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It is very common for children of pre-school and school age to have stomach aches. Some have it more or less every day, for a long time, and some get it more acutely. This post is about the sudden stomach aches. When I meet a child with acute stomach pains, there are five conditions that I want to make sure not to miss: appendicitis, testicular torsion, strangulated hernias, invagination and blockage in the intestine. But almost always, the stomach pain is due to constipation.

Stomach ache and fever – could it be the appendix?

Appendicitis is quite common in children. It is an inflammation of the appendix. An inflammation basically always causes a little fever, a little fatigue and the child usually does not want to eat. The temperature in a child with appendicitis is usually not very high, around 37.8-38.8C (100.4-101.84F). Generally, they do not want to eat even their favorite foods and are a little pale and tired.

Many parents know that the appendix sits in the lower right part of the stomach and is aware of whether the child appears to be in pain there. As a rule, children up to the age of ten are not so sure about locating pain. They often know that they have a stomach ache, but almost always point to the navel, in the middle of the stomach. Even adults with appendicitis often have pain throughout the stomach for the first few days. Only after one to two days, the pain is usually localized to the lower right abdomen.

Take a urine sample (as it could be a urinary tract infection) and let the doctor feel the stomach. If the result of the urine test is negative and their stomach is soft, it is safe to go home. Although, you may need to feel the stomach again if it still hurts the next day. If the stomach feels affected by a suspected appendicitis, the child may go on to the hospital and have an ultrasound to see if it is appendicitis or not.

Scrotum problems

You’ll need to learn about your son’s scrotum – how does it normally feel? How do the testicles feel and how do they move around the scrotum. You may need to feel your son’s scrotum every now and then when you change his diapers. (Stop at the latest when the baby stops wearing a diaper). Then when a boy gets a stomach ache, you can differentiate between what’s normal, and what’s not.

If it hurts when you feel the scrotum, or if one testicle is very sore or does not feel as usual; go to the surgical emergency room or pediatric emergency room as soon as you can!

Sometimes the testicles twist around the blood vessels and nerves that it suspends from. It is an emergency condition that needs to be operated on as quickly as possible to have the chance to save the testicle from oxygen starvation.

Lumps in the groin

Always check the baby’s groin when they have a stomach ache. If there is a hard, sore, centimetre-sized lump, it can be a piece of bowel that has made its way through a weakening of the intestinal wall. This is called an inguinal hernia. Try pushing it back into the stomach. If it is possible and the pain eases, you can seek medical attention the next day and ask for a referral to the surgeon. You should get a referral even if no lump can be seen at the health center! The weakening of the abdominal wall needs to be repaired so that the intestine cannot push through again.

If the lump (hernia) cannot be pushed back, seek the pediatric emergency room or surgical emergency room at once!

Small nodules in the groin are often lymph nodes. Read more about swollen lymph nodes here.

Constipation

By far the most common reason why children get acute stomach pain, is constipation. Breastfed babies do not get constipated unless they have congenital bowel diseases, but that’s when they are constipated since birth. Talk to the children’s medical center if your newborn has been constipated since birth.

Babies who take formula, often get constipated. They’re going to have to fight and push to get the poop out. You can help them with 5-10 ml of Lactulose (available without a prescription at the pharmacy) daily. If they have started eating, you can give fruit purees, for example from pears or prunes.

Constipation is very common in children between one and ten years of age. Sometimes the constipation is clearly noticeable by the child pushing when they poop, and by the hard stools. Just as often, parents say that the child poops every day and it doesn’t seem hard. It’s not so rare for constipated children to poop themselves, or “spill” some poop in their panties or underpants. Sometimes there is so much hard poop in the intestine that it runs loose and then the child gets diarrhea as constipation symptoms.

Sooner or later, the constipated baby will have a stomach ache. The pain can be anything from a lot to a little. If the intestines are full enough, the child will throw up. Therefore, we give basically all children who come into the pediatric emergency room an enema to treat their constipation. What we give at the children’s emergency room is called “Klyx”. It is quite a large amount of liquid that is inserted into the rectum. The advantage of Klyx is that the liquid does not sting. Micro-enemas, Microlax for example, stings a lot in most children and irritates the intestinal mucosa.

Acute treatment of constipation in children

If your child has a stomach ache at home: feel free to give Klyx and see if it helps. (120 ml for children over one year).

If the child recovers after you give Klyx (that is, if they poop a lot and the pain eases), you do not have to go to the children’s emergency room. However, the child is likely to need a longer period of treatment (by mouth) for constipation so the intestine can function normally again. You can buy Lactulose yourself, starting with 15 ml daily for a child over 1 year. Lessen or increase the dose based on how the poop looks. If they have diarrhea, lower the dose by 5 ml at a time; and if they have hard poop, increase the dose by 5 ml at a time. If the child needs Lactulose for longer than one month or if the constipation comes back when you stop, go to the medical center and ask for a doctor’s appointment.

Vomiting and stomach ache

When there is a blockage in the intestine, the baby vomits and gets stomach pain. The intestine can twist around itself, or around a connective tissue strand in the stomach that has been there since birth or since a previous operation. Children with a blockage in the intestine, vomit and has stomach aches. Sometimes the stomach does not hurt all the time, but the pain comes and goes at reasonably regular intervals.

A child who vomits and has a stomach ache (without having diarrhea) even after Klyx, should go to the surgical emergency room or pediatric emergency room the same day!

Intussusception

Children between 7-8 months and 3-4 years of age may suffer from intussusception. A section of the intestine folds back onto itself (invaginates). The child will scream in a panic and appear to have a lot of pain for a short time, then will return to a normal state, and then scream just as intensely again. In general, the baby does not poop, but sometimes a little blood or mucus is exuded into the diaper. Eventually, the child begins to vomit and becomes increasingly exhausted, cold, sweaty and pallor. Invagination is easily cured in hospitals by inserting X-ray contrast agents into the rectum. A pressure is formed so that the intestine is pushed back to normal. Sometimes a minor operation is needed.

If your child is panic screaming, in short recurring periods, seek the pediatric emergency room and ask if it may be invagination. An ultrasound will confirm this.

Bloody diarrhea

A child who has stomach aches and bloody diarrhea usually has an intestinal infection, often bacterial (caused by salmonella bacteria, EHEC bacteria or shigella bacteria for example). Another cause may be an inflammatory bowel disease or food allergies, especially a cow’s milk protein allergy in infants.

Read more about cow’s milk protein allergy in children here.

Small streaks of blood in the stool of children who are otherwise well, are usually not dangerous. You don’t have to seek emergency for it.

Bloody vomit

The most common reason for bloody vomit is that a small vessel in the pharynx broke during the copious vomiting. The child is in no danger. So, if there are small blood streaks in the vomit, then you can wait at home.

Children with stomach aches and copious amounts of blood in their vomit, should seek the pediatric emergency room the same day!

Children may also get ulcers. They may get ulcers in the esophagus from an Helicobacter pylori infection, or from reflux, whereby the stomach acid moves up into the esophagus and irritates it.

Stomach ache, dull and cold sweats

If your child has a stomach ache, is dull, pale and has cold sweats, immediately seek the children’s emergency room.

This is what children look like when they have serious stomach conditions and often require surgery. Some of them, but far from all, however, have constipation.