You wake up at 2 a.m. to the sound of your five-year-old crying in his bedroom. You find him curled up in bed, holding his stomach and moaning in pain.
Your two-year-old begins crying after dinner, pointing to his abdomen and saying “ow-eeee”.
You pick up your twelve-year-old from school and he reports his stomach has been hurting all afternoon.
Your eight-year-old has complained of severe stomach pain all day. He suddenly starts to throw up and the pain becomes unbearable.
These are all very common scenarios, and can be very concerning to parents. With causes ranging from gas or heartburn to appendicitis, it is very difficult for a parent to know what is causing the pain and just how serious it is. Do you call your doctor? Do you rush your child to the emergency room? What should you do?
This discussion will help you identify the various causes of sudden abdominal pain, how to tell if it may be serious, and what to do in a variety of situations.
Abdominal pain is rarely an emergency, and usually doesn’t warrant an after hours call to your doctor. So for now, relax, don’t rush to page your doctor just yet. Read through this section first, and then decide what to do. If you think your child has one of the serious causes as described below, go to the ER right away. If the pain is not serious, but goes on for several days, you should probably have your pediatrician check it out during office hours.
Important note: this discussion focuses on sudden causes of pain, such as the scenarios listed above. It does not pertain to chronic, long-term abdominal pain. Click here on Chronic Abdominal Pain if your child’s problem has been going on for weeks or months.
These causes are not serious and usually don’t require a call to your doctor or any other urgent medical intervention.
- Intestinal illness – the most common cause of abdominal pain is the stomach or intestinal flu. If your child has vomiting, diarrhea, and fever, then you can be fairly sure the stomach pain is simply a part of a non-treatable and non-serious infection. Click on Vomiting, Diarrhea or Fever for help with these specific symptoms. Hepatitis A is another viral infection that can cause sudden belly pain, usually the right, upper belly where the liver is. Children will usually turn yellow during this infection. This is relatively rare, and occurs in outbreaks from restaurants or schools. Don’t worry that you child may have hepatitis during a fever and vomiting illness because it is almost always a stomach flu, not actual hepatitis.
- Food poisoning – this isn’t really “poisoning” as the term implies. It simply means there were some bad bacteria in something your child ate. If your child has sudden abdominal cramps, vomiting, and possibly diarrhea within 1 to 8 hours after eating some suspicious food, then it is probably food poisoning. Click here on Vomiting for help with this. Common foods that cause this include: fish, beef and mayonaisse.
- Gas – this is probably the most common cause of abdominal pain in the absence of any vomiting and diarrhea illness. Your child will experience sharp pains on and off that may move throughout the abdomen. Older children may tell you they can feel the gas bubbles moving along.
- Upset stomach or heartburn – this is different from food poisoning or gas pain. This simply means that your child ate something that didn’t agree with him, or has a temporary over-production of stomach acid. The pain is usually over the stomach (the upper middle and left side of the belly below the ribcage) or in the chest and may be described as burning or gnawing. Categories of offending foods include:
- Food intolerance or allergy – most commonly dairy products, nuts, berries, fish, wheat, eggs. Consider this if your child ate something for the first or second time.
- Acidic foods – foods that may cause heartburn include: foods with tomato sauce, greasy foods, and citrus fruits or juices.
- Almost any food may cause heartburn or upset stomach in some kids. Keep track of these suspected foods. Click on Gastritis for more information on causes and treatment of acid over-production in the stomach.
- Sore abdominal muscles – if your child has recently participated in an active sport or activity involving use of the abdominal muscles, this can create extreme soreness of these muscles. The pain is worse when you push on the belly or when your child uses the muscles such as in sitting up. These muscles may also become sore after prolonged vomiting.
- Menstrual cramps – don’t forget this cause in teenage girls. Cramps can occur even before periods have started. These are usually fairly obvious – cramping lower abdominal pain, may include back pain. It can start as young as 9 or 10 years of age. Treatment is ibuprofen click here for dosing. Please note that ibuprofen can cause stomach upset.
- Constipation – this is more often a cause of chronic abdominal pain. However, your child may have sudden onset of constipation that can cause severe abdominal pain. The pain can occur anywhere in the belly, although it is most often right in the middle near the belly button. The pain will come and go as the colon naturally contracts, trying to move the hard stool along. Click on Constipation for more help with this.
There are a few causes that are specific to younger infants.
- Colic – this refers to episodes of inconsolable crying for hours. The baby seems to be crying in pain, and the source of the pain appears to be the abdominal area. This is a very complex issue. Click here on Colic for more information.
