Abdominal Pain, Age 11 and Younger

Topic Overview

Abdominal pain in children is a common problem. About 1 out of 3 children is seen by a doctor for abdominal pain by the time they are age 15, but only a small number of these children have a serious problem.

Complaints of abdominal pain are more common in children younger than 11 years and are often caused by changes in eating and bowel habits. Most cases of abdominal pain are not serious, and home treatment is often all that is needed to help relieve the discomfort.

Abdominal pain in children is often frightening and frustrating for parents. Many times it is hard to find the exact cause of a child's abdominal pain. Pain without other symptoms that goes away completely in less than 3 hours is usually not serious.

In children, abdominal pain may be related to injury to the abdomen or an illness, such as an upset stomach, an ear infection, a urinary tract infection, or strep throat. Constipation is a common cause of abdominal pain in children. Some more serious causes of abdominal pain in children include appendicitis, lead poisoning, or problems with the intestines, such as intussusception or malrotation. Girls who start having menstrual periods may have abdominal pain each month, and the pain may be more severe in some months than others.

Generalized pain occurs in half of the abdomen or more. Localized pain is located in one area of the abdomen. Babies and toddlers often react differently to pain than older children who can talk about their pain. A baby may become fussy, draw his or her legs up toward the belly, or eat poorly. Older children may be able to point to the area of the pain and describe how severe it is.

Abdominal pain can occur one time, or it can occur repeatedly over several months. Recurrent abdominal pain (RAP) is a condition that affects children ages 4 to 11.

Check your child's symptoms to decide if and when your child should see a doctor.

