Abdominal pain in children is a very common disorder and can be triggered by many factors. Pediatricians are concerned, above all, about pain that occurs acutely and affects the general condition, located in the lower right lateral part of the abdomen, since it could correspond to an appendicular condition that would require immediate surgical treatment. This, fortunately, is less common, but should always be ruled out in the presence of abdominal pain.
Most abdominal pains in children are recurrent in time, predominantly in the morning and periumbilical location, corresponding to several possible pathologies or alterations that we will discuss later.
On the other hand, we should not forget the presence of abdominal pain that may accompany pneumonia or tonsillitis. This is frequent, so we should not limit ourselves to the child’s abdomen to look for the diagnosis.
Abdominal pain in children, is it due to any pathology?
Abdominal pain should never be underestimated, as it may be due to an important pathology, and that is why we are never reassured until we have the specific cause of the pain. It is normal that it corresponds to a banal pathology but the pediatrician should not be confident, especially in the presence of acute pain, in the presence of an abdominal bulging with muscular defense on examination and, in particular, in the presence of a palpable abdominal mass.
A separate issue that should be mentioned is infant colic, which is pain that affects children between 4 and 12 weeks of age, and which manifests itself with acute abdominal pain with crying and irritability. They usually occur at the end of the day or during the night, the child being perfectly well during the rest of the day and presenting a good weight curve. This alteration, in many cases, means frustration for the pediatrician, because the treatment sometimes is not effective and for the parents it is worrying, since they see their child crying non-stop without being able to console him. Fortunately, this alteration is cured by time and in a few weeks it disappears.
Consequences of abdominal pain in children
Abdominal pain at all ages is, in many cases, disabling. In infants it causes sleep disturbances, irritability, refusal of food, etc. In the older child the same thing happens, since if it is an acute picture the child shows an aspect of real disease and has to be reviewed urgently by the pediatrician. In the case of recurrent pains, the affectation is minor but in the peak period it causes the child to manifest a sad and annoying attitude that conditions his daily tasks. Sleep is rarely affected, as these recurrent abdominal pains usually appear in the morning or throughout the day.
How to deal with abdominal pain
The diagnosis of abdominal pain is fundamental. If it is an acute pain, the first diagnosis will be to suspect an acute abdomen caused by appendicitis. In this case the clinical, abdominal examination, blood tests and abdominal ultrasound are the keys to the diagnosis and to be able to apply the indicated surgical treatment.
In addition to acute abdominal pain, tonsillitis or pneumonia can cause abdominal pain at any given moment, so the child’s tonsils should always be explored and a thorough auscultation of the lungs should be performed, which can be supported by a chest X-ray to rule out the presence of pulmonary infiltration.
In the case of chronic and recurrent abdominal pain, the diagnostic approach must be very regulated and will include a detailed anamnesis of the pain, its intensity, when it appears and if it is related to any food or situation, such as stress or constipation. Secondly, a detailed examination of the child should be performed with palpation and percussion of the abdomen to rule out the presence of a mass, retained stool or muscular defense. It is essential to locate the pain in the abdomen, since the area in which it occurs will give us a lot of information: we must assess the anatomical area affected, which may be the stomach, intestine, urinary bladder, ovaries, etc.
From the diagnostic point of view, an analytical blood test should be performed, including a blood count and a leukocyte formula, liver tests, determination of specific cow’s milk IgE and determination of specific antibodies to gluten intolerance. A urinalysis is essential, since a urinary tract infection can be associated with this alteration. In the feces, the presence of some type of bacteria or virus will be determined; a parapsychological study is fundamental, since many infestations in childhood are associated with abdominal pain. The stool is also evaluated for total fat, which is increased in the case of lactose intolerance, and for the possible presence of Helicobacter Pylori antigen, which manifests itself in childhood with recurrent abdominal pain. Finally, abdominal ultrasound is mandatory and can provide information on the existence of mesenteric adenitis or an ovarian abnormality in girls that justifies such discomfort.
Treatments for abdominal pain
The treatment, as it is logical, will be directed to solve the cause. In this sense, surgical treatment will be applied in case of acute abdomen due to appendicitis or a tumor. In case of tonsillitis, pneumonia, urinary tract infection or presence of Helicobacter Pylori, antibiotic treatment will be applied, although in the latter case an endoscopy and further tests by the pediatric gastroenterologist should be performed before starting treatment.
If there is any relationship with any food, it should be avoided from the diet; if there is intolerance to milk or lactose, it should be substituted, and if the intolerance is to gluten, it should be eliminated from the child’s diet. In addition, it is essential to solve constipation which, in many cases, is the cause of this ailment.
On the other hand, parasitic conditions should be treated with appropriate medication. Finally, in some cases, abdominal pain is due to a psychological problem that triggers it and, in this case, the psychologist’s intervention is essential to address it.