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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
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  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

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Abdominal Pain

What is abdominal pain?

Abdominal pain refers to pain or cramping anywhere in the abdomen. 10% of children between the ages of 6 and 10, experience recurrent abdominal pain that generally does not coincide with the features of any medical condition. Medical textbooks have coined the terms ‘recurrent abdominal pain’ or ‘benign stomach ache of childhood’ to describe this problem. Irrespective of the label used, the pain and discomfort is truly experienced by your child and it is only natural for parents to feel concerned (Kids growth 1999-2010; Leary, 1990; Victoria Govt Institution, 2008).


Children with recurrent abdominal pain are often vague in their descriptions about exactly where the pain is situated. Soreness is usually ascribed to the area surrounding the navel, whereas children whose abdominal pain has an identifiable underlying cause are able to determine the exact site of the pain. Usually these pains are mild and are not severe enough to make your child cry. They are most commonly described as a dull ache and are generally not associated with other symptoms. However, some children may experience headaches, vomiting, pallor, or tiredness. These pains tend to vary in duration and time of onset. Until the age of 9, boys and girls experience these pains with similar frequency. 25% of prepubescent girls complain of recurrent lower abdominal pains, probably associated with the development of the pelvic organs (Kids growth, 1999-2010; Leary, 1990).


It is not completely understood why these pains occur, but in some children psychological factors may play an important role. The muscles of the digestive system are richly supplied with nerves. A child’s feelings and state of mind may cause these muscles to contract, producing cramping and pain. Children who commonly experience recurrent abdominal pain are more likely to be highly anxious, conscientious, highly strung and are more prone to fears and sleep disorders. A family history is likely to reveal other family members who have similar pains or personality traits, as well as over-focusing on eating and bowel habits. It is also possible for abdominal pain to be precipitated by a stressful event or trauma. However, abdominal pain is also found in well-adjusted children from well-adjusted families (Kids growth, 1999-2010; Leary, 1990).


Medical evaluation of children with recurrent abdominal pain

Although a physical cause for recurrent abdominal pain is rarely found, it is recommended that your child is evaluated by your doctor to eliminate the possibility of an underlying medical condition, such as a urinary tract infection, ulcer or food allergy (Kids growth, 1999-2010).


A careful medical history is important when evaluating a child with recurrent abdominal pain. Questions may include:

·         the severity of the pain

·         is the pain constant or intermittent?

·         what makes it better or worse?

·         does it occur in relation to eating, only at school or on the weekends?

·         is it accompanied by other symptoms? etc.

Your doctor will also perform a physical examination. He will then have sufficient information to make an informed decision about which tests are appropriate and cost-effective and will assist in the care of your child without putting him through any unnecessary discomfort. Generally, a few laboratory tests are sufficient (Kids growth, 1999-2010; Leary, 1990). Possible tests may include blood tests, urine test, stool sample, X-rays of the abdomen, ultrasound or a colonoscopy (Victoria Govt Institute, 2008).


Parenting a child with abdominal pain

Although there may not be any medically discernible cause for your child’s abdominal pain, it is a very real experience for him and should not be undermined. Parental sensitivity and ingenuity are the best medication for abdominal pain (Kids growth, 1999-2010; Leary, 1990).


There are certain factors that often contribute to abdominal pain in children; if these are eliminated, their pain may decrease in frequency and severity. They include:



Constipation is one of the most common causes of abdominal pain (See section on Constipation).



Alleviate any unnecessary stress or anxiety for your child. What may be an anxiety-provoking situation for one child, may be an exciting one for another, e.g. sleeping over at a friend’s house for the first time. Encourage your child to think of his stomach ache as his body’s signal that he may be worried about something. Keep the lines of communication open; to help him to discover the cause of his abdominal pain, externalise his feelings, and remove the internal tension from his stomach. Also, try to identify any changes in the environment on a particular day that may have preceded the abdominal pain.


Food related

Occasionally, children develop indigestion from eating too much, too fast, or from being forced to eat when they are not hungry, resulting in abdominal discomfort. Certain foods, such as wheat or dairy, may irritate the bowel due to a food allergy or intolerance. Keep a careful history of your child’s dietary habits in relation to his abdominal pain. If a pattern emerges, e.g. he gets a sore stomach every time he eats dairy products, eliminate these foods from his diet and observe whether the severity and frequency of his pain lessens.



Other possible causes of abdominal pain and general fatigue in children are hunger, low blood sugar and familial overconcern with food habits. Provide your children with a mid-morning and mid-afternoon snack to alleviate some of these problems.


Period pain

Some girls experience pain monthly just before or during their menstruation (Kids growth, 1999-2010; Leary, 1990; Victoria Govt Institute, 2008).


Relieving abdominal pain

·                Ensure that your child gets plenty of rest. Encourage him to lie on a bed or sofa, or sit comfortably in a chair.

·                Fill a hot water bottle with warm water and place it in a towel. Let your child hold it against his stomach.

·                Give your child paracetamol if he is miserable and in pain. Carefully check the label for the recommended dose.

·                Ensure that your child drinks plenty of clear fluids, especially water, to prevent dehydration.

