Abdominal Pain in Children

Abdominal pain is one of the most common medical problems for children. It represents up to 4% of all pediatric office visits and up to 30% of visits to our office. In addition, nearly 40% of school children complain of abdominal pain on a weekly basis. We generally divide pain into acute pain and chronic pain. Acute pain lasts for a short time period, usually less than a week while chronic pain lasts for a longer time period, usually more than a few months.

Acute abdominal pain is usually first evaluated by your pediatrician. 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 abdomen, often with fever, laboratory and/or x-ray abnormalities. If your pediatrician needs help with diagnosing or 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 extremely common in children. In fact, one in every 5 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. This pain is often divided into two categories: 1) "Organic" and 2) "Functional" pain.

The most common cause of chronic abdominal pain is "functional" abdominal pain. This is best understood as a problem with the interplay between the mind and the body and the way the nerves and muscles of the intestine or stomach are working -- or not working. Some liken this pain to 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 faster 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. One common type of functional abdominal pain is called irritable bowel syndrome. Unlike "organic" abdominal pain, functional abdominal pain is not caused by a physical blockage, infection, ulcer, or colitis. Functional pain is not typically associated with fevers, rectal bleeding, or abnormal blood, urine, stool, or x-ray tests. Sometimes, it can cause children to awake at night, eat less, and even miss school. This pain can also be triggered by factors such as constipation or lactose intolerance. Sometimes, it may be triggered by 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 doctor.

"Organic" abdominal pain signifies pain caused by a physical problem with the gastrointestinal system and is far less common than functional abdominal pain in children. Organic pain may be associated with fevers, blood in the stool, weight loss, jaundice as well as abnormal laboratory, x-ray, or endoscopic findings. Your doctor may decide to test your child for possibilities including celiac disease, eosinophilic esophagitis, peptic ulcer disease, Helicobacter pylori, inflammatory bowel disease), infections, pancreatic, gallbladder, and liver disease, among others.

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, your child's teachers, 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/2008%20Revisions/Abdominal%20Pain%20-%20Reviewed%20August%202008.pdf

A NY Times article on recurrent abdominal pain in children:
http://www.nytimes.com/2010/11/23/health/23klass.html?_r=2&ref=health

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.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