Is it more than just a stomach ache?
As a pediatric gastroenterologist, I frequently see children presenting with a variety of gastrointestinal conditions ranging from gastroesophageal reflux disease (GERD) to celiac disease to irritable bowel syndrome and inflammatory bowel disease.
Every one of these conditions can manifest at any age in childhood. Many of them will arise with some sort of abdominal pain complaint. The difficult part for parents is to try and recognize when a “tummy ache” is more concerning.
That’s why as a parent, it’s critical to know the warning signs of a serious gastrointestinal issue. While the signs may vary based on age, the most common include:
- Pain associated with blood in the stool or fever
- Persistent vomiting (more than 3-5 days)
- Unintentional weight loss
- Waking up in the middle of the night with pain
- Pain that comes on suddenly and resolves quickly
- Pain when moving (as opposed to when at rest)
It’s also important to note that any associations with the pain can help determine the cause (ex: any food triggers, time of day, weekday vs. weekend symptoms.)
We very frequently see children present with constipation, which is the passage of infrequent, large caliber or firm stools with an associated pain of passing. We tend to see this in infants around the time of beginning solid food (4-6 months), again at 1 year of age when they transition from breast milk or formula to cow’s milk and again around 3-4 when they begin potty training. The most common type of childhood constipation is called functional constipation, which oftentimes stems from withholding, potentially leading to weak pelvic floor muscles and worsening constipation.
Managing constipation focuses on getting the child back to passing daily soft, painless stools. Water and fiber intake are crucial, as are proper toilet habits. In some instances, we may need to use medication such as polyethylene glycol (MiraLax) to help soften stool and stimulant laxatives to help give the urge to pass stool. When taken appropriately, these medications are very effective.
Managing abdominal pain is done based on the cause of symptoms. If the child has GERD, their diet needs to be changed to avoid reflux-triggering foods (spicy and greasy foods, tomatoes, chocolate, caffeine, soda, citrus), and they may need medication to block or lower stomach acid production. If their pain is secondary to celiac disease, management would involve beginning a gluten-free diet.
If your child suffers frequent “tummy aches,” it’s time to call their pediatrician. They can connect you with a pediatric gastroenterologist.
Dr. Jonathan Cordova is a pediatric gastroenterologist with the Chicagoland Children’s Health Alliance, a partnership between Advocate and NorthShore University HealthSystem.
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About the Author
Dr. Jonathan Cordova is a pediatric gastroenterologist with the Chicagoland Children's Health Alliance, a partnership between Advocate and NorthShore University HealthSystem.
My PCP has helped me with silent reflux and says that and blood pressure are highly influenced by stress. He said he sees these issues in kids and often enough connects the root cause to problems at school, like bullying. I’ve grown to believe mental and physical health are so highly interrelated, they’re one and the same.
Took us 5 years to get dx of Heredity Angioedema. Told many times just a stomach flu. Multiple trips to ER – misdiagnosis not once but twice. Ped MD dont ignore this even if its rare
Anxiety can manifest itself in a “tummyache” with kids also. My daughter would get nervous about an upcoming event and immediately complain that her tummy hurt. I eventually was able to figure out that it was anxiety.