Nobody likes a tummy ache. Abdominal pain is one of the most common reasons a parent brings their child to the doctor. Evaluating this pain can be challenging for the parent and primary care physician. Causes of abdominal pain in children can range from trivial to life-threatening. The primary care physician often faces a decision on which patients need emergency referral.
To help determine the cause of abdominal pain, Children’s pediatric gastroenterologist and emergency medicine specialists recommend that primary care physicians consider the child’s history and exam. Typical triggers include infections, food poisoning, food allergies, envenomations and surgical complications. Duration of the pain and associated symptoms such as fever, vomiting or diarrhea can direct the workup. Older children can also describe the nature and location of the pain.
Here are some potential pitfalls that Children’s advises primary care physicians to be aware of when making a diagnosis, which also may be useful for parents to know:
- Vomiting alone does not always mean gastroenteritis.
- Bilious (green or yellow) vomiting could be a sign of obstruction that requires emergent referral no matter how well the patient appears.
- Hematemesis with abdominal pain is always a reason for urgent referral.
- Look out for surgical problems, urinary tract infections or with prolonged vomiting, increased intracranial pressure.
- Urinary tract infections do not usually cause abdominal pain alone; be cautious when making this diagnosis.
- Do a genital exam on males with abdominal pain. Testicular torsion can present as abdominal pain. Teenage boys, out of embarrassment, may not admit to testicular pain.
- Any child still vomiting after Zofran (ondansetron) administration requires emergent testing to determine the cause of the vomiting.
- Any child with right lower quadrant pain and fever should be suspected to have appendicitis until proven otherwise.
- Constipation defined by stools that are hard, dry and difficult to pass may be a source of severe abdominal pain. Decreasing frequency alone is not necessarily a sign of constipation.
Primary care physicians should also carefully consider ordering a computed tomography (CT) scan because of radiation exposure to a young body. An abdominal series upright and supine may be useful in diagnosing intestinal obstructions. Ultrasound is often used to diagnose or rule out numerous causes of abdominal pain. Children’s now has 24-hour ultrasound available during the week.
Services at Children’s
Children’s offers pediatric gastroenterology services at the Madera campus, including 24-7 care for appropriate acute pain referrals. Consultations are also offered at Children’s Modesto Pediatric Subspecialty Center, owned and operated by Specialty Medical Group in affiliation with Children’s; Children’s Merced Pediatric Subspecialty Center; and the Bakersfield Digestive Diseases and Endoscopy Center.