Belly pain is a common problem in children and there can be a number of different causes. Joe Perno, M.D., emergency medicine physician and vice president of medical affairs at Johns Hopkins All Children’s Hospital, explains the most common causes and how parents will know when it’s serious enough for an emergency center (EC) visit.
Warning Signs that Prompt an Emergency Center Visit
A child should be seen immediately if their abdominal pain is constant and severe including these issues:
- Appendicitis – Symptoms usually start with pain around the belly button and gradually moves to the lower right side. The pain is typically constant and made worse by movement or touching that area and is often followed by nausea, vomiting, fever or loss of appetite.
- Upset stomach with continued vomiting – Usually vomiting occurs first, followed by abdominal pain and often the pain is everywhere or in the upper part of the stomach with this condition. Although not necessarily an emergency, vomiting that doesn’t stop usually will require a visit to the emergency center to help prevent dehydration and evaluation.
- Intussusceptions – This occurs typically in children less than 2 years of age and it involves the intestines telescoping inside each other. The children usually have what appears to be severe abdominal pain intermittently interspersed with sleepiness. Many times children will pull their legs to their chests when they are in pain. Sometimes there will be blood in the stool which warrants a trip to the emergency center.
What is the most common cause of abdominal pain in children?
The most common cause of abdominal pain in children is constipation. Most kids do not eat enough vegetables or drink enough water and combined with a busy lifestyle, they end up constipated. Often children will not poop at school or will ignore the urge if they are too “busy” playing or watching TV. Constipation will often cause severe intermittent abdominal pain, and sometimes the children are doubled over in pain. Unlike appendicitis, they usually feel better with movement and the pain will resolve; sometimes for hours. Parents should review their child’s bowel habits and if they think they are constipated, and encourage fiber, fluids and even an over-the-counter laxative. Enemas are also a possible solution for parents.
What are some of the other causes of abdominal pain?
In girls, ovarian cysts or twisted ovaries can cause pain typically in the lower portion of the abdomen and can mimic appendicitis. Urinary tract infections can also cause pain in boys and girls. Also, testicular problems and hernias can present with abdominal pain. Overall, any pain that is not relenting, is severe or the source cannot easily be identified by the parents, a child should be seen by their doctor or in an emergency department.
For more information about the emergency center at Johns Hopkins All Children’s Hospital, visit: https://www.hopkinsallchildrens.org/services/emergency-medicine.
About the Author: Dr. Perno is the vice president of medical affairs at Johns Hopkins All Children’s Hospital. He joined the hospital staff in 2003. Dr. Perno also maintains clinical time in the Emergency Department, where he started as an attending physician in 2003 and served as assistant medical director from 2005 through 2015. He has chaired the hospital’s Medicine Quality of Care Committee, and in 2009 he was named vice chairman of the Department of Pediatric Medicine. Dr. Perno also has been a key member of several system innovation and quality improvement efforts and served as chief of the medical staff in 2016. Dr. Perno earned his medical degree from St. George’s University in West Indies, Grenada. He completed a pediatric residency from Rutgers Robert Wood Johnson Medical School in Piscataway, New Jersey, followed by a fellowship in pediatric emergency medicine from Primary Children’s Medical Center in Salt Lake City, Utah.