How to know when abdominal pain is more than just a 'tummy ache'
11/9/2023 by Rachel King, M.D.
"Mom, my tummy hurts." This is one of the most common complaints parents hear. How do you know when to wait it out and when to seek treatment? How do you know what level of attention is warranted? This complaint can be difficult to decipher for parents. Luckily, there are some tips and tricks that can help.
Start with a few questions
- Did it start suddenly or slowly?
- What do you observe has changed about your child?
- Are they still playing and acting like their usual self? Or are they crying, refusing to move or doubled over as if protecting their stomach?
- Are there any symptoms accompanying the abdominal pain?
Red flags
Go to the emergency department immediately if any of the following are true:
- Sudden onset of significant pain.
- Severe pain.
- Refusing to move.
- Refusing to stop moving (e.g., cannot find a comfortable position).
- Doubled over and holding or protecting the stomach.
- Uncontrollable crying or constant whimpering.
- Fever 100.4 degrees Fahrenheit or higher.
- Uncontrollable vomiting.
- Blood in bowel or urine.
- Yellowing of the skin or eyes.
- Not urinating at least twice in the last 24 hours.
- Unable to wake up and answer questions appropriately.
If the pain didn't start suddenly and isn't severe enough to significantly change your child's behavior, then you have a little time to dig deeper into what they are feeling. Ask questions like: 1) What does it feel like? 2) Point with one finger to where it hurts. 3) What makes it feel better/worse? The answer to these questions can give you clues to the origin of their pain.
Common causes of abdominal pain by location
- Upper abdomen: Pain in the upper abdomen without any of the above red flag symptoms is usually heartburn or indigestion. The clues that your child is experiencing indigestion or heartburn are burping, nausea or a sour taste in the mouth. To help with these symptoms, have your child drink a glass of water and eat a piece of bread. Having a bowel movement will typically also help the symptoms.
- Belly button: Pain around the belly button without any of the above red flag symptoms is common and can usually be handled at home. This pain is often caused by anxiety, stress, indigestion or heartburn. If the pain moves to the lower right or is associated with fever, vomiting, inability to have a bowel movement or pass gas, you should have your child evaluated for possible appendicitis. If the pain is severe, you should go to the emergency department. To help with anxiety or stress symptoms, you can have the child rest, provide a gentle belly rub and provide distraction with a quiet game, book or movie.
- Side(s) of the abdomen: Pain in the left abdomen without any of the above red flag symptoms is commonly constipation. However, if the pain starts on the far side of the abdomen and moves towards the groin, it could be a sign of kidney stones. If the pain is in the right lower abdomen or is associated with fever, vomiting or the inability to have a bowel movement or pass gas, you should have your child evaluated for possible appendicitis. If the pain is severe you should go to the emergency department. If your child suffers from constipation, have them drink extra water and spend time trying to have a bowel movement. If the issue remains for an extended period of time, schedule an appointment with their primary care clinician. If you have concerns about kidney stones, offer additional water and schedule an appointment with your child's primary care clinician.
- Pelvis or groin: Pain in the pelvis or groin without any of the above red flag symptoms could be caused by menstrual cramps or a urine infection. Urine infections also are typically associated with burning during urination, feeling an urgency to urinate with little urine output and wetting underwear or bedding when previously potty trained. Using a heating pad and taking ibuprofen (e.g., Advil) or acetaminophen (e.g., Tylenol) can provide comfort for menstrual cramps. If you suspect a urine infection, have the child drink lots of water and schedule an appointment with their primary care clinician.
Rachel King, M.D., is a pediatric resident in Community Pediatric and Adolescent Medicine in Rochester, Minn., with a special interest in pediatric emergency medicine.