“I have a tummyache.”

“I have a tummyache.”
Aug. 82022

Abdominal pain is a common reason for children to see their pediatrician. We like to divide the problem into acute and chronic causes. Let’s look at a few of each type.

Acute abdominal pain means the problem has occurred quite suddenly and has recently developed. Common reasons include food intolerances, infections, and constipation.

Lactose intolerance – Foods with lactose, which are mostly cow milk products, can cause pain when the intestine can no longer breakdown the milk sugar lactose. People are usually not born with this problem since the major sugar of breast milk is lactose. As we age we may slowly lose the enzyme in our intestine. The bacteria in our gut form gas when they breakdown the lactose.

Food allergies can also lead to abdominal pain. It can be difficult to identify the source. Often, an allergist can help.

There is a large number of bacteria and viruses that can cause abdominal pain. Whether or not your child has fever, vomiting, or diarrhea can help to clarify the source. Many of these infections are intestinal, but not always. Strep throat, for example, can sometimes seem more like an abdominal infection than a throat infection. There are plenty of others. And some illnesses that aren’t infections at all can lead to abdominal pain. Migraine is a very common one.

The most serious causes of acute pain include intestinal blockages. Intussusception, where the intestine slides into itself, and volvulus, where the intestine twists around itself, are fortunately rare.

Once abdominal pain becomes recurrent – that is, it seems to happen over and over again -- we start to think about some different causes. Actually, lactose intolerance and food allergies are usually chronic problems before they finally come to the attention of the pediatrician. The most common cause overwhelmingly is constipation. Children may withhold stool for various reasons. Sometimes it’s because when they’re being toilet trained, they graduate to a regular toilet and can no longer reach the floor to push properly. Children should always have something under their feet when they poop. The higher their knees are, the easier it will be. Diet, of course, is important. Not drinking enough and not eating enough fiber can lead to difficulty passing stool. There is a long list of other problems that cause chronic abdominal pain. It can take the expertise of a specialist who needs to look with a special camera (endoscope) to diagnose some of these problems. As you can tell, a child with abdominal pain needs proper attention. Don’t assume your child is making it up or that the problem will go away on its own. And if constant vomiting or diarrhea are part of the picture, you need to seek help right away.

Robert B. Golenbock, MD

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