Abdominal pain

Summary

• Abdominal pain is a common complaint in childhood.
• There are a variety of causes including infections, irritable bowel syndrome, urinary tract infections and functional abdominal pain.
• Functional abdominal pain is pain for which no cause is found.
• Functional abdominal pain accounts for around 90 percent of abdominal pains in older children.
• Treatment varies with the cause.

Causes

Recurrent abdominal pain is common in childhood, occurring in at least 10 percent of preschool and school-age children. In children younger than two years old, there is usually a cause which can be found and treated. But in older children only about 10 percent of cases of abdominal pain have a so-called organic cause. Frequent abdominal pain without a cause is often called "functional" abdominal pain.

Common causes

Gastroenteritis describes an inflammation of the stomach and the rest of the bowel. The symptoms are cramps, diarrhoea, and often vomiting as well. Diarrhoea may be very watery, and may contain blood and mucous. This is often caused by a virus.

Other causes are bacteria and parasites, such as amoebae and Giardia. In the more affluent sectors of South African society, gastroenteritis tends to occur mainly in winter, and is caused by viruses, particularly rotavirus, and adenovirus species. In the less affluent sectors of our society, gastroenteritis is a summer illness, caused by viruses as well as bacteria, such as E.coli, Salmonella and Shigella.

Parasites tend to be a problem in older children. The treatment of viral gastroenteritis is by replacement of fluids and salts. The viral types will not respond to antibiotics. Spread of the illness can be by hand to mouth contact, or through droplets in the air. The illness can often be prevented by meticulous attention to hand-washing and careful food preparation.

Appendicitis is an infection of the appendix, which is a tube-like glandular appendage, attached to the large bowel or colon. Infection causes inflammation, which results in pain, classically in the right lower part of the stomach. However, this pain can be felt elsewhere in the abdomen, and often starts around the belly button.

There is usually loss of appetite, nausea, sometimes vomiting and fever accompanying the pain. In the later stages of the inflammation, the child will lie very still, rather than rolling around, which is more common in cramping pain. It is unusual in children below the age of two, and is most common in the teens and early twenties.

Irritable bowel syndrome is an illness which causes attacks of abdominal pain, cramps and diarrhoea, often alternating with constipation. There is no fever. The cause is not known and treatment is difficult. If you notice that there are particular things which your child eats which cause this, then eliminate them from the diet. It is often associated with anxiety, so measures to calm the child can be helpful. This can be confused with lactose intolerance.

Lactose intolerance, i.e. intolerance of the enzyme lactose results in problems digesting milk and milk products. This causes bloating, indigestion, gas and diarrhoea. It is very rare under the age of three years, although a considerable number of adults may be lactose intolerant as an acquired condition.

Urinary tract infections: An infection in the bladder, kidneys, or lower part of the urinary tract can cause pain in the lower part of the abdomen, back and sides. This type of infection also causes pain on urinating, frequent urination, bed-wetting, sometimes fever and, in severe cases, nausea and vomiting. It is unusual in very young children. Treatment is with antibiotics, plenty of fluids and paracetamol or its equivalent for pain control.

Constipation is a common cause of abdominal pain in children. It is often a vague pain, involving the whole abdominal area. Changing the whole family’s diet to include fresh fruit and vegetables and brown bread will often prevent further episodes.

Functional abdominal pain is abdominal pain for which no cause is found. It occurs in at least 10 percent pre-school and school-age children, and accounts for around 90 percent of abdominal pain in older children. The cause is not known and the symptoms are often not specific. The treatment is reassurance.

When to call the doctor

You must call the doctor or take your child to an emergency centre immediately if:

• The pain is severe.
• Your child has a high fever.
• Diarrhoea and vomiting are severe.
• Your child is lying still with a rigid or a distended abdomen.
• There are any signs of bleeding usually from the mouth or from the anus.
• Your child is feeling faint or losing consciousness.

Previously reviewed by Dr John D. Burgess, FCPaed (CMSA), Senior Specialist, Red Cross Children's Hospital

Reviewed by Prof Eugene Weinberg, Paediatrician, February 2011