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Part 4: Keeping Your Child Healthy  >  The A-Z of Childhood Illnesses  >  Abdominal Pain

If your child has pain in the abdomen, but otherwise looks well, you can be almost sure that the problem is not serious. See the doctor if you have cause to be anxious.

CAUSES: Below are given some of the important causes of abdominal pain in children.

  • Psychological Factors
  • Medical Causes
  • Surgical Conditions

Psychological Factors

SYMPTOMS: School going children often complain of recurrent pain, usually located around the navel. In most cases, the pain is not severe and the child does not complain about it if he is involved in doing something interesting. It rarely wakes him up from his sleep. He is perfectly all right in between the attacks, which may last for a few moments or longer, but rarely for more than half an hour. There may be a family history of similar pain in other children or in the parent(s). Usually, these children are quite intelligent.

CAUSES: Consider if there is any reason for the child to become emotionally upset. Is he being bullied in school? Is he afraid of his new teacher? Are the examinations causing much anxiety? Is he upset because of a quarrel between his parents?

MANAGEMENT: It is not always easy to probe the mind of a child. If the symptoms persist, take the advice of a doctor, who may even refer him to a family counsellor, psychologist or a psychiatrist. Don’t upset the child by remarks like, ‘You are just acting’ or ‘Do not try to fool us’. I believe that such children do get pain, but the symptom is probably due to some, not yet fully understood mechanism or is related more to the mind rather than the body - possibly a subconscious way of attracting the parents’ attention for more body contact. Hence, the treatment lies in understanding the child, helping him with his underlying emotional problem, if any, rather than being harsh towards him.


Medical Causes

Worms

Infection is caused by ingestion of the mature eggs of common worms — Ascaris lumbricoides (commonly called roundworm), threadworms, trichuris trichiura (whipworms) and tapeworms — or the penetration of the larvae of the hookworm into the child’s skin. It is a misconception that consuming an excess of sugary foods causes worms; but it is important to restrict the intake of such foods as a matter of fact.

Ascariasis (infection with round worms) The round worms measure from 15 to 35 cms in length and are 3 to 4 mms in diameter. They are either passed out as worms or their eggs are excreted. If a person defecates in the open, the soil also gets contaminated with the eggs. A child may touch the infected soil and the infection may travel from the hand to the mouth. Alternatively, food can become infected by the excreta or by flies.

SYMPTOMS: Most children with ascariasis do not have any complaints. Sometimes, it may cause pain in the abdomen, distension of the abdomen and even intestinal obstruction, resulting in absence of stools and persistent vomiting. Grinding the teeth while sleeping (Bruxism) is not due to worms.

PREVENTION: Washing one’s hands thoroughly with soap and water before a meal should be a ritual even if the child uses a spoon, knife and fork for eating. Also, teach your child to wash his hands thoroughly after going to the toilet. Mebendazole or albendazole is used for the treatment of ascariasis.


Threadworms are quite common and usually are more of a nuisance than a serious problem. Only rarely, when they block the appendix, do they cause abdominal pain. 

SYMPTOMS: Generally, children may not sleep well due to itching around the anus. This happens because the threadlike, female worms, measuring about 1 cm, come out of the intestine at night and lay eggs on the skin around the anus. The eggs are carried by the child or an adult under the fingernails, or they may spread in the home through clothing or bedding. The patient may ingest these eggs from his own fingernails or may infect others by contamination of food while serving/cooking. These eggs, when swallowed, grow to adulthood.

TREATMENT: It is important to treat all the members of the family, including the house help, with a single dose of 100 mg of mebendazole for children and adults, with a repeat dose after 2 weeks. In certain cases, the treatment may have to be repeated every 3 months.


Hookworms attach themselves to the upper, small intestine and suck blood, resulting in anaemia. Larvae of hookworms emerge from eggs lying in warm damp soil and penetrate the skin of people walking barefoot in farms or gardens. They grow to adulthood inside the body.

TREATMENT: Anaemia is treated with iron and the patient is given mebendazole as in ascariasis.


Whipworm (Trichuris Trichiura) infection is caused by ingestion of eggs passed in the stool, and spreads with unclean hands and through flies, which, in turn, contaminate water and food. Whipworms rarely cause pain in the abdomen, but they are an important, though not common cause of prolapse of the rectum in children. 

