What’s causing my child’s stomach pain? With Adam Linck, M.D.

By Kristy Bleizeffer Feb 7, 2018

Abdominal pain is one of the most common complaints in young children, and it can be particularly difficult for parents to figure out what’s causing it. Is it gas? A virus? Something more serious?

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Here, Adam Linck, M.D., describes some of the more common causes of stomach pain and what parents should do about them.

What are the common causes of stomach pain in children?

The most common cause of abdominal pain in children changes with age. Often in the clinic, the abdominal pain we deal with most is caused by an acute illness or constipation.

  • In children under 1, we can see colic, milk protein allergy or pyloric stenosis.
  • From about 6 months to 2 years, we can see foreign body ingestion, intussusception, Meckel’s diverticulum, and/or a urinary tract infection (UTI).
  • From 2-5 we see again foreign body ingestion, appendicitis, intussusception, Meckel’s diverticulum, UTI and/or constipation.
  • In children older than 5 it is roughly the same, but we can start to see diabetic ketoacidosis as well, along with anxiety-induced abdominal pain.  Celiac disease is a rare cause of chronic abdominal pain in children.

How do I tell if the pain is from constipation or gas?

The most common constipation we deal with is Functional Constipation. This normally develops in early childhood as toilet training is introduced. Children are either resistant to training or have a fear of using the toilet. This leads to stool withholding and distention of the colon wall which can cause pain.

Constipation is usually the cause when pain develops over time, is generalized, and develops around toilet training. A change in diet, such as introducing solids at 6 months and or whole milk at 1 year, could also suggest constipation.

What if the stomach ache is accompanied by other symptoms, such as vomiting or diarrhea?

Vomiting and diarrhea, especially in an acute setting, are most likely associated with an acute viral illness. If your child develops vomiting without stools or diarrhea, this could be signs of an obstruction due to foreign body ingestion or pyloric stenosis.

If there are no signs of acute illness and your child is vomiting, I would suggest seeking a doctor’s opinion. Diarrhea can develop in an acute illness or with constipation. This sounds strange, but with constipation, as the stool dilates the colon, bile and softer stool can seep around the hard stool and come out, leading to fecal incontinence. This isn’t uncommon.

How can I tell the difference between a stomach ache and appendicitis?

Appendicitis is fairly typical in its presentation. Normally, the pain starts around the belly button and later moves into the right lower quadrant. Classically, it is also associated with anorexia (loss of appetite), fever and vomiting. Pain is normally significant and progressively worsens over time. If you are concerned your child has appendicitis, I would always recommend being evaluated by your doctor.

Can stress or anxiety play a role?

Stress and anxiety seem to play a significant role in abdominal pain. Most of the time, I find this associated in school-aged children. Whether they are being bullied, worried about their school performance, or just a change in their routine can cause the onset.

A pain diary is normally helpful in diagnosing this, and other causes should be ruled out prior to making this diagnosis. If school related, this pain is normally not present on the weekends or in the summer time. This can be helpful to know when consulting with your physician.

What about food allergies?

Nausea with vomiting, abdominal cramping and diarrhea or bloating can be a sign of food allergy. They are not very common, happening in 5 to 10 percent of young children. Most allergies occur prior to age 2 and can be diagnosed with allergy testing, if necessary.

Most of the time, just avoiding the offending agent is all that is needed. A food diary can be helpful to determine the cause. Dairy, eggs, nuts and wheat tend to be the most common culprits, and children with allergic rhinitis, asthma and eczema are more likely to have allergies to food.

When should I see the doctor about my child’s stomach pain?

There is no clear-cut decision on when to see the physician. Most of the time, acute viral illness will resolve in 1 to 3 days and monitoring hydration during that time is important.

I would encourage everyone to seek advice from their physician if their child is having persistent, worsening abdominal pain or if you as a parent are concerned about your child’s abdominal pain.