When to worry about a child’s stomachache, according to experts

From Romper

By Jessica Booth

Anyone who has ever spent time with a young child can tell you that they tend to get stomachaches often. Whether it’s because they snuck a few extra snacks, are feeling full after eating, or just want attention, little kids are no stranger to abdominal pain. The most annoying part about this, though, is that it’s hard to know when to worry about a child’s stomachache. How do you know if something is seriously wrong, or if it’s just a run-of-the-mill pain that will go away on its own?

Kids aren’t that great at communicating how their body pains feel, simply because they don’t know any better. Instead, it’s up to you as the parent to look out for signs that you may need to dial up their pediatrician.

It’s also important to note that stomach pain in children is often due to stress, which may not warrant a doctor’s visit. Dr. Mitchell Katz, pediatric gastroenterologist and medical director of gastroenterology at CHOC, tells Romper, “Stomach pain can be the result of sadness, stress, or anxiety. Though this type of pain is more common in school-age children, children younger than 5 under unusual stress may also experience it.” Look for the symptoms below, but if you don’t notice them, know that the pain may be emotional rather than physical.

And if you do notice the below symptoms, take note of them. “Parents have to take a step back and judge the severity of the pain when deciding to give their child medications for stomach issues,” says Katz. “If they think the issues are due to something as simple as a few missed bowel movements, there’s no harm in a stool softener. If significant pain is present, it’s always better to call your primary care provider to talk about the condition.” Here’s how to know if you should worry about your child’s stomachache:

1. They Keep Complaining About A Stomachache

If your child is complaining about their stomach pain more than they usually would complain about something, that could be an indication that the pain is severe. See if you can distract them from what they’re feeling — if their favorite movie or game doesn’t take their mind off of it, that’s probably because it’s really bothering them.

Dr. Leann Poston of Invigor Medical, says, “If the pain is severe and your child cannot be distracted from the pain, contact your doctor. If the pain is not as severe, consider the age of the child. Children who cannot express their pain well warrant a call to a physician more quickly than those who can describe where the pain is located and what it feels like and thus provide reassurance.”

2. The Stomach Pain Is In Their Lower Right Side

It’s important to find out where the pain is coming from, as pain in certain spots can be a sign of a more serious problem. Dr. Sylvia Owusu-Ansah, associate professor of pediatrics and medical director of UPMC Children’s Hospital of Pittsburgh, tells Romper that if the pain is in the right lower quadrant of the abdomen, especially if it’s tender to the touch, you should be on the alert. “That may signify something such as appendicitis, or in females, ovarian torsion, where the ovary rotates on itself and cuts off the blood supply,” she says.

3. The Stomach Pain Is Also In Their Back or Groin

The right lower quadrant of the abdomen isn’t the only spot you’ll want to watch out for. Owusu-Ansah says, “If the pain radiates to the back or groin area, it may be referred pain from other areas in the body, such as the kidneys or the bladder and urinary tract system, and may indicate infections in that area or ailments such as kidney stones.”

Another warning sign is if urination is bothering them as well. “If a child is complaining that it hurts to pee with abdominal pain, it may be a urinary tract infection,” says Owusu-Ansah. And if boys experience groin pain and stomach pain, you should check the testicular area for pain and/or swelling or discoloration.

4. They’re Vomiting A Lot & Have Stomach Pain

Vomiting is never fun to deal with, but it happens. Some kids tend to vomit a lot more than others, but excessive vomiting — when a child keeps vomiting over and over again — may be a warning sign, especially if they’re unable to keep any fluids or solids down.

“In children, this may quickly lead to dehydration, which is monitored by urine output, or how much a child urinates during the day,” explains Owusu-Ansah. “If the amount significantly decreases, that can be an early sign of dehydration.”

5. They Have A Fever & Stomach Pain

Kids get fevers. It happens! A fever is the body’s way of reacting to an infection or pain, and can be relatively harmless. Still, that doesn’t mean you should ignore it, especially if it comes along with severe abdominal pain. Owusu-Ansah says, “Children with abdominal pain with fever should be checked out for any type of abdominal infection or kidney/urinary infections in the genital area. Upper abdominal pain with fever and cough can be a sign of lower lung lobe pneumonia with referred pain to the stomach. Abdominal pain with fever should be attended to and evaluated by a physician.”

