ABDOMINAL PAIN IN CHILDREN.
Children often complain of pain in the tummy (abdomen). It
can be a sign of illness, but often a child will have pain,
and not be unwell. Some of the children who have abdominal
pain will be having a difficult time, perhaps at home, perhaps
at school. Research has shown that up to 10% of children have
abdominal pain which comes and goes. An ‘illness’
causes the pain in only about 5% of these children.
If a child complains of tummy pain and seems unwell, perhaps
has a fever, is vomiting, has diarrhoea (runny poo), is not
wanting to drink or eat and not wanting to do things that
she or he normally enjoys (such as playing), then the
child is likely to have an illness. If you suspect that your
child may be ill you should seek medical attention. ILLNESSES
THAT CAUSE TUMMY PAIN.
There are many illnesses that can cause tummy pain, including:
- Infections in the gut.
- Infections or pain in other parts
of the body; young children often have tummy pain with a sore
throat, ear infections and infections of the lungs.
- Infections in the kidney or bladder.
- Appendicitis.
- Food poisoning.
- There are special considerations in the
tropics such as amoebiasis, giardia, worm infestation and
typhoid fever; all of which may cause abdominal discomfort.
SIGNS THAT A CHILD HAS AN ILLNESS CAUSING THE TUMMY PAIN
- The child seems unwell, is doing
less than usual, or lying down, not wanting to move or wriggling
around trying to find a position that makes the pain feel
better.
- Vomiting, diarrhoea (runny poo),
refusing food, refusing drinks.
- Fever, flushed or pale skin, sweaty
skin, or very dry skin if the child is dehydrated
- Pain when passing urine or passing
urine much more often than usual.
- Pain that is keeping the child awake,
or which wakes her during the night.
- Babies will cry and draw their legs
up to their tummy.
APPENDICITIS
- Appendicitis is a fairly common
problem which can come at any age although it is unusual in
very young children (under one year).
- The appendix is a small, dead-end
tube leading from the caecum, (which is part of the gut) and
it can become blocked, and infected/ inflamed causing appendicitis.
- Appendicitis causes pain which usually
starts in the middle of the tummy, around the umbilicus (belly
button), and as it gets worse the pain moves to the lower
right side of the tummy, and the tummy becomes tender (sore
to touch).
- A child with appendicitis usually
shows other signs of being unwell such as fever, refusing
food, vomiting and sometimes diarrhoea.
- Most tummy pain is not appendicitis.
- Appendicitis will sometimes settle
without surgical treatment, but an operation to remove the
appendix is often needed (appendicectomy).
- Always check with your doctor if
you think it may be appendicitis.
WHAT YOU CAN DO.
If your child seems unwell and in pain for more than a couple
of hours, you should seek medical advice. Signs that would
indicate the need for urgent attention would be:
- Whether he will drink (drinking
helps prevent dehydration).
- The age of the child (babies de-hydrate
much faster than older children).
- If there is vomiting and frequent
runny bowel motions.
- If the temperature is high for more
than a few hours.
OTHER HEALTH PROBLEMS THAT CAN CAUSE TUMMY PAIN
There are many other health problems that can cause tummy
pain for children.
- Constipation is often thought to
be a cause of pain, but not all people who have constipation
have pain.
- Trapped gas can be a cause of very
strong tummy pains.
- Some people who have pain will have
food intolerances. Their gut cannot digest some foods and
this can cause damage to the lining of the gut. They may be
intolerant to lactose in milk or gluten. (True food allergies
are likely to cause other problems such as rashes through
to difficulty with breathing rather than just tummy pain).
- Migraine can cause tummy pain for
young children.
- Coughing a lot can cause muscle
pain which can be quite severe.
IRRITABLE BOWEL SYNDROME
This is a common cause of tummy pain that goes on for many
weeks or months. At least 5% of adults have irritable bowel
syndrome, and it often first happens in the teenage years
(and sometimes in younger children).
- The pain can be really bad, but
no physical cause for it can be found. There can also be feelings
of being bloated (a lot of wind in the tummy) and nausea (feeling
sick).
