If your child has pain in the abdomen, but otherwise
looks well, you can be almost sure that the problem is not serious. See the doctor if you have cause to be anxious.
CAUSES: Below are given some of the important causes of abdominal pain in children.
Psychological Factors
Medical Causes
Surgical Conditions
Psychological Factors
SYMPTOMS: School going children often complain of recurrent pain, usually located around the navel. In
most cases, the pain is not severe and the child does not
complain about it if he is involved in doing something
interesting. It rarely wakes him up from his sleep. He is perfectly all
right in between the attacks, which may last for a few moments or longer, but rarely for more than half an hour. There may
be a family history of similar pain in other children or in
the parent(s). Usually, these children are quite
intelligent.
CAUSES: Consider if there is any reason for the child to become emotionally upset. Is he being bullied in school?
Is he afraid of his new teacher? Are the examinations
causing much anxiety? Is he upset because of a quarrel between his parents?
MANAGEMENT: It is not always easy to probe the mind of a child. If the symptoms persist, take the advice of a
doctor, who may even refer him to a family counsellor,
psychologist or a psychiatrist. Don’t upset the child by remarks like, ‘You
are just acting’ or ‘Do not try to fool us’. I
believe that such children do get pain, but the symptom is probably due to
some, not yet fully understood mechanism or is related
more to the mind rather than the body - possibly a
subconscious way of attracting the parents’ attention for more body
contact. Hence, the treatment lies in understanding the child,
helping him with his underlying emotional problem, if any,
rather than being harsh towards him.
Medical Causes
Worms
Infection is caused by ingestion of the mature eggs of
common worms — Ascaris
lumbricoides (commonly
called roundworm), threadworms, trichuris trichiura (whipworms) and
tapeworms — or the penetration of the larvae of the hookworm
into the child’s skin. It is a misconception that consuming an
excess of sugary foods causes worms; but it is important to
restrict the intake of such foods as a matter of fact.
Ascariasis (infection
with round worms) The round worms measure from 15 to 35 cms in length and are 3 to 4 mms
in diameter. They are either passed out as worms or their
eggs are excreted. If a person defecates in the open, the
soil also gets contaminated with the eggs. A child may touch the infected soil and the infection may travel from the hand
to the mouth. Alternatively, food can become infected by the
excreta or by flies.
SYMPTOMS: Most children with ascariasis do not have any complaints. Sometimes, it may cause pain in the
abdomen, distension of the abdomen and even intestinal obstruction, resulting in absence
of stools and
persistent vomiting. Grinding the teeth while sleeping (Bruxism) is not due to worms.
PREVENTION: Washing one’s hands thoroughly with soap and water before a meal should be a ritual even if the
child uses a spoon, knife and fork for eating. Also, teach
your child to wash his hands thoroughly after going to the toilet. Mebendazole or albendazole is used for the treatment of
ascariasis.
Threadworms are
quite common and usually are more of a nuisance than a serious problem. Only rarely, when
they block the appendix, do they cause abdominal pain.
SYMPTOMS: Generally, children may not sleep well due to itching around the anus. This happens because the
threadlike, female worms, measuring about 1 cm, come out of the intestine at night and lay eggs on the skin around
the
anus. The eggs are carried by the child or an adult under the fingernails, or they may spread in the home through
clothing or bedding. The patient may ingest these eggs from his
own fingernails or may infect others by contamination of
food while serving/cooking. These eggs, when swallowed, grow
to adulthood.
TREATMENT: It is important to treat all the members of the family, including the house help, with a single dose
of 100 mg of mebendazole for children and adults, with a
repeat dose after 2 weeks. In certain cases, the treatment may
have to be repeated every 3 months.
Hookworms attach
themselves to the upper, small intestine and suck blood, resulting in anaemia. Larvae
of hookworms emerge from eggs lying in warm damp soil and penetrate the skin of people walking barefoot in farms
or gardens. They grow to adulthood inside the body.
TREATMENT: Anaemia is treated with iron and the patient is given mebendazole as in
ascariasis.
Whipworm (Trichuris Trichiura) infection is caused by ingestion of eggs passed in the stool, and spreads with
unclean hands and through flies, which, in turn,
contaminate water and food. Whipworms rarely cause pain in the
abdomen, but they are an important, though not common cause of prolapse of the rectum in children.
TREATMENT: Same as for ascariasis.
Tapeworms are
several metres long and inhabit the intestines. They have several segments, which are passed
into the stool as small, flat, white pieces (like seeds
of gourd or marrow, Kadu and ghia), about 1 cm long. The
infection stems from eating infected pork or beef, which is not
cooked properly. Food or water contaminated with the eggs of tapeworms may also cause infection. The disease may,
therefore, develop in children who do not eat meat.
