Abdominal Pain in your child
by Dr David Foo
Consultant Paediatrician
MBBS, MRCPCH
Sri Kota Specialist Medical Centre, Klang & Foo Child Specialist, Pelangi Damansara, Petaling Jaya
Abdominal pain or stomachache is one of the commonest complains among children which brought to the attention of the parents and doctors. It can be acute or chronic (longstanding); functional (without cause) or organic (with cause).
Every child has different level of perception and tolerance to abdominal pain. For example, 2 kids with the same problem could react differently to the pain, which will lead to different degree of parental anxiety and reaction.
This is one of the reasons that make the evaluation of abdominal pain so challenging, as it is important to differentiate between the benign causes eg : acute gastroenteritis or constipation from the more life threatening surgical emergency.
Most of the time, there are no identifiable organic causes, despite detailed medical examination and exhaustive investigations. This type of functional abdominal pain is usually non-specific and self-limiting.
What is functional abdominal pain?
Functional abdominal pain ( ie. without cause ) is as uncomfortable and disruptive to your kid ‘s normal activity as organic abdominal pain ( with exact cause ). Parents and doctors may become frustrated and pressured for not able to identify the underlying cause and getting to the bottom of the problem.
How do we know our child is having functional abdominal pain?
Some of the features of functional abdominal pain are :
- No temporal pattern
- Improve during weekend or holiday
- Easily distracted from the pain
- Well in between the episodes of pain
- No other associated systemic complains eg : loss of weight or appetite, fever etc.
Some of the affected children are from dysfunctional families or they are natural worriers. Some of them might have other psychological issues and stresses at school and finding excuses to avoid certain activities.
Sometimes, focus on the child ‘s abdominal pain may be a way of diverting attention from other family stresses.
What are the treatments of my child ‘s functional abdominal pain?
Treatment is mainly reassurance. The parents should be advised to avoid reinforce the symptom with excessive concerns. Children are encouraged to resume their routine activity as early as possible.
Other issues like family or school problems should be addressed. Spend time with your children and find out what troubles them at school or home.
Despite these concerns about psychosocial factors, some children with functional abdominal pain appear to be well adjusted and from well adapted families.
What are the common medical causes of organic abdominal pain in children?
1.Constipation
Many children nowadays have this problem of passing hard stool or infrequent stooling. Treatment options include dietary changes and laxative or stool softener. Try to encourage your children into regular toilet habit.
2. Urinary tract infection
This is caused by bacteria that get into the urine. Increased urinary frequency, pain on passing urine, urgency, smelly urine and fever might suggest urinary tract infection as the cause of abdominal pain.
A child whom has chronic constipation, repeatedly hold his urine and has abnormality of the urinary tract tend to get urine infection easily.
A urine sample is needed to confirm the diagnosis.
A course of appropriate antibiotic will settle the infection.
3. Infantile colic
It affect 10 to 20% of infants during the 3rd and 4th week of life. The babies scream, draw their legs up during each episode.
Beside anticolic medications, infant massage will help to relax the baby and parents.
4. Acute gastroenteritis or stomach flu
The abdominal pain is always associated with diarrhea, vomiting and fever.
Most of times it is viral in nature. Treatment is mainly rehydration.
5. Flatulence or excessive gas
Some children tend to swallow air during eating, drinking, crying or even talking. Other causes are sucking on empty bottle, food high in fiber and carbonated drinks, antibiotic, lactose intolerance and constipation.
In general, symptomatic treatment might be just sufficient. Probiotics may be helpful.
What is Henoch-Schonlein purpura ?
This type of abdominal pain is associated with joint pain, joint swelling and skin rashes( purpura or petechiae ) mainly on the buttock and the limbs. It is always preceded by upper respiratory tract infection. It may involve other organs including the kidneys( blood and protein in the urine ), central nervous system and lungs.
What is the commonest surgical cause of abdominal pain?
Appendix is a small pouch of intestine that branches off the caecum ( part of the large bowel ) in the lower right quadrant of the abdomen.
In Acute Appendicitis ( inflammation of the appendix ), the pain always starts as discomfort around the belly before it move towards the right hip.
Other signs are involuntary guarding or rigidity, abdominal distention, rebound abdominal tenderness, fever, vomiting, refusal to eat or walk.
Treatment is surgical removal of the inflammed appendix, but sometimes it might settle spontaneously.
What is intussusception?
It is telescoping of a segment of intestine into the adjacent segment.
It is an emergency that requires immediate attention. The warning symptoms are recurrent vomiting, severe colicky abdominal pain, passing out blood and mucous in stool.
What are the warning signs of abdominal pain the require immediate attention?
- Recurrence
- Abnormal bowel habit ( constipation, diarrhea, incontinence )
- Recurrent, bile stained or feculent vomiting
- Rectal bleeding, bloody diarrhea ( classic red current jelly stool in intussusception )
- Dysuria
- Pain that awaken child at night
- Constitutional symptoms ( fever, weight loss, loss of appetite )
- Significant abdominal injury
- Severe and worsening abdominal pain
- Family history of gastrointestinal or systemic illnesses eg peptic ulcer disease, inflammatory bowel disease, lactose intolerance )
What do I expect from the doctor‘s clinic ?
Detailed history taking and physical examination
Depending on the clinical findings, the doctor might just reassure you or order relevant blood, urine and stool tests.
An ultrasound abdomen or x-ray or even a CT scan might be required.
