Sudden Abdominal Pain

Children will often complain of tummy pains and finding the cause can be difficult making it hard to know when to seek medical advice, and when to ‘ignore’. This is a common presentation to emergency departments and doctors rooms with parents worried about conditions such as appendicitis or some other abdominal catastrophe. Acute abdominal pains can be due to either a localised problem in the gastrointestinal tract or part of a general illness such as a virus.  The acute abdominal pain will be discussed here as it is a concerning symptom that sometimes need prompt evaluation. Click here to see the article on recurrent abdominal pain.

What Happensshutterstock_196947491

The child will complain of tummy pains, may double over and cry, or lie quietly on the couch. The next few hours will determine whether there is a need to take this further. The cause  could  be as simple as an ‘indigestion like’ pain or some vague non specific gastrointestinal complaint, or the start of a more serious cause that will require assessment and possible investigation.   To help decide where this pain is coming from it is important to look for other symptoms and the following is a rough guide with the most common ailments covered first.

Infection

Abdominal pain is a common symptom of infections, whether specific for the gastrointestinal tract or elsewhere. Simple viruses, that cause colds and influenza will often have pains in the abdominal as part of the ‘picture’.  Symptoms such as temperature, runny nose, cough and sore throat will be clues. Gastrointestinal infection will have temperature, vomiting and diarrhoea. The abdominal pains in this situation are ‘part of the illness’ and are about 5-6/10 in intensity, come and go and the child will usually be able to ‘walk and talk’.  Sometimes though when they get the pains the child maybe upset and double over. These pains last for a few minutes at a time.  When assessed by a doctor the tummy will appear normal when examined, or slightly tender. Appetite maybe lost or diminished. One of the more common infections that can present as abdominal pain is bacterial tonsillitis. It is always important to assess for tonsillitis when a child has fever and tummy pains in this age group.

Acute constipation

Sometimes children will become constipated and will complain of abdominal pain. Many parents will understand this and suggest to a child to ‘sit on the toilet’. This can happen due to a variety of causes, such as a briefly poor diet, being ‘too busy’ to go to the toilet, not being able to access a toilet etc.  The pain will come and go, sometimes result in distress, doubling over and crying, followed by a period of improvement in pain before ‘indigestion’ returns. The doctor will sometimes feel that the child is constipated by feeling the abdomen and ruling out more significant causes. There will be no fever and no other symptoms. Constipation does not cause temperature, or vomiting.

Other non specific causes of acute abdominal pain. 

In many cases the cause will not be obvious and will eventually settle. This can be confusing. Causes will be guessed and I suppose adults would label this pain indigestion. Clear fluids and time will settle these types of pains. However if they recur then this would be under the category below – recurrent abdominal pains.

The more serious causes such as appendicitis

Many parents will be concerned about appendicitis. However this is rare in childhood, and is more often seen in the adolescent or young adult.  The pain of appendicitis  will gradually increase, and become constant rather than intermittent. Movement, coughing, sneezing will worsen the pain, and there may be a low grade temperature, loss of appetite and sometimes vomiting. The child will appear unwell and may well be quiet as vocalising and crying will worsen the pain. The abdominal examination is abnormal and suggestive of something more sinister.

Other serious causes will result in significant vomiting, which may be bile stained (obstruction), and the child will clearly need emergency department assessment. Serious infections and surgical causes will present in this way.

Management 

Apart from the more  serious causes the management is providing clear fluids, reassurance and if needed getting a medical assessment. If the child is hungry then it is highly unlikely that there is a significant cause for the abdominal pains and this is a reassuring symptom. If vomiting becomes a significant symptom with lethargy and dehydration then the hospital assessment is essential to ensure there is not a serious infection or surgical illness.  For non specific causes once the pain has abated and the child appears active and hungry, gently re introducing food is appropriate.

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