TREATMENT: Same as for ascariasis.


Tapeworms are several metres long and inhabit the intestines. They have several segments, which are passed into the stool as small, flat, white pieces (like seeds of gourd or marrow, Kadu and ghia), about 1 cm long. The infection stems from eating infected pork or beef, which is not cooked properly. Food or water contaminated with the eggs of tapeworms may also cause infection. The disease may, therefore, develop in children who do not eat meat.

SYMPTOMS: Tapeworms may not cause much problem except for mild pain in the abdomen. But, in rare cases, they may form cysts in the child’s brain. This condition is called neurocysticercosis and can lead to headaches, fits or even death.

PREVENTION: Meat eaters must make sure that it is well cooked. Personal hygiene for all members of the family remains equally important. 

TREATMENT: The drugs found useful are niclosamide for removal of adult worms, and praziquantel and albendazole for the cysts affecting the brain.


Bacillary Dysentery
SYMPTOMS: Frequent motions (not necessarily loose) with passage of blood or mucus and accompanied by griping pain that increases at the time of passing a motion is usually due to bacillary dysentery. At times, the child doesn’t pass any faecal matter, but only blood and/or mucus.

Unlike acute watery diarrhoea, vomiting and significant dehydration are not common features in dysentery, but some children can have frequent watery motions at the onset, sometimes accompanied by vomiting. 

Toddlers are prone to the condition during the monsoons. Children who are breastfed into the second year of life are less prone to the disease and even if they fall sick due to dysentery, the severity of the disease is less and they recover faster. The child can get infected from close contact with an infected person or by consuming contaminated water or food.

TREATMENT: If facilities exist, a routine stool examination can be undertaken. It would show the presence of mucus, red blood cells and leucocytes. Macrophages may also be present. Treatment consists of adequate hydration (see Diarrhoea in the chapter on Home Remedies), food and drugs. Drugs are required to control the bacterial infection. Some doctors advise anti-motility drugs to reduce the frequency of motions. Such drugs contain loperamide and diphenoxylate that are banned for use by children. Besides prolonging the illness, such drugs can also have serious side effects and must not be given.


Giardiasis And Amoebiasis
Giardiasis and amoebiasis may be suspected in children with persistent or recurrent pain in the abdomen. A stool examination of a fresh sample is asked for to confirm the diagnosis.

TREATMENT: The child is given a full course of metronidazole.


Food Poisoning
Food poisoning should be suspected if all those who have eaten the same food start getting abdominal pain, diarrhoea and vomiting, with or without fever. 

PREVENTION: Children should be discouraged from eating milk products outside the home. 

Food should be eaten the same day it is cooked. If this is not possible, the leftover items should be rapidly cooled in cold storage or kept in the deep-freeze compartment of the refrigerator, and thoroughly heated before consumption. Make sure that the centre of the food gets heated, leaving no cool spots.

TREATMENT: Same as for Diarrhoea in the chapter on Home Remedies.


Sore Throat And Vomiting
SYMPTOMS: Sore throat with enlargement of glands in the abdomen can cause abdominal pain in children above 2 years of age. The pain disappears as the sore throat gets treated.

Severe bouts of cough or vomiting leading to soreness of the abdominal muscles may also present as abdominal pain. The remedy lies in treating the cause of sore throat, cough or vomiting.


Tuberculosis Of The Abdomen

Tuberculosis of the abdomen should be considered if the child who complains of pain in the abdomen has associated features connected with a possible diagnosis of tuberculosis. These features include: A history of close contact with an adult having tuberculosis; loss of appetite and weight; distension of the abdomen with or without evidence of intestinal obstruction; and evidence of tuberculosis elsewhere in the body. For treatment, see section on Tuberculosis.


Constipation

This is a common cause of abdominal pain in children. The child does not look ill, nor run fever, but gets intermittent colicky pain in the stomach. There is no vomiting and the appetite is usually not affected. The child may have moved his bowels, but it may have been an incomplete evacuation. For treatment, see section on Constipation.
 

Surgical Conditions

Appendicitis

Appendicitis refers to inflammation of the appendix — a taillike structure connected to the caecum portion of the large intestine located in the right lower abdomen. If not detected early, an inflamed appendix may burst open, leading to a serious condition called peritonitis. 

