”My belly hurts” is an all to common complaint in children, and a puzzle to parents and medical professionals alike. Causes reach from surgical and medical to anxiety and school avoidance. Careful listening and detailed attention to history and presenting symptoms by parents and doctors can help to sieve the serious from the not so serious. If there is an obvious mild self-limiting illness like an upper airway infection or gastro bug and things can be managed with simplified diet , hydration , warm water bottles and mild pain killers in a not so unwell child, there is not so much worry. Note that only 1 in 15 children with acute (new onset ) of abdominal pain require surgical admission and only 60 % of these require specific therapy including surgery. Yet 1% of children, most commonly in the 10-12 year olds will develop acute appendicitis ( inflammation of the appendix) Warning signs for acute surgical or medical tummy ache are:
- persistent vomiting especially if bile stained ( yellow / watery)
- sudden onset of severe pain
- pain in one location
- pain away from the central abdomen (the belly button area)
- significant and persistent Weight loss
- child prefers to be still
- fever especially prolonged and not controllable
- fluid refusal
- obvious swelling / lumps of the abdominal wall (Hernia)
- bloody stools
- chronic ( over days ) diarrhoea ( frequent soft – watery stools)
Lack of an obvious simple explanation and any or more of above red flag presentations should lead to a visit of GP or after hour service. The Physician will familiarize himself with the parents and child , ask a lot of questions , do a simple physical examination, including some basic tests like Urine bedside testing , stool testing to help him differentiate between simple self limiting causes and the ones like Appendicitis , urinary infections , diabetes , gastroenteritis , abdominal and genital trauma (especially in boys), even chest infection which require treatment or admission to hospital.
Even trickier is the recurrent abdominal pain of childhood , intermittent quiet severe tummy pain or cramps for hours or days between long periods of no symptoms at all. Only 8% of these more chronic presentations eventually reveal some organic (medical, surgical ) pathology. These chronic pains are often over investigated , when attention to detail and history could safe the child from unnecessary sometimes in itself stressful tests. Most chronic pains are better managed with simple medications , dietary modifications, as well as reassurance. Conditions include stomach migraine of childhood , Irritable bowel, constipation , and mesenteric adenitis ( abdominal lymphnode swelling of childhood), anxiety , bullying. Similar red flags as for acute pain apply though, others are:
- age less than 5
- mouth ulcerations
- skin disease around the rectum
It seems to be even harder to keep the good from the bad in chronic pain but studies show that significant time of school and no significant weight loss suggest a non organic cause.
Good communication between parents , GP, specialists, child and family is essential for a good outcome.
Helko Schenk
11 1 2010
- persistent vomiting especially if bile stained ( yellow / watery)
- sudden onset of severe pain
- pain in one location
- pain away from the central abdomen (the belly button area)
- significant and persistent Weight loss
- child prefers to be still
- fever especially prolonged and not controllable
- fluid refusal
- obvious swelling / lumps of the abdominal wall (Hernia)
- bloody stools
- chronic ( over days ) diarrhoea ( frequent soft – watery stools)
Lack of an obvious simple explanation and any or more of above red flag presentations should lead to a visit of GP or after hour service. The Physician will familiarize himself with the parents and child , ask a lot of questions , do a simple physical examination, including some basic tests like Urine bedside testing , stool testing to help him differentiate between simple self limiting causes and the ones like Appendicitis , urinary infections , diabetes , gastroenteritis , abdominal and genital trauma (especially in boys), even chest infection which require treatment or admission to hospital.
Even trickier is the recurrent abdominal pain of childhood , intermittent quiet severe tummy pain or cramps for hours or days between long periods of no symptoms at all. Only 8% of these more chronic presentations eventually reveal some organic (medical, surgical ) pathology. These chronic pains are often over investigated , when attention to detail and history could safe the child from unnecessary sometimes in itself stressful tests. Most chronic pains are better managed with simple medications , dietary modifications, as well as reassurance. Conditions include stomach migraine of childhood , Irritable bowel, constipation , and mesenteric adenitis ( abdominal lymphnode swelling of childhood), anxiety , bullying. Similar red flags as for acute pain apply though, others are:
- age less than 5
- mouth ulcerations
- skin disease around the rectum
It seems to be even harder to keep the good from the bad in chronic pain but studies show that significant time of school and no significant weight loss suggest a non organic cause.
Good communication between parents , GP, specialists, child and family is essential for a good outcome.
Helko Schenk
11 1 2010
Parents always in a worry of their children that their child always facing problem of recurrent abdominal pain. Thanks for sharing such a nice information.
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