Check Your Symptoms

Does your child have pain or cramping in the belly?
This also includes injuries to the belly.
Yes
Abdominal pain
No
Abdominal pain
How old are you?
Less than 3 months
Less than 3 months
3 months to 11 years
3 months to 11 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Has your child had surgery on the chest or belly in the past 2 weeks?
Yes
Recent abdominal surgery
No
Recent abdominal surgery
Has your child swallowed or inhaled an object?
Yes
Swallowed or inhaled object
No
Swallowed or inhaled object
Does your child have symptoms of shock?
Yes
Signs of shock
No
Signs of shock
Do you think your baby might be very sick?
A sick baby probably will not be acting normally. For example, the baby may be much fussier than usual or not want to eat.
Yes
Baby might be very sick
No
Baby might be very sick
How sick do you think your baby is?
Extremely sick
Baby is very sick (limp and not responsive)
Sick
Baby is sick (sleepier than usual, not eating or drinking like usual)
Do you think your baby may be dehydrated?
Yes
May be dehydrated
No
May be dehydrated
Are the symptoms severe, moderate, or mild?
Severe
Severe dehydration
Moderate
Moderate dehydration
Mild
Mild dehydration
Do you think your baby has a fever?
Yes
Fever
No
Fever
Did you take a rectal temperature?
Taking a rectal temperature is the only way to be sure that a baby this age does not have a fever. If you don't know the rectal temperature, it's safest to assume the baby has a fever and needs to be seen by a doctor. Any problem that causes a fever at this age could be serious.
Yes
Rectal temperature taken
No
Rectal temperature taken
Is it 100.4°F (38°C) or higher?
Yes
Temperature at least 100.4°F (38°C)
No
Temperature at least 100.4°F (38°C)
Do you think your child may be dehydrated?
It can be harder to tell in a baby or young child than it is in an older child.
Yes
May be dehydrated
No
May be dehydrated
Are the symptoms severe, moderate, or mild?
Severe
Severe dehydration
Moderate
Moderate dehydration
Mild
Mild dehydration
Is your child having trouble drinking enough to replace the fluids he or she has lost?
Little sips of fluid usually are not enough. The child needs to be able to take in and keep down plenty of fluids.
Yes
Unable to drink enough fluids
No
Able to drink enough fluids
Does your child have pain in the belly?
Yes
Belly pain
No
Belly pain
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
Does the belly feel hard when you touch it?
Normally the belly is soft and has some "give." A hard, rigid belly may be a sign of a more serious problem.
Yes
Abdomen is hard (rigid) to the touch
No
Abdomen is hard (rigid) to the touch
Does pressing on the belly cause severe pain?
Yes
Pressing on abdomen causes severe pain
No
Pressing on abdomen causes severe pain
Has the pain:
Gotten worse?
Pain is increasing
Stayed about the same (not better or worse)?
Pain is unchanged
Gotten better?
Pain is improving
How long has your child had pain?
Less than 4 hours
Less than 4 hours
4 hours but less than 1 day (24 hours)
4 hours but less than 1 day (24 hours)
1 to 3 days
1 to 3 days
More than 3 days
More than 3 days
Does the belly hurt all over or mostly in one area?
Pain that is most intense in just one area is likely to be more serious than a bellyache that hurts all over.
Mostly in one area
Localized pain
All over
Generalized pain
Is the pain in the lower right part of the belly?
Yes
Pain in lower right part of belly
No
Pain in lower right part of belly
Does your child have pain with a new bulge in the belly button or groin?
Yes
Pain with new bulge in navel or groin
No
Pain with new bulge in navel or groin
Is your child nauseated or vomiting?
Nauseated means you feel sick to your stomach, like you are going to vomit.
Yes
Nausea or vomiting
No
Nausea or vomiting
Within the past week, has your child had an injury to the abdomen, like a blow to the belly or a hard fall?
Yes
Abdominal injury within past week
No
Abdominal injury within past week
Since the injury, has there been any bleeding from the rectum, urethra, or vagina?
Yes
Bleeding from rectum, vaginal or urethra since injury
No
Bleeding from rectum, vaginal or urethra since injury
Is there a belly wound that is deeper than a scratch?
Yes
Penetrating wound
No
Penetrating wound
Do you think that the injury may have been caused by abuse?
Yes
Injury may have been caused by abuse
No
Injury may have been caused by abuse
Has your child vomited since the injury?
Yes
Vomited after injury
No
Vomited after injury
Is there pain just below the ribs?
Pain just below the ribs after an injury can be a symptom of serious damage to the liver or spleen.
Yes
Pain is below ribs
No
Pain is below ribs
Do you think your child has a fever?
Yes
Fever
No
Fever
Did you take your child's temperature?
Yes
Temperature taken
No
Temperature taken
How high is the fever? The answer may depend on how you took the temperature.
High: 104°F (40°C) or higher, oral
High fever: 104°F (40°C) or higher, oral
Moderate: 100.4°F (38°C) to 103.9°F (39.9°C), oral
Moderate fever: 100.4°F (38°C) to 103.9°F (39.9°C), oral
Mild: 100.3°F (37.9°C) or lower, oral
Mild fever: 100.3°F (37.9°C) or lower, oral
How high do you think the fever is?
High
Feels fever is high
Moderate
Feels fever is moderate
Mild or low
Feels fever is mild
How long has your child had a fever?
Less than 2 days (48 hours)
Fever for less than 2 days
From 2 days to less than 1 week
Fever for more than 2 days and less than 1 week
1 week or longer
Fever for 1 week or more
Does your child have a health problem or take medicine that weakens his or her immune system?
Yes
Disease or medicine that causes immune system problems
No
Disease or medicine that causes immune system problems
Does your child have shaking chills or very heavy sweating?
Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off the child or soaking through his or her clothes.
Yes
Shaking chills or heavy sweating
No
Shaking chills or heavy sweating
Are your child's stools black or bloody?
Yes
Black or bloody stools
No
Black or bloody stools
How much blood is there?
More than a few drops. Blood is mixed in with the stool, not just on the surface.
More than a few drops of blood on stool or diaper
A few drops on the stool or diaper
A few drops of blood in stool or diaper
Does your child have diabetes?
Yes
Diabetes
No
Diabetes
Is your child's diabetes getting out of control because your child is sick?
Yes
Diabetes is affected by illness
No
Diabetes is affected by illness
Do you and your child's doctor have a plan for what to do when your child is sick?
Yes
Diabetes illness plan
No
Diabetes illness plan
Is the plan helping get your child's blood sugar under control?
Yes
Diabetes illness plan working
No
Diabetes illness plan not working
How fast is it getting out of control?
Quickly (over several hours)
Blood sugar quickly worsening
Slowly (over days)
Blood sugar slowly worsening
Do you think that a medicine could be causing the belly pain?
Think about whether the belly pain started after you began using a new medicine or a higher dose of a medicine.
Yes
Medicine may be causing abdominal pain
No
Medicine may be causing abdominal pain
Have your child's symptoms lasted longer than 1 week?
Yes
Child's symptoms have lasted longer than 1 week
No
Child's symptoms have lasted longer than 1 week

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Babies can quickly get dehydrated when they lose fluids because of problems like vomiting or fever.

