Abdominal pain in children

What is abdominal pain in children?

Abdominal pain is pain felt anywhere in the area between the bottom of the ribs and the pelvis. It is very common in babies, infants and children under 12 years.

There are many different causes of abdominal pain in children, including trapped wind, constipation, gastroenteritis (‘gastro’ or stomach bug) and appendicitis.

Most episodes in children are not serious and will get better without treatment in hours or days. But, if the pain is severe, does not go away, or your child seems generally unwell, take them to the doctor or hospital emergency department.

This page is about abdominal pain in children under the age of 12. Go here for information on abdominal pain in older children and adults.

What symptoms may accompany abdominal pain in children?

Symptoms of abdominal pain may come on quickly or they may have been present for a while. The pain may be steady, worsening, or it may come and go, and it can be either mild or severe.

Noticing the pattern and the location of the pain can help your doctor with making a diagnosis.

Abdominal pain in children may be accompanied by other symptoms, such as wind, burping, passing gas (farting), vomiting, diarrhoea, constipation or fever.

You may notice behaviours in your child that suggest they might be in pain. These include crying, curling up in a ball, wanting to stay still because of the pain, not wanting to play, refusing food or drinks, becoming fussy or grumpy, and facial expressions.

How can I help my child explain their pain symptoms?

Young children and babies may not be able to tell an adult where they feel the pain, or what it feels like. When trying to work out your child’s symptoms, it can help to ask simple questions, such as:

• “Can you point to where it hurts?”
• “Did you wake up with the pain?”
• “When did you go to the toilet last?”

Try not to ask leading questions or transmit your anxiety to them.

What causes abdominal pain in children?

Abdominal pain can have many different causes in children — some are common; others are rare. Some of these causes are not found to be causes of abdominal pain in adults.

Here are some of the causes of abdominal pain in children:

Constipation

Constipation is common in children. Generally, a child is constipated if they have 2 or fewer than 2 bowel movements (poos) per week. Most children poo every 2 to 3 days. Babies who are breast-fed may pass a stool only once a week.

Often, constipation in children has no physical cause and occurs because they perviously have had a painful or unpleasant bowel movement. Encopresis is a condition where impacted stool partially blocks the lower bowel, leading to diarrhoea leak around the blockage.

Trapped wind

Intestinal gas (wind) is a normal byproduct of digestion. Wind pain is very common in newborn babies, and they swallow air when they are feeding and crying. If your baby wriggles or cries when feeding they may have wind. If they cry when laid down after feeding, this could also be wind.

Babies get rid of wind by burping or passing wind from their bottoms (farting). They may need some help with this. There are techniques that can help you with burping your baby after a feed.

Older children with excess wind may be constipated, have lactose intolerance or may have eaten foods that cause excessive gas.

The abdominal pain is normally relieved when the gas is released by burping or passing wind.

Gastroenteritis

Gastroenteritis, or ‘gastro’, is caused by an infection in the gut — usually a viral infection, but sometimes a bacterial one. These infections are easily spread between people, especially between children. Gastroenteritis causes vomiting, diarrhoea, fever and abdominal pain.

Children and small babies are more susceptible to becoming dehydrated from gastroenteritis and babies under 6 months should be seen by a doctor if they develop gastroenteritis.

Rotavirus is one common cause of severe gastroenteritis in babies, but vaccination against it is available as part of the National Immunisation Program. Older children are more likely to have gastroenteritis caused by Norovirus — sometimes known as ‘the winter vomiting bug’.

Food poisoning

Food poisoning is caused by germs that grow in food which has been poorly prepared or stored. The symptoms are the same as those of gastroenteritis, but they are usually more severe. Again, babies and small children are more at risk of dehydration than older children and care should be taken to ensure they stay hydrated. See below for how to treat dehydration.

Irritable bowel syndrome

irritable bowel syndrome (IBS) causes abdominal pain which may be related to one or more of the following: defecating (pooing), or a change in how often a child poos, or a change in the appearance of the poo.

Some children will have diarrhoea, some will have constipation and others will have alternating diarrhoea and constipation. If a child’s constipation is due to IBS, the abdominal pain does not go away after pooing whereas it does with regular constipation.

Lactose intolerance

Lactose intolerance is a reduced ability to digest lactose — a sugar found in milk and dairy products. This results in bloating, wind and diarrhoea after consuming food or drink containing lactose. It is very rare in babies. Lactose intolerance in children may be temporary, such as after a bout of gastroenteritis, or it may be permanent.

Colic

Colic is the name given to excessive crying and distress in babies. It is very common, especially in very young babies. The cause is not fully known, but colic appears to be harmless — other than the distress it causes to parents and the child.

Babies with colic cry loudly, can’t be consoled, may bring their knees up, and they have wind. See here for more information on colic in babies and when to visit the doctor.

Urinary tract infections

Urinary tract infections (UTI) are common in children. Abdominal pain can be one of the symptoms in older children, along with pain when urinating, or urinating more often than normal, and sometimes fever.

Appendicitis

Appendicitis is an emergency. If you think your child may have appendicitis, you should take them immediately to a doctor or hospital. A burst appendix can lead to life-threatening infection.