- The pain may come soon after eating,
and may improve when the child passes poo, or wind.
- The pain may be felt around the
belly button, or sometimes in other parts of the tummy. The
tummy will be tender when touched, but not as tender as appendicitis.
- Irritable bowel syndrome can be
triggered by infections such as gastroenteritis, but can last
long after the infection has gone.
- Staying off some foods, such as
milk, seems to help some of the time.
- Usually the person looks well, is
not losing weight, eats reasonably well and can manage usual
activities.
- A person with irritable bowel syndrome
may be more ‘sensitive’ to pain, finding a ‘normal’
level of muscle tightening (as it pushes food along) painful.
- The pain usually goes after some
time (this can be quite a long time) but it often comes back
later.
If a person looks unwell, is losing weight and not eating
well, the pain is not likely to be irritable bowel syndrome.
PERIOD PAIN
- When girls start to have periods,
they usually do not have much pain with the periods (although
a few girls get some “monthly” pain even before
they start having periods).
- After about a year, they start to
ovulate regularly and the periods may be more painful. About
two thirds of girls have pain with their periods.
- Some girls (about 10%) have very
painful periods, called dysmenorrhoea, which can interfere
with their normal activities, including going to school,
for one or more days each cycle.
- The period pain is usually a cramping
pain in the lower abdomen and sometimes the back. Some girls
feel quite unwell when they have period pain.
- There are some medications which
make a big difference for period pain, so go to the doctor
for advice.
- Other things which may help period
pain are using a hot water bottle on the tummy and regular
exercise.
OTHER CAUSES OF TUMMY PAIN
Children often feel pain in their tummy when they are worried
about things that are happening to themselves or to people
they love. Some of the things that may cause the worry include:
- being teased or bullied at school
or kindergarten
- being worried about a test, or not
knowing how to do the work they have to do at school
- being frightened by something, for
example by a big dog they have to walk near
- problems in the family, such as
someone being ill
- when parents are angry with each
other
- being over-tired.
Signs that worry may be causing the pain
- pain that occurs regularly in the
morning, and stops them doing something such as going to school,
but does not stop them playing later, or eating well
- having problems with learning or
behaviour at school
- having pain that happens when someone
gets angry or upset at home
- behaving as if they are well most
of the time.
WHAT TO DO ABOUT WORRY PAIN
- If there do not seem to be any physical
problems causing the pain, you will need to think about whether
there is anything which is upsetting your child at home, school,
kindergarten or with friends.
- Your child may be worried about
telling you he is being bullied or teased, so you may need
to raise the topic.
- If there are problems at home where
parents are angry or upset, it is very important to talk to
your child, making it clear that you will keep him safe.
- If the pain is keeping your child
home from school a lot, talk to the school to work out ways
to help him return to school.
- When you talk about this with your
child, remember that the pain is real so it won’t be
helpful to say that it is not. You might find it helpful to
talk about how worries can cause strange feelings in the tummy
(such as ‘butterflies’ or even pain). Let your
child know that you want to help and that it is OK to tell
you whatever might be worrying them.
- Without pressing your child for
information, arrange some quiet relaxed times together which
may open the way for sharing. For example you could sit on
the end of the bed at the end of the day for a chat. If you
think you might know what the worry is, you could try telling
her a story about someone else with a similar worry to let
her know that you understand.
- Sometimes ‘hands on’
things may help, such as tummy or foot massage.
HOW CONCERNED SHOULD YOU BE?
It can be tricky to get the level of concern about tummy pain
right. If you show a lot of concern, this can worry your child
and they may feel even stronger pain, however you should not
ignore the pain, because it is real and distressing. It can
be very useful to have a careful check of your child by your
family doctor, so that if there is need, tests can be done,
but if the doctor is confident that the pain is not due to
a serious health problem, both you and your child can relax.
Kim Patra is a qualified Registered Nurse / Midwife, and mother
of three, who has been living and working in Bali for past
15 years. She has assisted many traveller (...
and others) either as a flying medical escort
or just a voice on the end of the phone! Kim is happy
to discuss any health concerns that your may have. Her
e-mail contact is info@chcbali.com
