Parents’ guide to stomach pain

Artist: @ellieloomes

About the author: Sophie is a General Practitioner who has previously worked with Night Doctor and now based in the South West, WA. She has an interest in women’s and children’s health and has completed additional training in obstetrics and gynaecology, sexual health and skin cancer surgery. Aside from her clinical work she also teaches medical students at the University of Notre Dame, was formerly a co-opted member of the RACGP WA Faculty Board, and is a current delegate for the RACGP Future Leaders Program.

Tummy troubles, including stomach pain and gastro, are common in children of all ages, and it can often be confusing to know when to seek medical attention. In Part 1 of our Tummy Trouble blog, we will answer the most common questions we get asked at Night Doctor, with the aim to help parents know what to do if their child complains of pain in their tummy.

Why does my child have tummy pain?

Abdominal pain is a common symptom in children and there are many potential causes. Some commonly treated causes include constipation, viruses, gastro and urinary tract infections. Whilst we can identify the cause in some patients, often we may not find a cause in children with mild tummy pain.¹

There are also some serious causes of tummy pain in children, however these are less common. These include infections and problems requiring surgery, such as appendicitis.²

When should I think about getting a doctor to take a look?

Often parents are not sure when they should see a doctor for their child’s tummy pain. It is never unreasonable to seek medical attention if you are worried about your child. You should not delay seeing a doctor if you are concerned about your child,^1-3 or if they:

• Have pain that is severe

• Have pain that lasts for several hours, or is coming and going

• Complain of pain localised to one area of their tummy

• Have a fever (above 38.5⁰C)

• Have a rash

• Appear pale, tired or drowsy

• Have prolonged vomiting or diarrhoea

• Have blood in their vomit or poo

• Are refusing to eat or drink

• Have any swelling or lumps in their tummy or groin

• Complain of pain with urination, or have smelly urine or blood in their urine

Should I take my child to the emergency department?

Most cases of tummy pain in children are not an emergency and do not require a trip to the emergency department.

There are a small number of times when it is necessary to attend an emergency department, such as:

• Your child is experiencing tummy pain after a trauma, such as a fall or accident

• For boys: your child has swollen or painful testicles

If you are unsure whether your child needs to attend the emergency department or be reviewed by a doctor, it is important to speak to a medical professional. At Night Doctor, our doctors triage all patients within half an hour of booking, which allows us to help you make that decision and give you advice while you are waiting for a doctor. We will also arrange an immediate conference call with a doctor if there are any concerns at the time of booking that your child’s illness may be an emergency. You can also contact HealthDirect (1800 022 222) for advice on how soon your child requires a doctor review.

What can I do to help my child’s pain?

There are many things that you can do to help your child’s tummy pain. Often simple things such as rubbing their tummy or distracting them can make them more comfortable. You can also try offering a drink of water, some plain food, or get them to sit on the toilet.³

If these do not help, you can give paracetamol at the recommended dosage for their age/weight. You can find more information about paracetamol and ibuprofen in our previous blog.

We do not recommend giving aspirin for pain to any child under 12 years of age, unless it is advised by your doctor. It can cause a rare but serious illness called Reyes Syndrome.⁴

If I give my child paracetamol, will it prevent the doctor from working out what is going wrong?

We find that a lot of parents avoid giving pain relief to their children because of a concern it will prevent the doctor from working out what is wrong. Giving your child paracetamol will not prevent the doctor from diagnosing your child’s condition and will not mask any serious cause for your child’s tummy pain.² In fact, giving simple pain relief like paracetamol can be a good measure to try before deciding whether your child needs to see a doctor.

What does a doctor look for when checking my child?

As with any child we examine, one of the first things we want to determine is how unwell your child is. We know that your child is not their normal well self and that’s why we are here to help. However, as doctors, we have a concept of ‘well’ and ‘unwell’ that helps us determine if there is something serious going on. We look at a number of things to determine this, including their general appearance and their ‘vital signs’ (heart rate, breathing rate, temperature), as well as taking into consideration information you have told us.

We will then examine their tummy. You will be surprised at how much information we can get from simply laying a hand on their tummy. If the tummy is soft when pressing and not very sore, then a serious cause for their pain is much less likely.

We often do simple tests such as checking your child’s urine for infection or testing their blood sugar.⁵

Finally we will bring all the information together and try to work out the cause for your child’s tummy pain. In an unwell child, it is important to find the cause, but often in a well child we may not be able to find a cause.^3,5

Here is an example of the sequence of our assessment of a child with tummy pain:

What if no cause is found?

Often no cause is found in children who are experiencing tummy pain.^3,5 Some children may have repeated episodes with no cause found, and this can be quite confusing and distressing for parents. This is sometimes referred to as functional abdominal pain, and is quite common (affecting 10-15% of children). Some children may also have repeated abdominal pain when they are worried (about themselves, friends, family or school).^1,2,5 If your child is experiencing repeated episodes of pain it is important they are reviewed by their regular GP who will be able to help diagnose and treat the pain if a cause can be found and offer support and reassurance.

References

1. Victorian Government Emergency Department Factsheets: Abdominal pain in children
2. Kids Health WA Paediatric Acute Care Guideline: Acute Abdominal Pain
3. The Children’s Hospital at Westmead Fact Sheet: Abdominal pain
4. Royal Children’s Hospital Melbourne Fact Sheets: Pain relief for children – Paracetamol and Ibuprofen
5. Royal Children’s Hospital Clinical Practice Guidelines: Abdominal pain

This information is general and may not apply to you or another person. If you have any concerns about your health or the health and wellbeing of a child, consult a doctor or other healthcare professional. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.