Every child complains about a bellyache now and then. How can a parent tell what is wrong, and if it is dangerous? It is not always easy.
Children less than 5 or 6 years of age often do not have the words to describe their sensations accurately. Toddlers do not separate emotional from physical distress.
The young child’s bellyache may represent hunger, fatigue, or a need to use the bathroom. School age children may wake with bellyaches on school days. Are they sick, or just anxious about an important test? What about when the bellyache comes at a birthday party? Some bellyaches come from too much excitement or worry.
How can parents learn when to be concerned?
There are clues to help to decide if the bellyache is a medical problem:
Intensity. If the child is smiling and standing comfortably as they report the bellyache, the pain is mild. If the child is grimacing and frowning, and has stopped normal activities, the pain is moderate. If the child is lying down, legs flexed and crying, the pain is severe.
Duration. If the pain lasts less than 5 minutes, it is unlikely to be anything to worry about, even if it comes and goes for many days.
Chronicity. Chronic or recurrent bellyaches are common, affecting more than 10% of school-aged children, and more than 10% of teens and adults.
Most chronic bellyaches are functional, meaning that the pain is real, but is not due to any disease. The pain is due to an altered way in which the body is working, not due to a disease characterized by tissue damage, inflammation, or a structural abnormality.
Like shivering in the cold, or a runner’s leg cramp, functional abdominal pain is a symptom that falls within the expected range of behaviors for a person’s body.
Position. The closer the pain is to the bellybutton, the more likely it is functional.
The Rule of Ones. The Rule of Ones states that if a person has only one symptom, that symptom is probably functional. If there is more than one symptom, it may be best to see your doctor.
For example, bellyache alone – probably functional. Bellyache and fever, bellyache and vomiting, bellyache and weight loss – may not be functional, see your doctor.
Loss of ability to participate in routine activities. If chronic or recurrent bellyaches prevent a child from doing their usual activities like eating, going to school, playing with friends, or sleeping through the night, then it is time to see your doctor.
A functional disorder is characterized by symptoms that are caused by an altered way in which the body is working, not by a disease characterized by tissue damage or inflammation. There are several pediatric functional gastrointestinal disorders associated with abdominal pain.
For most of the functional disorders no medical tests are necessary or desirable, because there is no test that confirms the functional gastrointestinal disorders. The diagnosis for each pediatric functional gastrointestinal disorder depends upon meeting symptom-based criteria, in the absence of warning signs of disease fevers, weight loss, or bloody bowel movements.
Children old enough to give accurate pain histories may have the same functional abdominal pain disorders as adults. In both children and adults functional gastrointestinal disorders are more common than gastrointestinal disease.
See your doctor if your child exhibits warning signs like:
- weight loss,
- blood in the stools,
- waking in the night with pain,
- difficulty swallowing, or
- pain with urination.
If you are uncertain or have questions about your child's health status, be sure to contact a healthcare provider.
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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.
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Adapted from IFFGD Publication #809 by Paul Hyman, MD, Professor of Pediatrics; Chief, Division of Pediatric Gastroenterology, Children’s Hospital and Louisiana State University Center for Health Sciences, New Orleans, LA.