Stomachaches, though common in children, are rarely life threatening or dangerous, but how do you know when tummy troubles signal something serious? From acute abdominal pain that comes on suddenly to chronic gastrointestinal issues, here’s how to know when to seek medical attention.
When Stomachaches Interfere With Life
Frequent stomachaches could indicate that something in the digestive system needs medical attention. Keep in mind that children might say that their stomach hurts when the pain could actually be in any part of the digestive system. If your child’s bellyaches start to interfere with daily life — disrupting school attendance or social events like birthdays or soccer games — they may be worth a trip to the doctor’s office. “It doesn’t necessarily signal disease, but it does signal that they need to seek medical care," says Craig Friesen, MD, the division director of gastroenterology and the medical director of the abdominal pain program at Children’s Mercy Hospital in Kansas City and a professor of pediatrics at the University of Missouri–Kansas City School of Medicine. With very young kids, who aren’t yet able to fully communicate what’s going on, your doctor may take a different approach. A little girl may say her tummy hurts, but what she’s really saying is that she’s having a bowel movement and needs to use the toilet. “Most of what I do with toddlers is tell them to go to the bathroom and, if it still hurts, to go play,” Dr. Friesen says. “If they don’t do either, then the child needs to be evaluated.”
The Most Common Signs to Look For
Children of all ages do experience stomach pain on occasion, says Deborah Goldman, MD, a pediatric gastroenterologist at the Cleveland Clinic. “Signs and symptoms vary according to the age of the child, and the causes vary by age. We can see things in infants that we don’t see in adolescents.” While infants may show distress by crying and being fussy, a child younger than 8 might say their tummy hurts but can’t describe the pain. “I ask them to point to where the pain is worst,” Friesen says. “If they point to the lower right, they may need to go to the ER for appendicitis.” So if your child’s pain persists, you should try to keep track of new and existing symptoms.
Constipation
One of the top reasons for abdominal pain is constipation. A child may be constipated if they’re not eating enough fiber from fruits and vegetables, which can make their digestive system sluggish and make having a bowel movement hard. While it may be distressing, constipation is rarely an emergency. “People get really nervous about constipation, but it can be normal for a kid not to poop for a couple of days,” says Wendy Hobson-Rohrer, MD, a professor in pediatrics at the University of Utah Health in Salt Lake City. “As long as the stools are soft and not hard balls and the child is not straining, infrequency isn’t usually a problem.” Encopresis is an extreme form of constipation. It occurs when the child holds hard stool because it is painful to poop. The hardened stool stretches the colon and rectum, and in time affects the ability of the child to sense the stool. Eventually, the anal sphincter weakens around the hardened stool, allowing softer stool to leak out, leaving telltale skid marks on the underwear. Parents may think the child has diarrhea but it is actually a more extreme form of constipation. “Encopresis can happen at any age, but it is most common in school-age kids,” says Dr. Hobson-Rohrer. “This is a medical condition, and you don’t want to punish the child, because they cannot control what is happening.” While upsetting, encopresis is treatable, but it can take several months to retrain the anal sphincter and intestine to work properly again.
Diarrhea
If your child is suddenly passing loose, watery stools three or more times a day, they have diarrhea, which most kids experience from time to time. Diarrhea usually lasts at most a few days, but if it sticks around longer, it could lead to severe dehydration. It can also signal an infection or a more serious health issue. Infants, toddlers, and young children should be taken to the doctor if they experience symptoms such as:
Diarrhea that lasts more than two daysDiarrhea accompanied by a fever of 102 degrees F or higherSevere abdominal painBloody stools or stools that are black and tarry or contain pusDiarrhea accompanied by frequent vomitingSigns of dehydration
Diarrhea may be caused by bacterial and viral infections, food intolerance, reaction to medicines, intestinal diseases, or parasites that enter the body through food or water, like Cryptosporidium, which is found in public pools. According to the Centers for Disease Control and Prevention (CDC), Cryptosporidium is the leading cause of outbreaks of diarrhea linked to water.
Anxiety
Stress and anxiety can be another reason why kids might have a bellyache. The enteric nervous system, sometimes called the “second brain,” is located in the gut and helps regulate gastrointestinal functions. It also communicates with the central nervous system through what’s known as the gut-brain axis, a link through which the brain can influence the gut and vice versa. When a situation is stressful enough to trigger a fight-or-flight response, for example, digestion slows. Even less severe stress can also disrupt the digestive system, causing pain. Emerging evidence, such as the results of a study published in General Psychiatry in 2019, suggests that the gut microbiome — the bacteria, viruses, and fungi that live in the digestive system — can impact mental health by way of the gut-brain axis. RELATED: Have Anxiety? Here’s What Your Gut Has to Do With It “The brain-stomach connection is real,” says Hobson-Rohrer. “Anxiety can cause children to experience belly pain when there is nothing wrong with their digestive system.” Warm compresses or a heating pad can relieve belly pain caused by indigestion. Warm (not hot) chamomile tea or mint tea can calm the child and help get the digestive process moving.
When Stomach Problems Mean Something Serious
Sudden onset of severe abdominal pain likely requires medical attention right away. Appendicitis, for example, can produce sudden, sharp pain in the lower right side of the abdomen. In children, symptoms can also include vomiting, fever, and loss of appetite. This condition occurs when the appendix, a small, finger-shaped pouch attached to the large intestine, becomes inflamed and infected. Appendicitis requires surgery to remove the infected organ. Frequent though less acute stomach problems could indicate that the digestive system needs medical attention, as well. This kind of chronic pain may not necessarily require a trip to the emergency room, but it’s important to see your pediatrician or a specialist to find out what’s going on and get it properly treated. This kind of pain could be due to conditions such as ulcerative colitis, Crohn’s disease, or certain congenital issues, like misaligned or twisted organs in the GI tract. In particular, pain below the belly button may indicate chronic issues such as irritable bowel syndrome or inflammatory bowel disease, disorders that affect the small and large intestines. While many kids with either of these disorders will have loose stools, diarrhea, gas and bloating, parents should seek medical attention immediately if there is blood in the stool, weight loss, or slow or delayed weight gain. A digestive condition like celiac disease (an intolerance to gluten, the protein found in wheat, barley, and rye) can be harder to spot and requires further testing. Symptoms include abdominal pain, bloating, gassiness, failure to gain weight, and loose or hard stools. Managing celiac disease always requires following a strict diet. To ensure that children continue to receive enough nutrition for health and growth, Hobson-Rohrer urges parents to work with their pediatrician when eliminating foods from the diet. Children can also be lactose intolerant, which means they can’t produce enough lactase, the enzyme that helps break down lactose, the sugar found in milk and dairy products. This can lead to bloating, flatulence, and other tummy symptoms. According to Hobson-Rohrer, it is rare to see kids with severe lactose intolerance; however, some babies have milk allergies, which occurs when the immune system overreacts to the proteins in the milk. Symptoms are usually hives, wheezing, vomiting, and bloody stools, but these conditions often resolve as the child gets older. Though most tummy woes are likely to pass, recognizing some of the most worrisome signs and knowing when to call the doctor will make both you and your child feel better sooner. “If you can console the child, you probably do not need to seek immediate medical attention,” said Hobson-Rohrer. “If the child is crying and inconsolable and has symptoms like a tense belly, vomiting, and bloody stool, it is important to seek immediate medical care.”
