Abdominal Pain in Children

Abdominal pain is one of the most common medical problems for children. We generally divide pain into acute pain and chronic pain. Chronic pain lasts for some time, usually more than a few months while acute pain lasts for a shorter time period, usually less than a week.

Your pediatrician or family doctor should be the first to evaluate acute pain. It can be caused by a variety of problems including infections, constipation, appendicitis, urinary tract problems, pancreatitis, gallstones, and many other disorders. Appendicitis usually presents with pain in the right lower quadrant, often with fever. If your pediatrician needs help with diagnosing and treating the cause of acute pain, he may send you to a pediatric surgeon, the emergency room, or sometimes, to one of our doctors, especially if surgical problems appear unlikely.

Chronic abdominal pain is common in children. Up to one out of every 8 school aged kids may experience chronic abdominal pain. Often, the pain is felt around the belly button. It may be associated with some nausea, diarrhea or constipation. The most common cause of this kind of abdominal pain is "functional pain." This is best understood as a problem with the way the nerves and muscles of the intestine or stomach are working - or not working properly. Many consider this pain as occurring because of a "sensitive stomach." In children and adults with functional pain (also called visceral hyperalgesia), it has been shown that the nerves in the stomach cause pain much quicker when the stomach is stretched than in individuals who do not have functional pain. In addition, research centers have demonstrated increased levels of pain neurotransmitters in the intestinal lining of patients with functional pain.

Functional abdominal pain is not caused by a blockage, infection, ulcer, or colitis. Functional pain is not associated with fevers, rectal bleeding, or abnormal blood, urine or stool tests. Sometimes, it can cause children to awake at night. Sometimes, it may or be associated with stressors in the family, like a new school, a conflict with friends or family, divorce (or stressed parents), or a recent illness or death in a child's family. It will be important for you to carefully consider all of the stressors in your child's life and discuss them with your pediatrician.

Our doctors are experts in evaluating and treating abdominal pain. Please help us by bringing a copy of all previous lab tests and growth records with you to your specialist's appointment. Together, we will decide if further testing is needed. Medications used to treat the symptoms may include antacid treatments, stool softeners, a high fiber diet, muscle relaxants, or in some cases migraine-type medications.

Before you see the gastroenterologist for chronic pain, it is a good idea to try a few simple dietary changes. You may wish to try a lactose free diet to see if milk (specifically the sugar in milk, lactose) is causing the problem. Sometimes it is as simple as reducing the child's intake of junk food, high fructose corn syrup (a sweetener found in many foods that can cause cramping and bloating), caffeine, sodas, or excessive spicy or fried foods.

Acute and chronic abdominal pain can be very challenging for you, your child, and your doctors. The good news is that most chronic abdominal pain in children eventually goes away and is not caused by serious health problems. As with any condition, please discuss your symptoms and concerns with your medical providers and especially notify them if there are any major changes in the symptoms.

Additional information can be found at these websites:

A link on functional, chronic pain:
http://www.naspghan.org/user-assets/Documents/pdf/diseaseInfo/AbPain-E.pdf

A link on lactose intolerance:
http://www.naspghan.org/user-assets/Documents/pdf/diseaseInfo/Lactose-E.pdf

A link on infant colic:
http://www.naspghan.org/user-assets/Documents/pdf/diseaseInfo/Colic-E.pdf

Amitriptyline, Nortriptyline , and Desipramine: What you need to know:
http://www.ccdhc.org/diseases/TCAs.pdf

A handout on constipation in kids:
http://www.naspghan.org/user-assets/Documents/pdf/diseaseInfo/Constipation-E.pdf

An article on irritable bowel syndrome:
http://www.jhu.edu/~jhumag/0497web/gastro1.html

Links to the International Foundation for Functional Disorders:
http://www.iffgd.org/GIDisorders/GImain.html
http://www.aboutkidsgi.org/

A link to the UNC Center for Functional GI disorders which has numerous patient education materials:
http://www.med.unc.edu/medicine/fgidc/public_education_materials.htm