care provider tease out the cause of the pain.  Relationship in timing to school days versus weekends is an important clue. Associated symptoms like bowel habit and nausea is helpful. A food diary to look at associations with some foods such as wheat and dairy may provide connections to intolerances.

It is so difficult to watch your child in pain. For most tummy aches, the reason is usually not a sinister one and a reassuring empathic caregiver, a heating pad, some fluids and Tylenol might just be the cure. An added cuddle is sometimes just the needed healing touch.

Dr. Bhooma Bhayana is a family physician in London and the mother of two young men and proud grandmother of three! She continues to find wonder and enjoyment in family practice despite more than 30 years on the job!