Appendicitis causes pain around the navel, or belly button area, which then moves to the lower right side of the abdomen and becomes sharper. A child with appendicitis may complain of worsening tummy pain, lose their appetite, vomit, be uncomfortable when sitting upright or standing up, and have pain when moving. They may try to keep very still.

Intussusception

Intussusception occurs when a part of the bowel slides into an adjoining part of the bowel, like a telescope. It is a serious condition, often causing a blockage (bowel obstruction) preventing the normal flow of food or fluids. This can be fatal if not treated.

Children with intussusception may have intermittent severe pain causing crying and distress. They may have bleeding from the bottom, vomiting, or be lethargic/listless — either all the time or in waves. In between the episodes the child may seem relatively well.

Incarcerated hernia

A hernia happens when an organ or body tissue bulges through an abnormal weak spot into another place. It can happen to the stomach or intestine if they bulge through the abdominal wall. Some children have a weakness in the abdominal wall when they are born and have an inguinal hernia. These are relatively common in children and young babies.

An incarcerated hernia describes what happens if the hernia can’t be put back and the contents of the hernia become trapped in the abdominal wall. This is a medical emergency as blood flow may be cut off, causing tissue to die. This is known as a strangulated hernia. The bowel may also become blocked.

Symptoms of a strangulated inguinal hernia include pain in the groin, nausea, vomiting, sudden pain, and not being able to pass wind or move the bowels. The hernia bulge may turn dark red or purple.

Testicular torsion

Testicular torsion is when a testicle rotates and twists the spermatic cord, reducing blood flow to the testicle. It is a medical emergency and needs surgery to save the testicle. It is more common in adolescent boys but can happen in younger boys.

Symptoms of testicular torsion are pain and swelling in the testicle, and one testicle sitting higher than the other. Pain is usually in the testicle but may be in the abdomen.

Ingestion of a foreign body

Young children frequently put things in their mouths and end up swallowing them. Most foreign bodies that reach the gastrointestinal tract will pass out of the body without any help. A minority of objects will cause problems.

Button batteries and magnets can cause serious and life-threatening complications. If you suspect your child has swallowed a button battery or magnet, go to the nearest hospital emergency department or ring the Poisons Information Centre 13 11 26.

Symptoms of having ingested a foreign body include drooling, loss of appetite, noisy breathing or coughing, vomiting, abdominal pain and dark bowel motions.

When should my child see a doctor?

Most children will have a sore tummy / abdominal pain at some point. Mostly, it won’t be a serious illness, but, if a baby or child has any of the following, you should take them to the doctor or hospital emergency department as soon as possible:

• severe abdominal pain
• pain that is made worse by movement
• pain that wakes them from sleep
• pain that comes and goes, or that doesn’t go away, or that is getting worse
• pain and a fever (temperature above 38 degrees Celsius)
• problems passing urine (doing a wee)
• pain when they pass urine
• they are pale, sweaty and lethargic
• they are tired and listless
• for more than 24 hours
• lots of diarrhoea (8-10 watery poos, or 2-3 large poos per day)
• signs of dehydration – thirst, sunken eyes, drowsy, dry lips and tongue
• a skin rash as well as pain
• fewer than 4 wet nappies per day if they are a baby
• pain or swelling in their groin or testicles in a boy

Go straight to the hospital emergency department if there is:

• vomit that is green or bloody
• poo that is black or red (may have blood in it), including bloody diarrhoea

How is abdominal pain diagnosed in children?

A doctor will ask you (or your child) questions about their pain. They will put your child at ease before carefully examining them. Sometimes tests will be needed to find the cause of abdominal pain in a child. These include:

• blood tests
• urine or stool (poo) samples
• ultrasound
• x-rays

How is abdominal pain treated in babies and children?

Often no specific treatment is necessary, other than home care (see earlier). However, some treatments that may be needed include:

• oral rehydration solution or intravenous fluids
• pain relief — usually paracetamol at the recommended dose for age and weight
• an operation (surgery)

Antibiotics are not normally recommended for gastroenteritis, as most infections will be due to a virus.

How do I take care of a child with abdominal pain?

If you are taking care of a child with a sore tummy or abdominal pain:

• make sure that they rest
• it’s very important that they drink enough clear fluids — encourage them to take small sips often
• if they don’t want to eat, don’t push them
• if they are hungry, give them bland food, such as crackers, bananas, or toast
• if simple pain relief is needed, paracetamol is usually the recommended pain relief medicine
• sitting on the toilet may help them do a poo, which may improve the pain
• distract them from the pain by reading a book, rubbing their tummy or with toys or quiet games

If a baby has abdominal pain, follow advice for pain management in babies. Burping the baby may help if the baby has wind.

If a baby is sick with gastroenteritis:

• breast fed babies should continue to be breastfed, but may need feeding more often
• oral rehydration solutions may be needed, as well as breast milk
• bottle fed babies may need their formula and oral rehydration solution

Resources and support

If you need advice on what to do for your child, call healthdirect on 1800 022 222 (known as NURSE-ON-CALL in Victoria) to speak with a registered nurse, 24 hours, 7 days a week.

Pregnancy, Birth and Baby has a helpful list of resources: Who can I call for information and advice?

For more information and support, try these resources:

• Raising Children Network
• Royal Children’s Hospital Melbourne
• Sydney Children’s Hospitals Network