·                If your child is hungry, give him bland food such as rice, crackers, banana or toast, provided that his abdominal pain is not accompanied by other symptoms. Do not force your child to eat if he feels unwell; he will resume eating when he feels better.

·                Distraction techniques such as rubbing your child’s tummy or reading him a story sometimes helps to relieve the pain.

·                If your child’s recurrent abdominal pain seems to be anxiety-related, encourage him to talk about his worries, is something upsetting him at home, school, kindergarten or with friends, or consider taking him for a relaxing massage, or to a homeopath for a constitutional remedy (Collins, 2003; Victoria Govt Institution, 2008).


More serious causes of abdominal pain



The appendix is a small, worm-like tube that branches off at the beginning of the large intestine. Although the appendix has no known function, it can become infected and inflamed, resulting in a condition known as appendicitis that requires surgery. Pain generally begins around the navel, increases in severity and moves to the lower right hand side of the abdomen. Children with appendicitis often lie still, because any pressure increases the pain, as does movement or deep breathing. This type of abdominal pain is accompanied by fever, nausea, possibly vomiting, diarrhoea or constipation, and is severe enough to make your child cry. If your child has any of these symptoms, call your doctor within 3 hours. If the pain continues for 6 hours, take your child to the emergency room immediately. Untreated appendicitis may result in a perforated or burst appendix, or a potentially dangerous condition known as peritonitis, where pus enters the abdominal cavity and causes widespread infection. If you suspect appendicitis, do not give your child anything to eat or drink in case an operation is necessary, and try not to give them painkillers because they will mask the symptoms and make diagnosis more difficult (Collins, 2003).


Abdominal obstruction

If your child suddenly experiences severe, intermittent attacks of abdominal pain accompanied by a swollen abdomen, incessant vomiting that produces a greenish-yellow fluid and he seems generally unwell, he may be suffering from an intestinal obstruction. In children under the age of 2, this generally occurs when a small part of the bowel folds in on a larger part of the bowel, resulting in a disorder known as intussusception. Other possible causes of intestinal obstruction in children of all ages include an incarcerated hernia, a genetic abnormality of the intestine, Crohn’s disease, and volvulus, or a twisting of the intestine. Other signs that indicate a possible intestinal obstruction are wind but an inability to pass faeces or the attainment of temporary relief when passing wind and upon defecation, in the case of a partial obstruction. Call your doctor immediately if any of the above symptoms present themselves (Collins, 2003; Leary, 1990).


Inflammatory bowel disease (IBD)

Crohn’s disease and ulcerative colitis are rare in children under the age of 7, but more common in adolescents. Crohn’s disease is a condition that causes the intestinal wall to become inflamed, sore and swollen. It can affect both the small and large intestine (ileocolitis). It is called ileitis when it is in the ileum or last part of the small intestine or Crohn’s colitis when it affects the colon. Symptoms include abdominal pain and spasms, diarrhoea, fever, weight loss due to the small intestine’s inability to absorb nutrients and reduced appetite, nausea and sometimes ulceration of the anus (Collins, 2003; Australian Crohn’s & Colitis Assoc Inc.).


Ulcerative colitis causes the colon and rectum to become inflamed and ulcerated. It produces abdominal pain, bloody diarrhoea that might eventually lead to anaemia, a feeling of fullness in the bowel, fever, nausea, poor growth and loss of appetite (Collins, 2003).


The cause of IBD is not known and because it is a chronic condition treatment generally involves the control and management of symptoms, e.g. the use of anti-inflammatory drugs. Your child may be given liquid supplementation in order to provide him with sufficient nutrients. In severe cases, he may require drugs and nutrients intravenously or the damaged parts of the intestine may require surgical removal (Collins, 2003; Australian Crohn’s & Colitis Assoc Inc.).


If your child is experiencing the above symptoms, contact your doctor within 24 hours. A bacterial infection is most commonly the cause but if an IBD is suspected, an X-ray using barium or a colonoscopy will be performed to establish an accurate diagnosis (Collins, 2003).


Food poisoning

Abdominal pain due to food poisoning usually occurs 2 hours after eating the offending meal and is generally experienced in the upper-middle abdomen. Symptoms include retching or ‘dry heaves’, nausea, chills without fever, a soft abdomen when pressed, and a general, overal, unwell feeling (Leary, 1990).



Children with infections such as a sore throat or pneumonia may initially present with abdominal pain that is later accompanied by fever and chills. This may occur because there are glands in the abdomen that swell and produce pain when there is a generalised infection (Leary, 1990).


Gastroenteritis (See section on Diarrhoea).


Urinary Tract Infections (UTI)

Young children may feel vague pain in response to a UTI. As a result, paediatricians often check their urine to assist in their diagnosis (Leary, 1990).



As a general rule, if your child is able to accurately locate, using only one finger, the source of his abdominal pain, it is more serious than if he provides a vague description. The further away from the umbilicus their pain is, the more concerned you should be, especially if their pain resides in the lower right part of the abdomen. Pain in the lower part of the abdomen in general is also a cause for concern (Kids growth, 1999-2010; Leary, 1990).