Cincinnati Children's Blog

Stomach Pain In Kids: When To Worry

Stomach Pain In Kids: When To Worry

Tummy aches are a common complaint in kids of all ages. Sometimes it’s minor: perhaps your child just needs to go to the bathroom. But other times stomach pain can signal something much more serious. Trouble is, how do you tell the difference?

Most often these complaints come from eating too much, constipation, or being anxious or worried. But it’s important to ask your child for more information, in case the pain is being caused by something else.

Below are the stomachache questions I am asked most often, and tips to help figure out when your child’s pain deserves a trip to the doctor.

1. What Questions Should I Ask My Child? 

When your child has abdominal pain, find out these answers to get a better idea of what might be causing the pain:

  • When did the pain start?
  • What were you doing right before the pain started and when it started?
  • Where is your belly hurting?
  • How bad is the pain? (Use a number scale of 1-5, with 5 being the worst. For younger kids, ask how they feel on a range of happy/OK/sad/crying.)
  • Is it related to when or what they last ate? 
  • When was the last time you pooped?

Pay attention if your child complains several times a day or over several days. Take note of how often they complain and when. Jot some notes down for yourself. This information will be important to know if you end up calling the doctor.

Sometimes a trip to the bathroom will take care of things. Other times the “watch and wait” approach works. If your child doesn’t complain again, whatever was bothering them might have passed. If they have pain but are otherwise acting as they normally do — laughing, eating, playing — chances are it may not be serious.

2. What Could My Child’s Stomach Pain Mean?

Stomach pain can signal a wide range of problems. It often shows up with diarrhea, gas, nausea and vomiting. It can also come on with a viral or respiratory illness.

Pain in the upper abdomen could signal:

  • Heartburn/indigestion
  • Gallstones
  • Stomach ulcers
  • Pancreatitis

Mid-abdomen pain can be due to:

  • Digestion issues/constipation
  • Stress/anxiety
  • Kidney stones
  • Urinary tract infection

Pain in the lower abdomen could mean:

  • Constipation
  • Gastroenteritis
  • Pelvic or groin pain
  • Menstrual cramps, for anyone who has had their first period
  • Urinary tract infection
  • Appendicitis (typically on the right side of the body)

You can see from this list that some forms of stomach pain can be treated at home, while others might be due to something more serious. Other less common causes aren’t listed above, but may still be to blame. 

3. When Should I Call the Doctor?

If you’re ever in doubt, call your pediatrician.

In particular, call the doctor if:

  • The pain is severe, comes on suddenly and doesn’t let up – especially pain in the lower right part of the stomach (which can signal appendicitis)
  • The pain doesn’t go away and you don’t know what’s causing it
  • Your child has blood in their vomit or stool
  • Your child’s belly looks swollen
  • It hurts when you press on your child’s belly
  • Your child looks or acts sick, or has other symptoms along with the stomach pain
  • Your child has had belly surgery in the past and you’re not sure if things are OK
  • Your child has multiple medical problems and you’re not sure if the pain is a real problem

Whenever possible, I feel it’s best to start with a conversation with your doctor rather than going straight to the emergency room. However, if your doctor is unavailable or it’s after office hours, leave a message with their answering service and then seek immediate treatment for any of the above reasons.

4. What Will The Doctor Want To Know?

You can help the doctor by having the answers to these questions ready at your child’s appointment:

  • How long has your child been complaining of this pain?
  • Does it seem to be related to when or what they eat? 
  • Are they going to the bathroom regularly? When was the last time they pooped?  Was the poop normal or are they having diarrhea?  
  • Does their pain occur around school? (This could signal anxiety about school.) 
  • Have they had any nausea or vomiting? 

For more serious conditions, this information can help lead the doctor in knowing if further tests might be needed such as ultrasound, X-ray or CT scan.

Our goal is to rule out the more common causes of stomachaches, so we know if we need to dig deeper.

5. Appendicitis Or Gastroenteritis?

“Is it appendicitis?” is one of the most frequent questions that comes up, and for good reason. Early diagnosis of appendicitis can make it easier for us to treat the appendicitis and less likely to have major problems from advanced or ruptured appendicitis. The good news is, appendicitis is not really as common in kids when compared to things like stomach viruses, pain related to stress, or constipation.

But gastroenteritis is. Also often called “the stomach flu” or “a stomach bug,” gastroenteritis is caused by a virus and usually comes on quickly. These two conditions share many symptoms, which may include:

  • Abdominal pain
  • Low-grade fever
  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea and constipation

With appendicitis, pain typically starts in the mid belly, but over the first 24 hours usually settles in the lower right side of the belly, and may get worse over time. Gastroenteritis is usually short-lived and improves on its own.

Take note: These symptoms can also be a sign of food poisoning or a viral illness. 

As you can see, tummy troubles can be tricky. If you’re not sure what’s upsetting your child’s stomach, it’s best to call your pediatrician.

Sometimes ongoing stomach pain doesn’t respond to typical treatments and can’t be narrowed down to a common diagnosis. In these cases, your pediatrician might refer you to a gastroenterologist (sometimes called a GI specialist). These doctors specialize in problems related to the belly. They are often part of the care team when it comes to managing stomach pain.

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