Recurrent Abdominal Pain in Children: What a Parent Needs to Know

By Dr. Arvind Taneja in Paediatrics (Ped)

Jul 26 , 2022 | 2 min read

It is common for a family to have a child with the complaint of recurrent abdominal pain. Occasionally it may be associated with one or two vomits. When asked where the pain is felt, the child vaguely passes their hand over the belly button. The intensity of the pain may make them cry; it usually lasts 15-30 minutes before it is gone, only to reoccur at another time and date.

A distressed parents' consultation with the doctor shows no abnormality. The doctor either prescribes an anti-colic medication or launches into an often-unfruitful investigation.

At least one in ten school children suffers from this complaint, and the problem is directly proportional to the family's socio-economic status. Well-to-do families' children do not eat enough fruit, vegetables, and cereals; they have frequent access to junk foods, refined flour (maida), and sugary soft drinks, leading to constipation and consequent abdominal pain.

These children are above the age of five years and below 12 years. Pain in a child below three years has to be taken much more seriously.

There are two categories of belly aches:

Organic Group

Constitutes less than 10% of the total cases.

Deterioration over time in the child's general condition, especially a loss of weight, persistent vomiting, and diarrhoea or fever, raises red flags for the family and the doctor. The further the pain is from the belly button, the more likely it belongs to the organic group.

Non-Organic Group

Constitutes 90% of the cases where no organic cause is found.

Investigations:

The minimum that needs to be done includes:

Stool examination: routine, microscopic, and reducing substances
Urine examination: routine microscopic
Complete blood count and ESR
A plain X-ray of the abdomen to rule out constipation and stones
Investigation to rule out wheat allergy.

The doctor should spend significant time understanding the family and the school dynamics. Quite often, there is family strife, similar symptoms in other members of the family, school difficulties, and insistence on drinking milk as being responsible.

A word of caution about suspecting chronic appendicitis: an appendix never "groans", it only "bites", and most medical professionals believe such an entity does not exist.

The more time the doctor spends on the history of the pain; the less time they are likely to spend on the treatment.

Treatment:

Convince the parent that organic causes have been ruled out by history, physical examination, and investigations
Every child with recurrent abdominal pain must be given at least a month's trial of being taken off milk to rule out lactose intolerance which is very common to develop in Indian children as they grow into the school-age group.
Absenteeism from school to be strongly discouraged
If constipation is established by history and plain x-ray abdomen, a regime of osmotic laxatives under medical supervision and modification of diet to include fibre and eliminate junk foods must be tried to retrain the bowel.