If you notice that your child has a fever, stomach pain, increased sleepiness, and blood in their stool, call your doctor — Owusu-Ansah says this could be a sign of infection or even low blood pressure or blood loss.

6. They Are Bloated & Have Stomach Pain

Stomach pain that is accompanied by severe bloating can be a sign that your child is very constipated, which isn’t something to brush off. This is an especially important sign in children who can’t verbalize their pain yet.

“It can be a sign of a more benign process such as constipation, but constipation can also be severe in nature and require removal of impacted stool,” says Owusu-Ansah.

You should also keep an eye on any change in their stool. Owusu-Ansah says that signs of bad constipation include hardened stools, pellet-like stools, or blood in the stool caused by small tears around the anal area from constipation or internal or external hemorrhoids.

7. Their Vomit Is A Weird Color & They Have Stomach Pain

Not only do you want to pay attention to how often your child is vomiting (which shouldn’t be hard!), but you’ll also want to note the color of it. “Green vomit can be a sign of a blockage in the intestine,” says Owusu-Ansah. “Sometimes people vomit some yellow-green material when they have vomited up everything else, but stomach pain and green vomit should never be ignored and is an emergency.”

Bloody vomit is also a sign that something may be seriously wrong. “Children who have been vomiting a lot can sometimes vomit some blood. Children can have blood in their vomit from other sources such as a nosebleed or bleeding in the mouth from a lost tooth, as blood is an irritant for the stomach,” says Owusu-Ansah. “Stomach pain and bloody vomiting needs a consult with at least the pediatrician or primary care physician if not the emergency department.”

8. There Is Blood In Their Stool & They Have A Stomachache

As unpleasant as it may be, you should take a look at your child’s stool if they have a stomachache to check for blood. Poston says, “Blood in the stool, like blood in vomit, can range from serious to innocent. If a child is constipated, pushing the stool out of the rectum may cause a small amount of blood on the outside of the stool.”

She adds, “If the blood is more than a streak, is mixed with the stool, or the stool has a black, tarry appearance to it, these may be signs of a more serious cause of bleeding such as an infection or inflammation in the bowel.” In that case, definitely call a doctor.

9. There Are Signs Of Allergies With The Stomachache

It may not sound surprising, but stomach pain can also be a sign of an allergy, which isn’t something you want to ignore. Watch your child to see if you notice other allergy symptoms, such as hives, dizziness, nausea, difficulty breathing, vomiting, or fainting. “Any of these combinations can be collective symptoms associated with a severe allergic reaction otherwise known as anaphylaxis,” says Owusu-Ansah. “This would be a 911 call.”

She adds, “If the child has a known allergy and has anaphylaxis and has an epinephrine auto injector available, it should be used immediately to prevent severe illness or death.”

10. They Are Very Young With A Stomachache

When it comes to babies who can’t verbalize their pain, it’s hard to know when they have a stomachache, let alone how serious the pain is. Poston says, “Vomiting and diarrhea in a baby less than 3 months old needs to be evaluated as soon as possible. Any fever in a baby under 3 months old does as well.”

11. It’s A Recurring Stomachache

Have you noticed that your child keeps having the same stomachache? Maybe it comes up every few days or every other day, but if you notice the same symptoms are recurring, it could be a warning sign that’s something wrong, even if the symptoms seem mild. Poston says that any stomachache that sticks around, especially for a week, needs a doctor’s attention. “Recurring stomachaches can be due to constipation, diarrhea, inflammatory bowel diseases, food intolerances, acid reflux, urinary tract infections, or a myriad of other causes,” she says. “If the child is pale, febrile, unable to eat or drink, is excessively tired, or has lost weight, a doctor’s visit is a good idea.”

But these recurring stomachaches can be hard to sort out. Poston suggests keeping a diary of symptoms, including the time of day, the foods eaten, any stressors or behaviors, and the last bowel movement your child had. “This information combined with a parent’s observations are more likely to lead to an accurate diagnosis.”

12. They Have Respiratory Issues & A Stomachache

You probably think of pneumonia as strictly a respiratory illness, but for a child, it can also cause stomach pain, especially if they are very young. “Contact your doctor if your child has difficulty breathing, an uncontrollable cough, fever combined with cough, or vomiting with a cough,” says Poston.