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Guidelines For Parents to deal with abdominal pain in children

Tummy pain is common in children of all ages. It could be due to hunger, excess intestinal gas or many simple causes. It can often be confusing for the parents when to seek medical attention. This article aims to help parents know what to do if their child complains of pain in their tummy.

Why does my child have tummy pain?

The problem in finding out the exact cause for crying is confounded by the fact that babies cannot communicate. Some babies cry a lot without any apparent cause, but many have a clear pattern. In babies less than 6 months the most common cause is “Evening colic” or “Infantile colic”. These babies cry suddenly mostly in evenings, drawing up their legs to tummy with clenched fists. Babies with crying behaviour may have a highly active gut due to the excess gas swallowed during crying which in turn cause abdomen colic, discomfort and cry. Herbal remedies such as “gripe water”, “vasumbu” are not advisable which may aggravate or cause more trouble. These babies grow well and crying habit clears away after 3 months. In children more than 6 months the most common causes of abdomen pain is constipation. Passage of inordinately hard stools is defined as constipation. It is noted in 17% – 40% of cases; 95% cases of constipation are functional and only 5% are due to organic reasons. The pain could also be due to swollen lymph nodes in the abdomen, urinary tract infection, surgical conditions like appendicitis, intussusception, bowel ulcerations, bowel obstruction which in turn are commonly associated with constipation, rare intestinal anomalies, rarely renal stones, menstrual pain, rare medical conditions like pancreatitis, tuberculosis, food allergies like cow milk allergy or wheat allergy.

What causes constipation in children?

Sedentary lifestyle due to mobile phones, television and internet have significantly decreased outdoor playtime in recent years. The child thus tries to postpone defecation or does potty incompletely. In a child <1year it could result from changes in infant formula, early or late weaning and early (<1year) oral cow milk initiation. In toddlers, difficulty in toilet training or sickness, moving house, change in daily routine, starting schools, antacids and cold medications can cause constipation. In older children rushing to schools, inadequate time for morning potty habits, phobia to use school toilets and screen distractions can cause functional constipation. Organic causes could include Hirschprung’s disease, hypothyroidism, abnormal anal openings.

When should I think about talking my child to the doctor?

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, or if they:

Have severe painHave pain that lasts for several hours, or is repeated painComplain of pain to right side of tummyComplains of pain below umbilicus and pain while passing urineHave combination of fever (body temperature > 100 F ) or skin rashAppear pale, tired or drowsyHave prolonged vomiting or diarrhoeaHave blood in their vomit, poop or urineHave any swelling or lumps in their tummy or groin or painful swelling of their genitalsStraining while passing urine or smelly urine with or without bloodPassing “Ribbon like stools” (more likely in child less than 1 year)

When should I take my child to the emergency department?

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

Your child experiencing tummy pain after trauma such a fall or ingestion of acid/alkali/foreign body.Green vomiting.Swollen testicles in boys.Sudden groin swelling which is not reducing.

What care can be given at home before consulting my doctor?

Have your child lie down and rest.Do not force your child to eat if they feel unwell.Gently massage your child’s belly which can help with gas and indigestion.Give small sips of water frequently to prevent dehydration.Encourage sitting on the toilet in a proper position, sometimes emptying the bowel helps to ease the painIt may be useful to record a video when your child is in pain to see the pattern or photo of vomiting/pee/poop to show your doctor.

What does a doctor look for when checking my child?

Doctors look at number of things including their response, complaints, general appearance, their heart rate, breathing rate, temperature, as well as taking into consideration information you have told us. They will examine their tummy. You will be surprised at how much information we get from simply laying a hand on their tummy. If the abdomen is soft when pressing and not sore, then a serious cause for their pain is much less likely. (if your child is in lot of pain when you touch their tummy you should seek a doctor without delay). Simple tests like checking the blood cells count, checking their blood and urine for infection, scan of abdomen and Xray of abdomen will be done. Finally, all the information is assessed and the cause is worked out.

What if no cause is found?

Often no cause is found, and this is quite confusing. This is 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).

What is the outlook or future of these children?

Majority of the patients do well with appropriate dietary management, medical management and surgical management if they reach without delay. Recurrence depends  on patient’s long-term compliance with therapy. Post treatment, these patients often experience a greatly improved quality of life.

Advices to prevent abdomen pain in children?

Adequate fluids, fiber diet, avoid junk food.Proper toilet training and undistracted morning potty habit.Never give gripe water, vasumbu and castor oil to purge.Prevent self-medication which can mask or worsen pain.Glycerine suppository in constipation gives immediate relief. Find out trigger factors (like specific food, activity sometime even sun heat) and avoid.Dr. ABIRAMI KRITHIGA J, MBBS, MS(General Surgery) DrNB (Pediatric Surgery) FICRS (Robotic Surgery Consultant Pediatric Surgery Rainbow Children's Hospital, Sholinganallur, Chennai Dr. Abirami Krithiga J, MBBS, MS (General Surgery) Dr NB (Pediatric Surgery) FICRS (Robotic Surgery), Consultant Pediatric Surgery, Rainbow Children’s Hospital, Sholinganallur, Chennai

Dr. Abirami Krithiga J

MBBS, MS (General Surgery), Dr NB (Pediatric Surgery), FICRS (Robotic Surgery), Consultant Pediatric Surgery

Rainbow Children’s Hospital, Sholinganallur, Chennai

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