- Stomach upset from something in the mother’s diet in breastfeeding infants. For a list of foods that can cause this, click on Colic-causing foods.
- Formula intolerance – click on formula for more info on finding the right formula if your baby isn’t tolerating one.
- Gas – this is by far the most common cause. Almost every baby goes through fussy, gassy periods. It is often from an irritating food in mom’s diet, a formula intolerance, swallowed air during excessive crying, or from inadequate burping after feeds.
Here are some serious causes of pain that require a prompt call to your doctor.
- Appendicitis – this is probably the most worrisome cause of sudden abdominal pain for parents since it is so well known. The appendix is a one-inch long piece of intestines that branches off of the colon in the lower right part of the abdomen. It can become inflamed and infected for a variety of reasons. The pain most often starts as mild to moderate discomfort focusing around the belly button. Unfortunately, this is where children feel pain for most other non-serious causes as well, so early appendicitis is difficult to catch. Here’s how you can tell – the pain will move down to the lower right side of the abdomen and become much more severe. Here are the classic signs of appendicitis:
- Severe right lower abdominal pain
- Constant pain – it usually doesn’t come and go
- Gradually increased pain – the pain will usually get worse and worse
- Refusal to eat
- Vomiting – this is sometimes present, but not always
- Refusal to walk – a child with appendicitis will often lie down curled up in a fetal position
Try the jumping test – have your child stand up and jump up and down. With appendicitis, this will cause increased severely sharp pain and your child may grab his lower abdomen. The child will refuse to jump again, or may refuse to jump in the first place. If your child can jump up and down repeatedly with not much discomfort, then he probably doesn’t have appendicitis (this is not a perfect test, just a helpful tool to help decide how likely appendicitis is).
Appendicitis is rare in children younger than four years old.
Important note – keep in mind that many illnesses start off with vomiting, diarrhea, fever, and belly pain. Don’t jump to the conclusion of appendicitis until you have observed your child for several hours. Appendicitis rarely has the frequent vomiting and diarrhea that is characteristic of the stomach flu. Most causes of abdominal pain don’t focus of the lower right area of the belly. Unless the pain moves to the lower right abdomen, becomes increasingly severe, and your child is unusually ill, then appendicitis is unlikely.
Another important note – unfortunately appendicitis doesn’t always behave exactly the way the textbooks say it’s supposed to. It can fool even the most discerning parent and doctor. IF YOU HAVE A SUSPICION THAT YOUR CHILD MAY HAVE APPENDICITIS, YOU SHOULD SEEK PROMPT MEDICAL ATTENTION.
- Intestinal obstruction – this is by far the most serious and emergent cause of sudden abdominal pain, but it is also the most rare. It is characterized by sudden excruciating belly pain, usually in the middle, with persistent projectile vomiting. One unique aspect of the vomitus is that it is dark green. It is important to know the difference between light green stomach mucus (which is not serious) and dark green bile. There are two processes that can occur in the intestines that can cause sudden obstruction:
- Intussusception – this unusual word refers to when a part of the intestines “telescopes” in upon itself, just like a telescope collapsing. This is usually occurs in children under age two. The unique aspect of this pain is that it can come and go. Your infant can be in severe pain, with his legs drawn up to his belly, for 20 minutes, and then relax and be pain-free for a half hour. This occurs because the “telescoped” intestine may intermittently open up again.
- Volvulus – this occurs when the intestines get twisted. The twisted area gets closed off. This occurs mostly in children over 2 years. This pain is severe, and constant.
- There are some other causes of serious severe abdominal pain. The bottom line is that if your child is in severe pain, is vomiting dark green bile repeatedly (not light green mucus), and seems severely ill, you should seek immediate medical attention.
If you have determined that your child is experiencing one of the non-serious causes of pain, here are some tips on how to relieve the discomfort.
- Intestinal illnesses, food poisoning or sore abdominal muscles – sit your child in a warm bath, gently rub his tummy, place warm towels or hot water bottle over his tummy. Try Ben-gay or similar cream for sore muscles.
- Gas pain – massage the tummy to try to move the gas bubbles along. You can give your child (even your newborn) some simethicone drops (Mylicon is a brand name). A warm bath may also help.
- Upset stomach or heartburn – give your child an antacid. Mylanta or Maalox work well. Tums is another choice. A drink of milk can also sooth heartburn.
- Constipation – click on it for more information.
- Menstrual cramps – ibuprofen, ibuprofen, ibuprofen! Ask your wife, it’s probably her best friend!
- Colic – click on it for more information.