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Abdominal pain - children under age 12

Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children

Almost all children have abdominal pain at one time or another. Abdominal pain is pain in the stomach or belly area. It can be anywhere between the chest and groin.

Most of the time, it is not caused by a serious medical problem. But sometimes abdominal pain can be a sign of something serious. Learn when you should seek medical care right away for your child with abdominal pain.

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Considerations

When your child complains of abdominal pain, see if they can describe it to you. Here are different kinds of pain:

• Generalized pain or pain over more than half of the belly. Your child can have this kind of pain when they have a stomach virus, indigestion, gas, or when they become constipated.
• Cramp-like pain is likely to be due to gas and bloating. It is often followed by diarrhea. It is usually not serious.
• Colicky pain is pain that comes in waves, usually starts and ends suddenly, and is often severe.
• Localized pain is pain in only one area of the belly. Your child may be having problems with their appendix, gallbladder, a hernia (twisted bowel), ovary, testicles, or stomach (ulcers).

If you have an infant or toddler, your child depends on you seeing that they are in pain. Suspect abdominal pain if your child is:

• More fussy than usual
• Drawing their legs up toward the belly
• Eating poorly

Causes

Your child could have abdominal pain for many reasons. It can be hard to know what is going on when your child has abdominal pain. Most of the time, there is nothing seriously wrong. But sometimes, it can be a sign that there is something serious and your child needs medical care.

Your child most likely is having abdominal pain from something that is not life threatening. For example, your child may have:

• Air swallowing
• Abdominal migraine
• Colic
• Constipation
• Gas
• Food allergy or intolerance
• Food poisoning
• Heartburn or acid reflux
• Ingesting grass or plants
• Mononucleosis ("mono")
• Stomach flu
• Strep throat
• Pain caused by anxiety or depression

Your child may have something more serious if the pain does not get better in 24 hours, gets worse or gets more frequent. Abdominal pain can be a sign of:

• Accidental poisoning
• Appendicitis
• Gallstones
• Hernia or other bowel twisting, blockage, or obstruction
• Inflammatory bowel disease (Crohn disease or ulcerative colitis)
• Intussusception, caused by part of the intestine being pulled inward into itself
• Pregnancy
• Sickle cell disease crisis
• Stomach ulcer
• Swallowed foreign bodies, especially coins or other solid objects
• Torsion (twisting) of the ovary
• Torsion (twisting) of the testicle
• Tumor or cancer
• Unusual inherited metabolic disorders (such as abnormal accumulation of protein and sugar breakdown products)
• Urinary tract infection

Home Care

Most of the time, you can use home care remedies and wait for your child to get better. If you are worried or your child's pain is getting worse, or the pain lasts longer than 24 hours, contact your health care provider.

Have your child lie quietly to see if the abdominal pain goes away.

Offer sips of water or other clear fluids.

Suggest that your child try to pass stool.

Avoid solid foods for a few hours. Then try small amounts of mild foods such as rice, applesauce, or crackers.

Do not give your child foods or drinks that are irritating to the stomach. Avoid:

• Caffeine
• Carbonated beverages
• Citrus
• Dairy products
• Fried or greasy foods
• High-fat foods
• Tomato products

Do not give aspirin, ibuprofen, acetaminophen (Tylenol), or similar medicines without first asking your child's provider.

To prevent many types of abdominal pain:

• Avoid fatty or greasy foods.
• Drink plenty of water each day.
• Eat small meals more often.
• Exercise regularly.
• Limit foods that produce gas.
• Make sure that meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.

To reduce the risk of accidental poisoning and ingestion of foreign bodies:

• Keep all cleaning supplies and hazardous materials in their original containers. 
• Store these dangerous items where infants and children cannot reach them.

Do not allow infants and young children to play with objects they can easily swallow.

When to Contact a Medical Professional

Contact your provider if the abdominal pain does not go away in 24 hours.

Seek medical help right away or call your local emergency number (such as 911) if your child:

• Is a baby younger than 3 months and has diarrhea or vomiting
• Is currently being treated for cancer
• Is unable to pass stool, especially if your child is also vomiting
• Is vomiting blood or has blood in the stool (especially if the blood is maroon or a dark, tarry black color)
• Has sudden, sharp abdominal pain
• Has a rigid, hard belly
• Has had a recent injury to the abdomen
• Is having trouble breathing

Contact your provider if your child has:

• Abdominal pain that lasts 1 week or longer, even if it comes and goes.
• Abdominal pain that does not improve in 24 hours. Contact your provider if it is getting more severe and frequent, or if your child is nauseous and vomiting with it.
• A burning sensation during urination.
• Diarrhea for more than 2 days.
• Vomiting for more than 12 hours.
• Fever over 100.4°F (38°C).
• Poor appetite for more than 2 days.
• Unexplained weight loss.

What to Expect at Your Office Visit

Talk to your provider about the location of the pain and its time pattern. Let your provider know if there are other symptoms like fever, fatigue, general ill feeling, change in behavior, nausea, vomiting, or changes in stool.

Your provider may ask the questions about the abdominal pain:

• What part of the stomach hurts? All over? Lower or upper? Right, left, or middle? Around the navel?
• Is the pain sharp or cramping, constant or comes and goes, or changes in intensity over minutes?
• Does the pain wake your child up at night?
• Has your child had similar pain in the past? How long has each episode lasted? How often has it occurred?
• Is the pain getting more severe?
• Does the pain get worse after eating or drinking? After eating greasy foods, milk products, or carbonated drinks? Has your child started eating something new?
• Does the pain get better after eating or having a bowel movement?
• Does the pain get worse after stress?
• Has there been a recent injury?
• What other symptoms are occurring at the same time?

During the physical examination, your provider will test to see if the pain is in a single area (point tenderness) or whether it is spread out.

They may do some tests to check on the cause of the pain. The tests may include:

• Blood, urine, and stool tests
• CT (computerized tomography, or advanced imaging) scan
• Ultrasound (sound wave examination) of the abdomen
• X-rays of the abdomen and chest

References

Maqbool A, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 332.

Martinez JP. Abdominal pain. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 23.

Miranda A. Abdominal pain. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 13.

Seller Rh, Symons AB. Abdominal pain in children. In: Seller RH, Symons AB, eds. Differential Diagnosis of Common Complaints. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 2.

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Review Date: 7/1/2023  

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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