SYMPTOMS: This condition should be suspected in the presence of persistent pain in the abdomen, often (though not always) associated with loss of appetite, vomiting and fever. The pain mostly begins around the centre of the abdomen (near the navel) and, after a few hours, gets localised to the right lower abdomen. The child who is otherwise active becomes quieter, resists examination of this part of the abdomen and gets even more pain when his abdomen is pressed gently over this region. Unattended peritonitis makes the abdomen feel hard like a board, and the pain and tenderness (pain when touched) becomes worse.

TREATMENT: A child with a possible diagnosis of appendicitis needs the immediate attention of a surgeon — preferably a paediatric surgeon.


Intestinal Obstruction
Intestinal obstruction is a serious surgical condition. Some of the causes are congenital obstruction (from birth), a mass of roundworms obstructing the intestines, intussusception and an obstructed inguinal hernia (discussed later in this section).

SYMPTOMS: The child with intestinal obstruction has pain in the abdomen, constipation, distension of the abdomen and projectile vomiting (vomit shooting out of the mouth with great force). It may be green in colour (due to the presence of bile) or may even contain faeces. The child will want to lie quietly in spite of the pain.

TREATMENT: The urgent care of a surgeon is vital.


Intussusception

Intussusception is a condition in which one portion of the intestine slips inside the portion next to it. The condition occurs commonly between the ages of 3 months and 3 years.

SYMPTOMS: There is a sudden onset of pain which lasts for 2 to 3 minutes and then occurs in repeated bouts every quarter hour or so. The child shrieks with pain and looks frighteningly pale. While a child usually becomes red in the face when he cries, in intussusception, the child looks pale, acutely ill, refuses to eat or drink and appears to be collapsing with continuing bouts. At this stage, the child may pass blood in the stool.

TREATMENT: A surgical opinion is urgently needed in such a situation.


Inguinal Hernia

Inguinal hernia with strangulation or obstruction may present itself in an infant who starts crying suddenly and the mother notices a hard swelling in the groin (junction between the abdomen and thigh). No attempt should be made to press on this swelling; show the child to your doctor. If unattended, obstructed inguinal hernia can present with signs of intestinal obstruction (as with Intussusception). If the treatment is unduly delayed, the blood vessels in the swelling get obstructed, causing damage to the surrounding intestines.

SYMPTOMS: Most often, the inguinal hernia is noticed as a swelling in the groin or the scrotum. The swelling becomes more prominent when the child cries. It may disappear on its own or by gentle pressure when it reduces with a gurgling feel. This is not an emergency situation, but as the possibility of strangulation exists, this hernia should be operated upon as soon as possible.

A strangulated hernia is an emergency needing urgent attention.

Some children may have hernia on both sides. 

At times, the child has some tender glands in the groin secondary to an infection in the lower limb. This should not be confused with hernia. A hernia should also be differentiated from a congenital hydrocele, which presents with swelling of the scrotum. This swelling does not change in size on crying or with pressure. It usually disappears on its own before the child is 1 year old. 

TREATMENT: If the doctor decides that the swelling is hernia, he/she may gently try and reduce it. Failing this, the child may be hospitalised for surgery.


Torsion Of Testes
This results in intense pain in the affected scrotum and swelling and tenderness (pain on touch) of the scrotum. This condition may be mistaken for inflammation of the testis and treated with antibiotics, and so result in loss of the testis.

TREATMENT: It is of prime importance to take a child with scrotal pain and swelling to a paediatric surgeon. If it is torsion, the child must be operated soon to avoid permanent damage to the testis.


Some Other Less Common Surgical Conditions
Other less common surgical conditions with pain in the abdomen, like injury to the abdomen and a stone in the urinary tract may also be kept in mind. The onset of pain with a stone is sudden. The pain is often located in the back and extends towards the groin. A dull ache persists, with outbursts of shooting unbearable pain. This may be associated with passage of blood in the urine.


Other Possible Causes Of Abdominal Pain In Children

  • Allergy or intolerance to animal milk
  • Colic in small infants
  • Dietary indiscretion
  • Abdominal epilepsy
  • Urinary infection
  • Referred pain from the chest in a child with pneumonia or pleural infection
  • Hepatitis (infection of liver)
  • Malaria
  • Hunger with low blood sugar

Infection of the gastrointestinal system with H. Pylori is also being considered as a possible, though not definite cause of abdominal pain. This is treated with metronidazole, amoxycillin and ranitidine.

