Stomach Pain / Abdominal Pain / Belly Pain
Stomach, abdominal, or even tummy pain can be quite confusing for both a parent and a child. For the parent wondering if the tummy pain is “real” or if their kiddo is trying to get out of going to their piano lesson today. For a pediatric provider it can be just as tricky. There are lots of things that can cause abdominal pain in children. The majority of off and on stomach pain in children has to do with something they ate or maybe skipping a bowel movement due to constipation or choice. This often leads us, as parents, to lean into stool softening foods such as pears and prunes or asking the kiddo to take a few minutes to sit on the potty to see if that makes their tummy troubles go away. A good rule of thumb, as a pediatrician, to determine how much concern I should have for a child’s tummy pain is if the pain is distractible or if the pain stops a child from doing something they love. A kiddo telling me their tummy hurts while they are jumping on a trampoline does not activate my Spidey senses as much as a kiddo refusing to play with a monster truck because their stomach hurts too much.
Other things that are more concerning symptoms relating to stomach pain are: increasing stomach pain with no relief from going potty or vomiting or abdominal pain that makes it difficult to walk around normally or hurts a lot when a kiddo jumps. These signs are more concerning and point to an inflammatory or infectious process that is causing so much inflammation in the abdominal cavity that it needs to be investigated with either a physical exam, imaging, or lab studies. Also, abdominal pain with blood in vomit or stool needs to be brought to your pediatrician’s attention ASAP. True, there are a lot of common stomach viruses that can cause enough irritation in the gut to show some blood in the potty, but it is still crucial to let your pediatrician know to make sure it sounds/looks like a stomach virus rather than the start of something more sinister. Also, if a child cannot sleep due to the pain or the pain is localized to one spot with no intermittent relief, I get worried for things like appendicitis. Another concerning part of a history with abdominal pain is if your kiddo’s stomach is continuing to hurt after they had an injury to their abdomen; like a soccer ball to the mid-section or trying to land that awesome jump on their bike and instead rammed their stomach into their handlebars.
The other tricky thing with belly pain in kids is that the brain to belly connection is extremely strong in kids and teens. When adults may just get nervous butterflies in their stomach, a similar response in kids can feel like a belly full of angry bees. So much so that kid can actually get “Abdominal Migraines.” This is why kids and teens are so much better at reading a room and sensing when a situation makes them nervous or anxious. These psychologically instigated pains in the stomach are very real, so we should never downplay them, but if you sense that your kiddo’s stomach pains are due to nerves and anxiety, it is important to work with your child to recognize these signs early and give them a name to better communicate to you when they are nervous or scared rather than having inflammatory abdominal pain.