In, most cases, abdominal pain is short-lived and disappears on its own without treatment. However, in some cases, there may be a serious physical cause, such as appendicitis, that needs urgent medical attention. It can be difficult to decide whether abdominal pain in a child, particularly a young child, needs medical attention or whether to wait and see. If your child has stomach ache or if his or her behaviour causes you to suspect abdominal pain, consult this chart for advice.
Warning
Danger signs Call an ambulance if your child has severe abdominal pain lasting for more than 4 hours or if pain is associated with any of the following symptoms:
Swelling in the groin
Swelling in the scrotum
Greenish-yellow vomit
Black or bloodstained faeces
Do not give your child painkillers or anything to eat or drink while waiting.
1Has your child been in severe pain continuously for more than 4 hours?
Possible cause A serious abdominal condition, such as appendicitis, is possible.
Action Your child will probably be admitted to hospital, where his or her condition can be closely observed and tests carried out. Do not give him or her painkillers or anything to eat or drink while you are waiting for help. Your child may need surgery to identify and treat the cause of the pain.
14Emergency! Call an ambulance
Possible causes A swelling in the groin may be due to a hernia (protrusion of part of the intestine through a weak area in the muscle wall of the abdomen) that has become trapped, or strangulated. Swelling in the scrotum may be due to torsion of the testis, in which a testis twists inside the scrotum.
Action In both cases, emergency surgery is needed. A child with a strangulated hernia must have the hernia repaired. This procedure involves replacing the intestine and repairing the weakness in the muscle wall (seeHernia repair). In the operation to treat torsion of the testis, the testis is untwisted, and both testes are then anchored to the wall of the scrotum to prevent the problem from recurring.
15
Possible cause This type of pain may be the first sign that your child has appendicitis or another condition in which the lining of the abdominal cavity becomes inflamed.
Action Give your child sips of water but nothing else to drink or eat. Follow the advice for relieving abdominal pain. Watch your child carefully, and if the pain is still there after 4 hours, call your doctor.
16
Possible cause and action Gastroenteritis (inflammation of the digestive tract), most commonly due to a viral infection, is the most likely cause. If your child has diarrhoea, follow the self-help measures for preventing dehydration in children. If he or she still has diarrhoea after 24 hours or if further symptoms develop, call your doctor.
17Emergency! Call an ambulance
Possible cause A condition known as intussusception, in which the intestine telescopes in on itself causing an obstruction, is possible. This condition is uncommon in children over 2.
Action Your child will be admitted to hospital for tests and an enema, which may correct the problem. If it does not, an operation to remove the obstruction will be needed.
18Emergency! Call an ambulance
Possible cause Your child may have an obstruction in the intestine.
Action Your child will be admitted to hospital for tests such as X-rays. He or she will probably need an operation to relieve the obstruction and treat the cause.
19
Possible causes These symptoms are often associated with abdominal pain in childhood, which may be due to swollen lymph nodes.
Action Unless your child shows any of the signs mentioned in the warning box, give the child painkillers and encourage him or her to drink. If the pain worsens or is no better within 24 hours, see your doctor.
Action Your doctor will test a sample of your child's urine. If the diagnosis is confirmed, a urine sample will be sent for analysis, and your child will be prescribed antibiotics. In some cases, further tests, such as ultrasound scanning (seeInvestigating the urinary tract in children), may be needed to look for any associated problems.
21
Possible cause and action The episodes of pain may be an expression of anxiety or stress. Talk to your child to try to find out if anything is worrying him or her. Call your doctor if other symptoms develop, if the pain is severe, or if your child still has abdominal pain the next day.
22
Possible cause Your child may have migraine. In children under age 8, the symptoms often include recurrent episodes of abdominal pain instead of the one-sided headaches that are typical of migraine in older children and adults. Consult your doctor.
Action Your doctor will examine your child and may arrange for tests such as a urine test to exclude other disorders. Taking painkillers should help to relieve the symptoms.
23
Possible cause Your child may have a food intolerance, such as lactose intolerance, in which symptoms such as abdominal pain, vomiting, and/or diarrhoea occur whenever a certain food is eaten. Consult your doctor.
Action Your doctor may suggest excluding possible problem foods or food groups from your child's diet for a trial period. If you need to exclude a food permanently from the diet, you may be referred to a dietician for advice.
24
Possible cause and action Recurrent unexplained abdominal pain is common in childhood and is unlikely to have a serious cause. During an episode, follow the advice for relieving abdominal pain. You should call your doctor if the pain is severe or if your child is still unwell the next day. Consult your doctor if the pain recurs frequently.
25
See your doctor if the pain persists for more than 24 hours and you are unable to make a diagnosis from this chart.
Self-Help Relieving abdominal pain
Easing abdominal pain Let your child lie down quietly, holding a well-wrapped hot-water bottle against his or her abdomen, until the pain eases.
The following measures may help to relieve mild abdominal pain in a child:
Let your child hold a wrapped hot-water bottle against the abdomen.
Give your child only water to drink and nothing to eat while he or she is in pain.
If the pain worsens or is still present the next day, call your doctor. Call an ambulance if severe pains lasts more than 4 hours.
Intussusception
Location
Obstruction due to intussusception This cut-away diagram shows how the last part of the small intestine pushes into part of the large intestine to cause an obstruction.
In intussusception, part of the intestine telescopes into itself, causing an obstruction. The cause is unknown, but it may occur during viral infections. If your doctor suspects that your child has intussusception, your child will be admitted to hospital and may be given intravenous fluids. An enema will probably be given to confirm the diagnosis. This may also correct the problem by forcing the intestine back into position. If the enema does not help, emergency surgery may be needed to relieve the obstruction and remove any damaged intestine.
Family Doctor Health Advisor is for information purposes only, and is designed as a general reference and catalyst to seeking further information.
The RACGP is not engaged in providing medical or other advice or services, and is not responsible for the results of any actions taken by any person on the basis of any information in this publication, or for any error in, or omission from, this publication.
Publication Date: 31 March 2009 Authorised By: RACGP