Choledochal cyst, an uncommon congenital malformation of the tubes draining bile from the liver, presents with attacks of abdominal pain, clay coloured stools and fever. Sonography of the abdomen clinches the diagnosis. Treatment consists of antibiotics to take care of the infection. The symptoms subside after treatment with antibiotics, though surgery is necessary, and as early as possible, as the cyst tends to get repeatedly infected and enlarges in size with the passage of time, making surgery more difficult in the later stages.

Meckel’s diverticulum, an anomalous tubular structure arising from the small intestine, can give rise to abdominal pain when inflamed. It is associated with rectal bleeding. The bleeding is usually dark red or, more rarely, bright red, if excessive and generally profuse. This constitutes a medical emergency. The bleeding may stop while the child receives treatment, and the surgeon may ask for investigations such as an isotope scan to confirm the diagnosis. However, it is not easy to confirm the diagnosis of Meckel’s diverticulum and the surgeon will usually need to operate to excise the diverticulum.




7 March, 2016

 
Part 4
The A-Z of Childhood Illnesses
 
Abdominal Pain
Abrasions or Scratches
Acute Glomerulonephritis
Acute Nephritis
Acute Watery Diarrhoea
Addictions
Adenoids
AIDS
Allergies
Anaemia
Anorexia (Poor Appetite)
Asthma
ADHD
Autism
Backache
Bed-Wetting (Enuresis)
Birth Deformities
Bites and Stings
Bleeding
Bone, Joint and Muscle Injuries
Bowlegs and Knock-Knees
Breathlessness
Bronchiolitis
Burns
Calcium Deficiency
Cancer
Cardiac Pulmonary Resuscitation
Cerebral Palsy (CP)
Chickenpox
Choking
Circumcision
Cleft Lip and Palate
Common Cold
Congenital Heart Disease
Constipation
Convulsions or Fits or Seizures
Cough
Croup
Crying
Cuts
Dengue Fever
Diabetes Mellitus
Diarrhoea, Dysentery ...
Diphtheria
Down's Syndrome
Earache, Ear Infections ...
Electric Shock
Encephalitis
Eye Problems
Fears
Foot Problems
German Measles (Rubella)
Glands in the Neck ...
Headache
Head Injury
Hepatitis
Hydrocephalus
Hypertension
Hypospadias
Influenza (Flu)
Jaundice
Joint Disorders
Kala-Azar
Leptospirosis
Limp and Pain in the Legs
Malaria
Malnutrition (Undernutrition)
Measles
Meningitis
Meningomyelocele
Menstrual Problems
Mental Retardation (MR)
Mouth To Mouth Breathing
Mumps
Nephrotic Syndrome
Nose-Related Problems
Obesity
Pneumonia
Poisoning
Poliomyelitis
Premature Baby
Prolapse of the Rectum
Rabies
Rheumatic Fever
Rheumatoid Arthritis
Rickets
Short Child
Skin Conditions
Sleep and Sleep Problems
Sore Throat (Pharyngitis)
Splinters
Stammering
Stridor (Noisy Breathing)
Teething and Care of Teeth
Tetanus (Lock Jaw)
Thrush
Thumb-Sucking
Tics
Torticollis
Tracheoesophageal Fistula
Tropical Eosinophilia
Tuberculosis (TB)
Typhoid
Umbilical Problems
Undescended Testis
Urinary Infection
Vaginal Discharge
Vomiting
Wheezing
Whooping Cough (Pertusis)



Part 4
Keeping Your Child Healthy
Choosing A Paediatrician
Proper Use of Medicines
Home Remedies
A First Aid Kit
The A-Z of Childhood Illnesses
Psychological Concerns
Managing A Hospital Stay
Emergencies
Prayer And Your Child's Health
The Role of Nature Cure
Homoeopathy
Ayurveda and Child Care
Congenital Heart Disease FAQ
 
Guide to Child Care
Home
Introduction
1 Pregnancy, Childbirth ...
2 The Growing Years
3 Feeding Infants, ...
4 Keeping Your Child Healthy
5 Keeping Your Child Happy
About Dr. R. K. Anand
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