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Abdominal pain (stomach ache)

pain; abdomen; tummy; abdominal; stress; truancy; school; irritable; bowel; irritable bowel; period; appendicitis; constipation; massage; urinary; kidney; bladder; lactose; intolerance; intolerant; coeliac; celiac; allergy; food; stomach; ache; nausea; bloating; wind; menstruation; dysmenorrhoea; worry;

Children often complain of stomach ache (pain in the tummy). It can be a sign of illness, but often a child will have pain, but not be unwell.

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Children often complain of stomach ache (pain in the tummy). It can be a sign of illness, but often a child will have pain, but not be unwell. Some of the children who have abdominal pain will be having a difficult time, perhaps at home, perhaps at school, but many children with strong pain do not seem to be stressed or unwell. Research has shown that up to 10% of children have abdominal pain which comes and goes. An illness causes the pain in only about 5% of these children.

If a child complains of tummy pain and seems unwell, perhaps has a fever, is vomiting, has diarrhoea (runny poo), is not wanting to drink or eat and not wanting to do things that she or he normally enjoys (such as playing), that child is likely to have an illness.

Illnesses that cause tummy pain

There are many illnesses that can cause tummy pain, including:

  • infections in the gut (see 'Gastroenteritis')
  • infections or pain in other parts of the body; young children often have tummy pain with a sore throat, ear infections and infections of the lungs (eg pneumonia)
  • infections in the kidney or bladder (see 'Urinary tract infection in young children')
  • appendicitis (see Appendicitis below)
  • food poisoning (toxins made by bacteria in the food cause damage to the gut)

Signs that a child has an illness causing the tummy pain

  • The child seems unwell, is doing less than usual, or lying down, not wanting to move or wriggling around trying to find a position that makes the pain feel better.
  • Vomiting, diarrhoea (runny poo), refusing food, refusing drinks.
  • Fever, flushed or pale skin, sweaty skin, or very dry skin if the child is dehydrated (see 'Gastroenteritis').
  • Pain when passing urine (doing a wee), passing urine much more often than usual.
  • Pain that is keeping the child awake, or which wakes her during the night.

Appendicitis

  • Appendicitis is a fairly common problem which can come at any age although it is unusual in very young children (under one year).
  • The appendix is a small, dead-end tube leading from the caecum, which is part of the bowel (gut) and it can become blocked, leading to appendicitis.
  • Appendicitis causes pain which usually starts in the middle of the tummy, around the umbilicus (belly button), and as it gets worse the pain moves to the lower right side of the tummy, and the tummy becomes tender (sore to touch).
  • A child with appendicitis usually shows other signs of being unwell such as fever, refusing food, vomiting and sometimes diarrhoea.
  • Most tummy pain is not appendicitis.
  • Appendicitis will sometimes settle without surgical treatment, but an operation to remove the appendix is often needed (appendicectomy).
  • Always check with your doctor if you think it may be appendicitis.

What you can do

If your child seems unwell and in pain for more than a couple of hours, it would be a good idea to have him checked by your doctor or health worker. How quickly you have him checked depends on several things like:

  • how old he is (babies need to be checked earlier than older children)
  • whether he will drink (drinking helps prevent dehydration)
  • whether he is vomiting and has runny poo (he will be losing fluid (water) from his body if he is vomiting and has diarrhoea)
  • his temperature is high for more than a few hours.

If it seems likely that your child has gastroenteritis, see the topic 'Gastroenteritis'  for ideas about drinks, food and when to have your child checked.

Other health problems that can cause tummy pain

There are many other health problems that can cause tummy pain for children.

  • Constipation is often thought to be a cause of pain, but not all people who have constipation have much tummy pain (see 'Constipation').
  • Some people who have pain will have food intolerances. Their gut cannot digest some foods and this can cause damage to the lining of the gut. They may be intolerant to lactose in milk (see 'Lactose intolerance in babies') or gluten (in wheat and other grains, see 'Coeliac disease').
  • True food allergies are likely to cause other problems such as rashes through to difficulty with breathing rather than just tummy pain (see 'Reactions to food').
  • Migraine can cause tummy pain for young children (see 'Migraine').
  • Coughing a lot can cause muscle pain which can be quite severe (bad).

Irritable bowel syndrome

This is a common cause of tummy pain that goes on for many weeks or months. At least 5% of adults have irritable bowel syndrome, and it often first happens in the teenage years (and sometimes in younger children).

  • The pain can be really bad, but no physical cause for it can be found. There can also be feelings of being bloated (a lot of wind in the tummy) and nausea (feeling sick).
  • The pain may come soon after eating, and may improve when the child passes poo, or wind.
  • The pain may be felt around the belly button (umbilicus), or sometimes in other parts of the tummy. The tummy will be tender when touched, but not as tender as appendicitis.
  • Irritable bowel syndrome can be triggered by infections such as gastroenteritis, but can last long after the infection has gone.
  • Staying off some foods, such as milk, seems to help some of the time.
  • Usually the person looks well, is not losing weight, eats reasonably well and can manage usual activities.
  • A person with irritable bowel syndrome may be more 'sensitive' to pain, finding a 'normal' level of muscle tightening (as it pushes food along) painful, but the pain is real - it is not 'all in the head'.
  • The pain usually goes after some time (and this can be quite a long time) but it also often comes back later.