SYMPTOMS: Tapeworms may not cause much problem except for mild pain in the abdomen. But, in rare cases,
they may form cysts in the child’s brain. This condition is
called neurocysticercosis and can lead to headaches, fits or even death.
PREVENTION: Meat eaters must make sure that it is well cooked. Personal hygiene for all members of the family
remains equally important.
TREATMENT: The drugs found useful are niclosamide for removal of adult worms, and praziquantel and albendazole
for the cysts affecting the brain.
Bacillary Dysentery
SYMPTOMS: Frequent motions (not necessarily loose) with passage of blood or mucus and accompanied by griping
pain that increases at the time of passing a motion is
usually due to bacillary dysentery. At times, the child doesn’t pass
any faecal matter, but only blood and/or mucus.
Unlike acute watery diarrhoea, vomiting and significant dehydration are not common features in dysentery, but
some children can have frequent watery motions at the onset, sometimes accompanied by vomiting.
Toddlers are prone to the condition during the monsoons. Children who are breastfed into the second
year of life are less prone to the disease and even if they
fall sick due to dysentery, the severity of the disease is
less and they recover faster. The child can get infected from close contact with an infected person or by consuming
contaminated water or food.
TREATMENT: If facilities exist, a routine stool examination can be undertaken. It would show the
presence of mucus, red blood cells and leucocytes. Macrophages
may also be present. Treatment consists of adequate
hydration (see Diarrhoeain the chapter
on Home Remedies), food and drugs. Drugs are required to control the bacterial infection.
Some doctors advise anti-motility drugs to reduce the
frequency of motions. Such drugs contain loperamide and diphenoxylate that are banned for use by children. Besides prolonging
the illness, such drugs can also have serious side effects
and must not be given.
Giardiasis And Amoebiasis
Giardiasis and amoebiasis may be suspected in children
with persistent or recurrent pain in the abdomen. A stool examination of a fresh sample is asked for to confirm
the diagnosis.
TREATMENT: The child is given a full course of metronidazole.
Food Poisoning
Food poisoning should be suspected if all those who have eaten the same food start getting abdominal pain,
diarrhoea and vomiting, with or without fever.
PREVENTION: Children should be discouraged from eating milk products outside the home.
Food should be eaten the same day it is cooked. If this
is not possible, the leftover items should be rapidly
cooled in cold storage or kept in the deep-freeze compartment of
the refrigerator, and thoroughly heated before consumption. Make sure that the centre of the food gets heated,
leaving no cool spots.
TREATMENT: Same as for Diarrhoeain the chapter
on Home Remedies.
Sore Throat And Vomiting
SYMPTOMS: Sore throat with enlargement of glands in the abdomen can cause abdominal pain in children above 2
years of age. The pain disappears as the sore throat gets
treated.
Severe bouts of cough or vomiting leading to soreness of the abdominal muscles may also present as abdominal
pain. The remedy lies in treating the cause of sore
throat, cough or vomiting.
Tuberculosis Of The Abdomen
Tuberculosis of the abdomen should be considered if the
child who complains of pain in the abdomen has associated features connected with a possible diagnosis of tuberculosis.
These features include: A history of close contact with an
adult having tuberculosis; loss of appetite and weight;
distension of the abdomen with or without evidence of intestinal obstruction; and evidence of tuberculosis elsewhere in
the body. For treatment, see section on Tuberculosis.
Constipation
This is a common cause of abdominal pain in children.
The child does not look ill, nor run fever, but gets
intermittent colicky pain in the stomach. There is no vomiting and
the appetite is usually not affected. The child may have
moved his bowels, but it may have been an incomplete evacuation.
For treatment, see section on Constipation.
Surgical Conditions
Appendicitis
Appendicitis refers to inflammation of the appendix —
a taillike structure connected to the caecum portion of the large intestine located in the right lower abdomen. If not
detected early, an inflamed appendix may burst open, leading to a serious condition called peritonitis.
SYMPTOMS: This condition should be suspected in the presence of persistent pain in the abdomen, often
(though not always) associated with loss of appetite, vomiting
and fever. The pain mostly begins around the centre of the abdomen (near the navel) and, after a few hours, gets
localised to the right lower abdomen. The child who is otherwise active becomes quieter, resists examination of
this part of the abdomen and gets even more pain when
his abdomen is pressed gently over this region. Unattended peritonitis makes the abdomen feel hard like a board,
and the pain and tenderness (pain when touched) becomes worse.
TREATMENT: A child with a possible diagnosis of appendicitis needs the immediate attention of a surgeon
— preferably a paediatric surgeon.
Intestinal Obstruction
Intestinal obstruction is a serious surgical condition.
