Kids’ Stomach Pain: What’s Serious, What’s Not

There are certain red flags parents should be aware of

By Deborah Jeanne Sergeant

My tummy hurts!”

Most parents hear those dreaded words at some point. 

Stomach pain in children is a common complaint with causes trivial to mental to potentially deadly. Sometimes, nerves can cause an upset stomach. Talking about any concerns the child has may reveal that something emotional is causing the upset stomach.

“Stress and anxiety are, by definition, not only about our thoughts or emotions, but our physical body,” said Jennifer Rapke, licensed clinical psychologist and chief of Child Psychiatry Consultation Liaison Service at Upstate Golisano Children’s Hospital. “Our nervous system responds to stress and causes a series of physical and chemical reactions in our body. Many people have heard the term ‘fight or flight’ or have heard about ‘stress sweat’ on TV commercials. These are referencing some of the chemical reactions that occur when the body is stressed. If the body is under stress for an extended period or chronically over time, these physical and chemical changes start to wear on our bodies and can cause medical problems, such as stomachaches, headaches, being more susceptible to colds, etcetera.”

Rapke said that acknowledging a child’s feelings and a comforting touch like a hug or a hand on the shoulder can help a child relax, along with offering a glass of water or sitting down to take a break together.

“These two steps ensure that they feel heard and that you care about their welfare,” Rapke said.

Ongoing stress can manifest as chronic stomach pain. Some children may need help in coping with stress. Rapke said that different approaches work for different children, whether distraction, physical stimulation like exercise or a therapeutic massage, or relaxation techniques like deep breaths, aromatherapy or peaceful music.

“Some of these will work in the short-term, but they are most effective when practiced even a few minutes every day,” Rapke said. “For example, there are many apps that have one- to five-minute activities you could use as part of your nighttime routine that help the body learn to calm itself more effectively over time.”

If that’s not it, a few clues can help show whether the cause requires medical attention or a wait-and-see approach. Even severe stomach pain is likely just a “tummy bug” type of infection; however, if it lasts for more than several days and/or is accompanied certain other symptoms, that can indicate other issues.

Sometimes, it can be difficult to get a complete picture from children. Small children may have swallowed an object causing an obstruction but fear telling their parents what they have done. Or girls experiencing their first period may not understand menstrual cramps or may feel embarrassed talking about menstrual cramps. Teens experimenting with drugs and alcohol may also fear punishment if they admit what they have been doing. Keeping open communication and demonstrating concern can help children feel freer to discuss their health.

Causes such as food intolerances or allergies tend to present sporadically as the child is exposed to the offending foods. These are usually accompanied by bloating, diarrhea, vomiting or, in the case of some food allergies, systemic responses, affecting other areas of the body. Much rarer are bowel cancers.

Pain is a red flag for appendicitis, along with fever and the child lying very still. Moving worsens the pain. Children will not want to eat or drink and will appear very ill.

It can also help to ask if it hurts to urinate or defecate. These symptoms can indicate urinary tract infection and constipation, respectively. Especially for younger children, monitor bathroom visits. Children who are constipated usually need more water, fiber and activity to find relief.

If these do not work, children should be seen by a provider.

Other less common issues could include ovarian torsion in girls, kidney stones, bowel intussusception, and, in adolescents, gall bladder, pancreatitis, and sexually transmitted diseases.

“Anytime a child has abdominal pain, you can have them be evaluated if it doesn’t go away after 24 hours,” said Jenilee Foster, physician assistant and regional lead provider with WellNow Urgent Care in Syracuse, Rochester and Buffalo. “Or, if the child has fever, vomiting or pain to touch, that’s more of a concern that they need to be evaluated.”

An urgent care center can determine if the pain is a minor issue or requires an emergency room visit for further care.

Foster added that quick onset is more worrisome than an issue that seems to develop more slowly, but it is okay to have abdominal pain evaluated and then learn it was not serious.

“It’s almost like chest pain,” Foster said. “You want to make sure it’s nothing. As a provider, you try to rule out those things that are more severe and make sure it’s treatable at home.”

In addition to monitoring symptoms, limit foods until the pain improves. These include spicy, acidic and dairy foods.

It may help to apply a hot pack or warm washcloth to the abdomen. Older children may find comfort in sipping warm water or herbal tea.