Abdominal pain in kids is one of the most common reasons for going to the emergency room. But how can one tell if the pain is from an infection and will pass, or if it’s being caused by something more serious like a chronic disease or a less common condition?
Many things can cause abdominal pain in toddlers and children, and the place the pain is located can often signal the reason behind it, so diagnosing and treating the pain's starting point is extremely important.
The causes of acute abdominal pain are many and varied, and most often the source of the pain is due to problems in the digestive system, but this isn’t always the case.
Intestinal infections as a result of viruses and bacteria are the most widespread and common cause for abdominal pain, with side effects like diarrhea, vomiting and sometimes fever.
In cases of viral or bacterial infections, the pain will usually go away in a short time, and a pediatrician can treat the child. Yet it's very important to follow up closely to prevent dehydration and consider if antibiotics are needed.
2. Problems that require surgery
Acute abdominal pain can be caused by various factors and can be manifested in cases of appendicitis, intestinal/bowel obstruction, and ovarian or testicular torsion (twisting) which causes intense lower abdominal pain.
Acute abdominal pain can also be caused by an incarcerated inguinal hernia, or intestinal prolapse - a condition in which any part of the intestinal tract is swallowed into another part next to it - although this rarely occurs rarely in children.
In these cases, the pain will usually be one-off rather than recurring, since it's an isolated event. In these situations, urgent medical care is required. Teen girls experiencing acute abdominal pain should also see a gynecologist.
Acute pain is often centered in a specific area of the abdomen. Pain will appear suddenly, worsen over time and not let up, unlike recurring pain that results from chronic diseases.
3. Urinary infection
Acute abdominal pain can also be caused by urinary tract inflammation or infection. Pain will be felt either in the lower abdomen, on the sides of it, or in the waist, rather than in the center of the abdomen, since the cause of the pain is inflammation of the kidneys.
In a significant number of cases, the pain will appear as part of a developing disease with fever and symptoms of urinary tract inflammation like burning or urgency during urination.
4. Abdominal pain due to diseases caused by disruption of the immune system
Some immune diseases are manifested by damage to the immune system and their initial sign will be abdominal pain. One common disease is celiac disease. Pain, a swollen abdomen, diarrhea, and impaired growth are the main symptoms. Celiac can be diagnosed with a simple blood test.
Intestinal diseases like Crohn's and colitis are also immune diseases of the digestive system. These syndromes are characterized by chronic inflammation that affects different areas of the digestive system. In some cases, the disease manifests itself in childhood or puberty and symptoms include chronic abdominal pain, bloody diarrhea, loss of appetite, weight loss and anemia.
5. Prolonged abdominal pain due to a rare genetic disease: Hereditary angioedema
Hereditary angioedema is a rare disease inherited by children. It's characterized by sudden attacks caused by a congenital deficiency of C1NH, an essential enzyme. As a result, the sufferer will experience painful and sudden edemas and swellings develop in almost all areas of the body: face, lips, eyes, tongue, stomach, hands and feet.
Unlike relatively common episodes of pain in children which sometimes persist for a long period of time, abdominal pain as a result of angioedema lasts only a few days, passes and after a certain period of dormancy returns again and again. Attacks appear without any warning and can last for several days.
So if your child suffers repeated bouts of abdominal pain or intestinal obstruction for no apparent reason and over time, it's important that parents contact a genetic counselor and geneticist for diagnosis and treatment if required.
Diagnosis is at any age, and the first factor is family background, if there is any, followed by a blood test and an assessment by a doctor specializing in allergy and immunology who will confirm or deny the results.
In recent years, preventive treatments have become available that enable the disease to be controlled over a long period of time, and in some cases to almost completely eliminate the attacks, their intensity and frequency.
It's important to monitor your child's behavior
There are many other reasons for abdominal pain in kids and teens. In most cases, the pain will go away by itself without needing special treatment.
Yet it's important to pay attention to cases of repeated episodes of pain that don't respond to medication, if the child complains of sharp and sudden or persistent pain, if he/she wakes up at night from pain or if he/she has no appetite and isn't gaining weight on a steady growth trajectory.
Be sure kids drink enough and don't get dehydrated; and in general, monitor the severity of the child's condition and behavior. Prolonged pain that tends to get worse requires a medical exam.
Dr. Cyril Yoffe is a senior physician and specialist in pediatrics and in allergy and clinical immunology and the manager of the hereditary angioedema clinic at the Schneider Center for Pediatrics, part of the Clalit health fund.