Some of the causes are congenital obstruction (from birth), a mass of roundworms obstructing the intestines,
intussusception and an obstructed inguinal hernia (discussed later in this section).
SYMPTOMS: The child with intestinal obstruction has pain in the abdomen, constipation, distension of the abdomen
and projectile vomiting (vomit shooting out of the mouth
with great force). It may be green in colour (due to the presence of bile) or may even contain faeces. The child will want to
lie quietly in spite of the pain.
TREATMENT: The urgent care of a surgeon is vital.
Intussusception
Intussusception is a condition in which one portion of
the intestine slips inside the portion next to it. The
condition occurs commonly between the ages of 3 months and 3
years.
SYMPTOMS: There is a sudden onset of pain which lasts for 2 to 3 minutes and then occurs in repeated bouts every
quarter hour or so. The child shrieks with pain and looks
frighteningly pale. While a child usually becomes red in the face when
he cries, in intussusception, the child looks pale, acutely
ill, refuses to eat or drink and appears to be collapsing with
continuing bouts. At this stage, the child may pass blood in the
stool.
TREATMENT: A surgical opinion is urgently needed in such a situation.
Inguinal Hernia
Inguinal hernia with strangulation or obstruction may present itself in an infant who starts crying suddenly
and the mother notices a hard swelling in the groin
(junction between the abdomen and thigh). No attempt should be made to press on this swelling; show the child to your
doctor. If unattended, obstructed inguinal hernia can present with signs of intestinal obstruction (as with
Intussusception).
If the treatment is unduly delayed, the blood vessels in the swelling get obstructed, causing
damage to the surrounding intestines.
SYMPTOMS: Most often, the inguinal hernia is noticed as a swelling in the groin or the scrotum. The swelling
becomes more prominent when the child cries. It may disappear on
its own or by gentle pressure when it reduces with a gurgling feel. This is not an emergency situation, but as the
possibility of strangulation exists, this hernia should be operated
upon as soon as possible.
A strangulated hernia is an emergency needing urgent attention.
Some children may have hernia on both sides.
At times, the child has some tender glands in the groin secondary to an infection in the lower limb. This should
not be confused with hernia. A hernia should also be
differentiated from a congenital hydrocele, which presents with swelling of
the scrotum. This swelling does not change in size on
crying or with pressure. It usually disappears on its own
before the child is 1 year old.
TREATMENT: If the doctor decides that the swelling is hernia, he/she may gently try and reduce it. Failing
this, the child may be hospitalised for surgery.
Torsion Of Testes
This results in intense pain in the affected scrotum and swelling and tenderness (pain on touch) of the scrotum.
This condition may be mistaken for inflammation of the testis and treated with antibiotics, and so result in
loss of the testis.
TREATMENT: It is of prime importance to take a child with scrotal pain and swelling to a paediatric surgeon.
If it is torsion, the child must be operated soon to avoid
permanent damage to the testis.
Some Other Less Common Surgical Conditions
Other less common surgical conditions with pain in the abdomen, like injury to the abdomen and a stone in the
urinary tract may also be kept in mind. The onset of
pain with a stone is sudden. The pain is often located in the back
and extends towards the groin. A dull ache persists, with outbursts of shooting unbearable pain. This may be
associated with passage of blood in the urine.
Other Possible Causes Of Abdominal Pain In Children
Allergy
or intolerance to animal milk
Colic
in small infants
Dietary
indiscretion
Abdominal
epilepsy
Urinary
infection
Referred
pain from the chest in a child with pneumonia or pleural infection
Hepatitis
(infection of liver)
Malaria
Hunger
with low blood sugar
Infection of the gastrointestinal system with H.
Pylori is also being considered as a possible, though not definite cause
of abdominal pain. This is treated with metronidazole, amoxycillin and ranitidine.
Choledochal cyst,
an uncommon congenital malformation of the tubes draining bile from the liver,
presents with attacks of abdominal pain, clay coloured stools and fever. Sonography of the abdomen clinches the
diagnosis. Treatment consists of antibiotics to take
care of the infection. The symptoms subside after treatment with antibiotics, though surgery is necessary, and as early
as possible, as the cyst tends to get repeatedly infected
and enlarges in size with the passage of time, making
surgery more difficult in the later stages.
Meckel’s diverticulum,
an anomalous tubular structure arising from the small intestine, can give rise to
abdominal pain when inflamed. It is associated with rectal
bleeding. The bleeding is usually dark red or, more rarely, bright
red, if excessive and generally profuse. This constitutes a
medical emergency. The bleeding may stop while the child receives treatment, and the surgeon may ask for investigations
such as an isotope scan to confirm the diagnosis. However, it is
not easy to confirm the diagnosis of Meckel’s diverticulum
and the surgeon will usually need to operate to excise the diverticulum.