If a person looks unwell, is losing weight and not eating well, the pain is not likely to be irritable bowel syndrome.

Period pain

  • When girls start to have periods, they usually do not have much pain with the periods (although a few girls get some "monthly" pain even before they start having periods).
  • After about a year, they start to ovulate regularly and the periods may be more painful. About two thirds of girls have pain with their periods.
  • Some girls (about 10%) have very painful periods, called dysmenorrhoea, which can interfere with their normal activities, including going to school, for one or more days each cycle.
  • The period pain is usually a cramping pain in the lower abdomen and sometimes the back. Some girls feel quite unwell when they have period pain.
  • There are some medications which make a big difference for period pain, so go to the doctor for advice. The contraceptive pill is usually not the medication that is recommended in the first instance.
  • Other things which may help period pain are using a hot water bottle on the tummy and regular exercise. Some people find that some vitamin products help with other period related problems (pre-menstrual symptoms), but they may not have any effect on period pain.
  • For more information see the topic on 'Periods').

Other causes of tummy pain

Children often feel pain in their tummy when they are worried about things that are happening to themselves or to people they love. Some of the things that may cause the worry include:

  • being teased or bullied at school or kindergarten
  • being worried about a test, or not knowing how to do the work they have to do at school
  • being frightened by something, for example by a big dog they have to walk near
  • problems in the family, such as someone being ill
  • when parents are angry with each other
  • over-tiredness.

Signs that worry may be causing the pain

  • pain that occurs regularly in the morning, and stops them doing something such as going to school, but does not stop them playing later, or eating well
  • having problems with learning or behaviour at school
  • having pain that happens when someone gets angry or upset at home
  • looking and behaving as if they are well most of the time.

What to do about worry pain

  • If there do not seem to be any physical problems causing the pain, you will need to think about whether there is anything which is upsetting your child at home, school, kindergarten or with friends. Make a time to have a friendly talk with your child's teacher. Seeing you talking together may help your child voice her fears.
  • Your child may be worried about telling you he is being bullied or teased, so you may need to raise the topic (See 'Bullying' for ideas about how to manage this).
  • If there are problems at home where parents are angry or upset, it is very important to talk to your child, making it clear that you will keep him safe and that you will look after yourself (see 'Feeling angry' for more ideas if this is the problem).
  • If the pain is keeping your child home from school a lot, talk to the school to work out ways to help him return to school (this is quite a common problem and schools usually have worked out successful ways of helping children to return to school). See 'School refusal and truancy'

When you talk about this with your child, remember that the pain is real so it won't be helpful to say that it is not.

  • You might find it helpful to talk about how worries can cause strange feelings in the tummy (such as 'butterflies' or even pain).
  • Let her know that you want to help her and that it is OK to tell you whatever might be worrying her.
  • If she does not respond straight away you could say that you understand that it is hard to talk about some things but that you are always ready to listen.

Without pressing your child for information, arrange some quiet relaxed times together which may open the way for sharing.

  • For example you could sit on the end of her bed at the end of the day for a chat.
  • If you think you might know what the worry is, you could try telling her a story about someone else with a similar worry to let her know that you understand.

Sometimes 'hands on' things may help, such as tummy or foot massage (ideas in the topic 'Baby massage' can work for older children and adults too).

How concerned should you be?

It can be tricky to get the level of concern about tummy pain right.

  • If you show a lot of concern, this can worry your child and she may feel even stronger pain.
  • However you can't ignore the pain, because it is real and distressing.
  • Many families try really hard to make diet changes to reduce the pain. Often this does not work. Cutting out milk and milk products is often tried, but this means that a good source of calcium is lost. See a dietician before you make major changes to you child's diet.
  • It can be very useful to have a careful check of your child by your family doctor, so that if there is a need, tests can be done, but if the doctor is confident that the pain is not due to a serious health problem, both you and your child can relax.
  • Even young children hear messages such as 'if the pain persists see your doctor', and they worry whether they could have cancer. You may have to ask the doctor directly about how she or he knows that the pain is not caused by cancer or other serious illness so that your child can relax and let this fear go.

The topic 'Feeling sick' has suggestions for caring for a sick child.

References

'Abdominal pain' in Garfunkel LC, Kaczorowski J, Christy C. Pediatric Clinical Advisor'. Mosby 2007

Hotopf M, et al. 'Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study'. BMJ Vol 316, 18/4/98, p1196-1200: www.bmj.com

Khan S 'Functional abdominal pain in children' American College of Gastroenterology 
http://www.acg.gi.org/patients/gihealth/functionalab.asp

Oberklaid F and Effron D. "Treating child abdominal pain". Australian Doctor ,19 October 2001, p52.

The Children's Hospital at Westmead (NSW) 'Abdominal pain (stomach ache)' (2008)
http://www.chw.edu.au/parents/factsheets/abdominal.htm

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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