Symptoms of dehydration can range from mild to severe. For example:

  • The baby may be fussy or cranky (mild dehydration), or the baby may be very sleepy and hard to wake up (severe dehydration).
  • The baby may have a little less urine than usual (mild dehydration), or the baby may not be urinating at all (severe dehydration).

With cramping pain in the belly:

  • The pain may hurt a little or a lot.
  • The amount of pain may change from minute to minute. Cramps often get better when you pass gas or have a bowel movement.
  • The pain may feel like a tightness or pinching in your belly.
  • The pain may be in one specific area or be over a larger area. It may move around.

You can get dehydrated when you lose a lot of fluids because of problems like vomiting or fever.

Symptoms of dehydration can range from mild to severe. For example:

  • You may feel tired and edgy (mild dehydration), or you may feel weak, not alert, and not able to think clearly (severe dehydration).
  • You may pass less urine than usual (mild dehydration), or you may not be passing urine at all (severe dehydration).

Severe dehydration means:

  • The child's mouth and eyes may be extremely dry.
  • The child may pass little or no urine for 12 or more hours.
  • The child may not seem alert or able to think clearly.
  • The child may be too weak or dizzy to stand.
  • The child may pass out.

Moderate dehydration means:

  • The child may be a lot more thirsty than usual.
  • The child's mouth and eyes may be drier than usual.
  • The child may pass little or no urine for 8 or more hours.
  • The child may feel dizzy when he or she stands or sits up.

Mild dehydration means:

  • The child may be more thirsty than usual.
  • The child may pass less urine than usual.

If you're not sure if a child's fever is high, moderate, or mild, think about these issues:

With a high fever:

  • The child feels very hot.
  • It is likely one of the highest fevers the child has ever had.

With a moderate fever:

  • The child feels warm or hot.
  • You are sure the child has a fever.

With a mild fever:

  • The child may feel a little warm.
  • You think the child might have a fever, but you're not sure.

A baby that is extremely sick:

  • May be limp and floppy like a rag doll.
  • May not respond at all to being held, touched, or talked to.
  • May be hard to wake up.

A baby that is sick (but not extremely sick):

  • May be sleepier than usual.
  • May not eat or drink as much as usual.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
  • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Pain in children 3 years and older

  • Severe pain (8 to 10): The pain is so bad that the child can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and sleep, but the child can tolerate it for hours or days.
  • Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.

Severe dehydration means:

  • The baby may be very sleepy and hard to wake up.
  • The baby may have a very dry mouth and very dry eyes (no tears).
  • The baby may have no wet diapers in 12 or more hours.

Moderate dehydration means:

  • The baby may have no wet diapers in 6 hours.
  • The baby may have a dry mouth and dry eyes (fewer tears than usual).

Mild dehydration means:

  • The baby may pass a little less urine than usual.

Blood in the stool can come from anywhere in the digestive tract, such as the stomach or intestines. Depending on where the blood is coming from and how fast it is moving, it may be bright red, reddish brown, or black like tar.

A little bit of bright red blood on the stool or on the toilet paper is often caused by mild irritation of the rectum. For example, this can happen if you have to strain hard to pass a stool or if you have a hemorrhoid.

Certain medicines and foods can affect the color of stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food coloring can turn the stool black.

If you take a medicine that affects the blood's ability to clot, such as aspirin, warfarin (Coumadin), enoxaparin (Lovenox), or clopidogrel (Plavix), it can cause some blood in your stools. If you take a blood thinner and have ongoing blood in your stools, call your doctor to discuss your symptoms.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Symptoms of shock in a child may include:

  • Passing out.
  • Being very sleepy or hard to wake up.
  • Not responding when being touched or talked to.
  • Breathing much faster than usual.
  • Acting confused. The child may not know where he or she is.

It is easy for your diabetes to become out of control when you are sick. Because of an illness:

  • Your blood sugar may be too high or too low.
  • You may not be able take your diabetes medicine (if you are vomiting or having trouble keeping food or fluids down).
  • You may not know how to adjust the timing or dose of your diabetes medicine.
  • You may not be eating enough or drinking enough fluids.

Temperature varies a little depending on how you measure it. For children up to 11 years old, here are the ranges for high, moderate, and mild according to how you took the temperature.

