Stomach pains are a common complaint among children and it is not uncommon for parents to question the validity of a child’s complaint. Whether physical, psychogenic or just an excuse to avoid an activity, stomach pain in children should always be investigated as it could be a symptom of a serious disorder.
The term ‘stomach pain‘ is often used by younger children to describe abdominal pain in general. Therefore the parent and practitioner have to isolate the pain to a specific quadrant or identify generalized abdominal pain. Other terms used by children to describe abdominal pain includes “sore tummy”, “tummy pain” and “belly ache”.
Infants cannot report stomach pain. Other symptoms may therefore be an indication of stomach pain in infants like crying when pressure is applied to the abdomen or when lying prone (on abdomen) and curled up legs.
Causes of Stomach Pain in Children
The following causes may account for abdominal pain in the left upper quadrant and upper middle area of the abdomen. These areas are where the stomach lies and therefore the more common site of stomach pain.
Children tend to overeat foods that they enjoy and may mistaken mild stomach discomfort or a stomach ache associated with indigestion as pain. They also tend to avoid meals when busy at play or faced with foods that they do not enjoy. In these cases hunger pangs may be reported as a stomach pain.
Pica which is the consumption of indigestible substances like sand and chalk is not uncommon in younger children. This may cause stomach discomfort or stomach pain. It is more often seen in children with nutrient deficiencies and mental retardation but may occur in any young child. Poisoning as a result of accidental intake of toxic substances are more likely to be seen in pica.
In these cases, other gastrointestinal symptoms may not be present.
Pain that starts shortly after eating specific foods may be associated with an intolerance or malabsorption syndrome. Excessive belching, stomach cramps, diarrhea or constipation, loud stomach noises and sometimes vomiting may also be present.
Common Gastrointestinal Disturbances
A number of acute gastrointestinal disturbances may result in stomach pain in children.
- Intestinal gas – excessive belching, excessive flatulence
- Indigestion (upset stomach) – bloating, nausea, stomach discomfort
- Acid reflux – heartburn, regurgitation, nausea
These causes are usually temporary and pass with little or no treatment.
Gastroeneteritis and Food Poisoning
Air, food or water borne pathogens may cause inflammation of the stomach and intestines which is known as gastroenteritis (common terms ~ stomach flu, tummy bug). Fever, nausea, vomiting and retching and diarrhea are often present. Viral pathogens are a common cause. Outbreaks (adenovirus or rotavirus) are often seen in school and day care settings.
Foods and drinks tainted with bacterial toxins are a common cause of food poisoning. It usually follows the ingestion of food and tends to affect others who have consumed the same foods. Vomiting, nausea and retching are usually present. Diarrhea and fever may not always be present.
Any obstruction within gastrointestinal tract may cause pain, loss of appetite, projectile vomiting and nausea. It is important to exclude an obstruction due to a foreign body as children tend to swallow objects either intentionally or accidentally.
Other causes may include conditions like intussusception (invagination of one part of the intestine into another like a telescope) or volvulus (twisting of the intestines). Apart from the symptoms mentioned above, bile vomiting may also be seen if the obstruction lies after the first part of the duodenum.
Passing stool less than three times a week or straining to have a bowel movement is considered as constipation. It is not uncommon in children and may be related to stress or anxiety, poor dietary habits, intestinal parasites, the use of certain medication and other chronic conditions. Hirschsprung’s disease needs to be considered in cases of severe constipation in infants.
Injury to the abdominal wall is common as children are more active and prone to injuries. Sore abdominal muscles may also be a cause of abdominal pain and is often temporary. The pain is more prominent upon change in position and deep breathing. Peritonitis is a serious condition where there is inflammation of the lining over the abdominal organs and presents with severe pain and abdominal distension. Immediate medical attention is necessary.
Urinary Tract and Kidney Problems
Urinary tract infections are more frequently seen in females and in children it is often related to poor hygiene. Untreated cases can progress to kidney infections. Abuse, particularly sexual abuse, should be considered in the event of repeated urinary tract infections especially if it is associated with changes in personality, appetite, sleep patterns and even bowel habits.