Gauging kids’ stomachaches
“My stomach hurts!”
It’s a complaint every parent hears -- usually more than once -- and it leads to a question every parent faces: Is it just a stomachache or is it a sign of something more serious?
Pediatric experts estimate that about 10% of school-age children suffer from recurrent abdominal pain. Most of these painful episodes are not associated with serious medical disorders, and the overwhelming majority resolve themselves without any treatment. Poor diet, stress or fecal retention are often to blame.
Because stomachaches are so common, some parents ignore them. That approach backfired on one family we know, whose son complained of stomachaches on and off from age 6. The child seemed otherwise well and the painful bouts improved without treatment. But at age 8, the pain intensified, and a gastrointestinal specialist was consulted. The doctor diagnosed Crohn’s disease, a serious inflammatory condition of the intestines. In retrospect, the child’s pain was probably caused by that disorder all along.
So how is a parent to know if a child’s stomachache will go away by itself or if it’s a sign of a medical condition that needs treatment? The following clues can help you decide whether “watchful waiting” is the best course or if the doctor should be called.
* Length of pain. If the pain improves on its own within several hours or with simple interventions such as eating or going to the toilet, a serious medical problem is unlikely. If the pain increases in intensity or if the child complains about it for more than two hours, call a doctor.
* Severity of pain. If the child continues to play normally while complaining of abdominal pain, urgent medical attention probably isn’t needed. If, however, the child appears to be in a significant amount of discomfort or is unable to participate in normal activities, an examination by a physician is warranted.
* Location of pain. It may be helpful to ask the child to point to the area that hurts most, using only one finger. This may be difficult to do if it’s a minor stomachache, since stomachaches often hurt all over. With some serious medical disorders -- though not all -- the pain will be concentrated in one spot. (For example, with appendicitis the pain characteristically begins around the bellybutton, and then moves to the lower right side of the abdomen.)
* Vomiting or nausea. The presence of nausea and vomiting increases the possibility that a significant medical problem exists. If vomiting is persistent or so severe that the child cannot keep down enough fluid to remain well-hydrated, talk to a physician.
* Fever. If the stomach pain is accompanied by a fever, the child may have an infection of the gastrointestinal tract.
* Diarrhea. Two of the most common causes of abdominal pain and diarrhea are gastroenteritis, an infection of the gastrointestinal tract, and food poisoning. Although both will generally improve quickly without treatment, call a doctor if the diarrhea persists longer than a day or two, is severe enough to cause dehydration or contains blood.
* Frequency and pattern of pain. Sometimes poor eating and voiding habits can cause repeated episodes of abdominal pain, and simple dietary changes (such as increasing fiber intake and avoiding foods high in fat and refined sugars) can help alleviate the discomfort. Recurrent abdominal pain is also linked to stress. So, it is not unreasonable for a parent to wonder about psychological causes, particularly if the child tends to complain at stressful times (like before a test at school). However, because recurrent pain can also be a sign of several medical disorders, the diagnosis of psychosomatic stomachaches should never be made without a thorough medical work-up.
If there is any question about what is causing a child’s abdominal pain, call the child’s doctor or health-care provider. Often, the doctor can determine the nature of the problem and provide reassurance after getting answers to a few questions over the phone. If the situation remains at all uncertain, the child should be examined by a doctor and appropriate tests ordered.
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Dr. Jonathan Fielding is the director of public health and the health officer for the L.A. County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in L.A. Their column appears the second and fourth Mondays of the month. Send questions to ourhealth@dhs.co.la.ca.us.