Oral (by mouth), ear, or rectal temperature

  • High: 104 °F (40 °C) and higher
  • Moderate: 100.4 °F (38 °C) to 103.9 °F (39.9 °C)
  • Mild: 100.3 °F (37.9 °C) and lower

Armpit (axillary) temperature

  • High: 103°F (39.5°C) and higher
  • Moderate: 99.4 °F (37.4 °C) to 102.9 °F (39.4 °C)
  • Mild: 99.3°F (37.3°C) and lower

Note: For children under 5 years old, rectal temperatures are the most accurate.

Many prescription and nonprescription medicines can cause belly pain or cramping. A few examples are:

  • Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
  • Antibiotics.
  • Antidiarrheals.
  • Laxatives.
  • Iron supplements.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:

  • Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
  • Steroid medicines, which are used to treat a variety of conditions.
  • Medicines taken after organ transplant.
  • Chemotherapy and radiation therapy for cancer.
  • Not having a spleen.

An illness plan for people with diabetes usually covers things like:

  • How often to test blood sugar and what the target range is.
  • Whether and how to adjust the dose and timing of insulin or other diabetes medicines.
  • What to do if you have trouble keeping food or fluids down.
  • When to call your doctor.

The plan is designed to help keep your diabetes in control even though you are sick. When you have diabetes, even a minor illness can cause problems.

Postoperative Problems

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

Abdominal Pain, Age 12 and Older
Swallowed or Inhaled Objects

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Home Treatment

Most of the time, a child's abdominal pain will get better with home treatment and the child will not need a visit to a doctor.

Home treatment for abdominal pain often depends on other symptoms that are present with the pain, such as diarrhea, nausea, or vomiting. See the Related Information section of this topic for information on some of these other symptoms.

Try the following, one at a time in the order listed, if your child has mild abdominal pain without other symptoms:

  • Have your child rest when he or she has mild stomachaches. Most symptoms will get better or go away in 30 minutes.
  • Have your child sip clear fluids, such as water, broth, tea, or fruit juice diluted with water.
  • Have your child try to pass a stool.

If the measures above do not work, you may also try these:

  • Serve your child several small meals instead of 2 or 3 large ones.
  • Serve mild foods, such as rice, dry toast or crackers, gelatin, or applesauce. Do not give your child spicy foods, other fruits, or drinks that have caffeine or carbonation until 48 hours after all symptoms have gone away. These foods may make your child's stomachache worse.
  • Do not give your child any medicines without talking to the doctor first. Medicines may mask the pain or make it worse.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Pain increases or localizes to one section of the abdomen.
  • Other symptoms develop, such as diarrhea, nausea, vomiting, or fever.
  • The belly feels hard or looks very swollen.
  • Symptoms become more severe or frequent.

Prevention

Abdominal pain in children can often be prevented.

  • Abdominal pain in children is often caused by irregular bowel habits. Become familiar with your child's normal bowel patterns. Also, be aware of the size and consistency of your child's stools. This will help to determine whether constipation is a problem. For information on preventing constipation and establishing toilet training, see the topic Constipation, Age 11 and Younger.
  • Try to make sure your child has regular eating habits. Overeating is a common cause of abdominal discomfort. Have your child eat slowly and stop when he or she feels full. For more information, see the topic Healthy Eating for Children.
  • Swallowing air (aerophagia) can cause abdominal pain and a swollen abdomen. Your child may also have a lot of belching or flatus. Limit chewing gum and carbonated beverages to help prevent this. Many children swallow air when they are anxious or frightened.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:

  • Has your child had an injury to the abdomen?
  • How long has your child had the pain?
  • What was your child doing when the pain started?
  • Has your child had similar episodes of abdominal pain before? What were these episodes like? How were they treated?
  • Is the pain constant, or does it come and go?
  • Is the pain localized to one area or generalized over the whole belly?
  • How severe is the pain? What has your child's activity level been?
  • Can your child describe the pain? Is the pain cramping, a steady ache, or sharp and burning?
  • What makes the pain better? What makes the pain worse?
  • Does your child have other symptoms, such as nausea, urinary problems, constipation, or diarrhea?
  • Is your child vomiting? If so, describe how much, how often, and how long.
  • Does your child have a fever?
  • Has your child recently traveled outside of his or her native country?
  • Has your child drunk any untreated well, stream, or lake water?
  • Does your child have any health risks?

References

Other Works Consulted

  • Campo JV, et al. (2004). Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics, 113(40): 817–823.

Credits

By Healthwise Staff
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
David Messenger, MD
Last Revised May 9, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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