Although tummy aches are a common complaint in children — the reason for 5 to 10 percent of all visits to a doctor or emergency facility — they seldom turn out to be a cause for serious concern. Most of the time, tummy pains are caused by a viral infection and disappear in a couple of days. A study from the University of Indiana showed that only one or two out of a hundred children had problems serious enough to require specific treatment or surgery.
Signs to Look For
There are some signs, however, that you should bring to your health care provider's attention to help figure things out. Oddly enough, severity of pain is not necessarily the most important issue. Gas trapped in a loop of bowel may cause sudden, inconsolable screaming in a child who writhes on the floor but has no fever, does not vomit, and recovers by relaxing in a warm bath.
Rather, a pattern of increasing pain over several hours that makes the child reluctant to stand up straight, let you touch his belly, or move is more likely to signal a serious problem. Other worrisome signs include:
You should bring these symptoms to your health care provider's attention immediately.
Recurring abdominal pain, especially if it wakens the child at night and is associated with weight loss, can signal a chronic inflammation or infection in the bowel. Recurring complaints that come up only in stressful situations (such as going to a new school or day care or leaving on a trip) and are accompanied by no other symptoms are a way of expressing tension. The child and the situation need investigation, not the tummy.
Abdominal pain accompanied by a rash on the buttocks and/or legs that resembles bruising can be caused by a condition called Henoch-Schonlein Purpura. You may never have heard of it, but it is surprisingly common. Nobody knows for sure what causes this condition, but it seems to be related to a bacterial or viral infection. Inflammation of the small blood vessels can lead to bleeding in the skin as well as the bowel and kidneys. While it's not life threatening, your pediatrician will want to watch your child carefully over several days.
Food sensitivity, especially lactose intolerance, can cause cramping and gas. There is frequently (but not always) a family history of problems digesting milk. If you suspect this is the problem, eliminate milk and milk products (or whatever food you think is responsible) for a week. If the symptoms disappear, reintroduce it. If symptoms return when milk is introduced, talk to your health care provider about adjusting your child's diet to eliminate milk while providing enough calcium.
The artificial sweetener sorbitol, used in sugar-free gum and soft drinks, can cause diarrhea, gas, and cramping.
Excessive apple juice or caffeinated drinks like colas can cause cramping and discomfort.
Unusual Causes of Belly Aches
Although most cases of abdominal pain are due to self-limited, mild viral infections-what we call gastroenteritis or the stomach flu-it may surprise you to learn that strep throat can sometimes occur not with throat pain but with a fever and belly pain. In fact, I have several times been called to a hospital to evaluate a child thought to have appendicitis and have diagnosed a strep infection instead.
Urine infections and pneumonia can sometimes cause abdominal pain as well. Pediatricians check urine samples and chest X-rays if we are not convinced that a bellyache is in the belly. Be alert to other complaints that come from other areas even if the main concern is the tummy.
Trust Your Instincts
If you think your child is really sick, let your health care provider know, even if there is nothing specific you can put your finger on. A grandmother in my practice saved the life of her grandchild who was vomiting. Although she had no other criteria for serious illness, the grandmother felt that she "just didn't look right." She turned out to have a twist in the bowel that can be life threatening and is notoriously difficult to diagnose.