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For the past four months your nine year old has been complaining of a stomachache almost daily. It hasn't really slowed him down, and it seems fairly mild.
Your 18 month old keeps pointing to her tummy and saying "ow-eeee". This has been happening on and off for several months now and you're starting to get concerned.
Your five year old has occasional bouts of severe abdominal pain. They only last for a few hours and always go away on their own. They have recently been happening more frequently and she is asking to go see the doctor.
These are all very common situations that many parents face with their children. For most kids, the pain is mild and doesn't seem bad enough to bother the doctor. Many parents may think their older child is faking or exaggerating the symptoms. Chronic abdominal pain is a very common condition, but unfortunately it is often very difficult to find the cause. Here are some guidelines to help you understand what may be causing the pain, how you can investigate it, and what signs to watch for that need medical attention.
Important note – this section deals with chronic, long-term abdominal pain. If your child is having sudden pain, or the pain has been occurring for less than one or two weeks, then see Acute Abdominal Pain for help.
1. Constipation – this is by far the most common cause of chronic abdominal pain. Here are some clues to help you decide if this is the cause:
If you think that constipation may be a cause of your child's abdominal pain, click on Constipation for an in-depth discussion on this topic.
2. Lactose intolerance or milk protein allergy – these two conditions are not the same thing. One is an inability to digest lactose sugar, the other is an allergic reaction throughout the body to milk proteins. Both, however, can cause upset stomach and abdominal pain. Symptoms include:
3. Heartburn, gastritis and ulcers – gastritis is the medical term for upset stomach or heartburn. It refers to inflammation in the stomach caused by over-production of stomach acid. Ulcers occur when this acid erodes too far into the stomach lining. Older children will describe it as a burning or gnawing pain over the upper middle or left side of the abdomen, or even the middle of the chest. Younger children can't describe a pain as "burning". There are two main causes of this over-production of acid:
The treatment for gastritis or stomach ulcers is to take antacid pills before meals (Zantac 75 or Pepcid AC are two common over-the-counter ones) or after meals you can try Tums, Maalox or Mylanta. If this type of burning pain continues for more than two weeks, you should see your doctor. The treatment for H. Pylori infection is several weeks of antibiotics and antacids together.
4. Intestinal infections – there are a variety of bacteria and parasites that can infect the stomach or intestines. The pain can occur anywhere in the belly. The biggest clue that the abdominal pain may be due to an intestinal infection is the presence of chronic diarrhea. These infections are diagnosed by sending samples of the diarrhea to a lab for testing. The treatment is medication to eradicate the infection.
5. Behavioral causes – this is particularly common in children ages 4 to 7. They will complain of belly pain simply to get more attention. The pain is probably not real in this case, however, if your child's desire for attention is very strong, she may perceive the pain as real. This commonly occurs when a new baby arrives in the family – your older child may feel left out. It can also occur during a move, when starting a new school, a family tragedy or break up, or any other time when your child may feel left out, insecure or worried about something. One way to approach this situation is when your child complains of the pain, simply acknowledge her by saying something like "I know dear, sometimes my tummy hurts too. But you will be okay." Do not give any special attention to it, and do not try to help your child find a remedy. For example, do not have her lay down and you rub her tummy to make it feel better. Make some effort to give her extra attention at times when she is NOT complaining. This will lessen her need to complain for attention. There is really no way to know for sure if the pain is due to behavior or illness. Use your instinct, and do not ignore the pain longer that you feel is appropriate.
Other causes – there are many other, less common causes. These include:
When to see the doctor. If the pain is mild and not interfering with your child's life or sleep, then it is okay to observe your child for a few weeks. The pain usually goes away on its own.If the pain is moderate to severe, then see your doctor.
Your doctor will need to know many details regarding the pain in order to evaluate its cause. Keep a diary for several weeks. Write down every day when the pain occurs, and answer the following questions with each episode:
You and your doctor will first decide if and when any testing is warranted. After talking to you, examining your child, and reviewing your pain diary, many times the doctor can diagnose the cause without any testing. If tests are necessary to determine the cause, here is a typical protocol that your doctor may follow. These tests go in order of least expensive, most helpful and most convenient, to most expensive, least helpful and least convenient: