Stomach pain in children – causes, symptoms and when to see a doctor

Stomach pain in children is pain or discomfort in the abdominal region and is one of the most common reasons why parents seek medical attention. In the vast majority of children, the cause is harmless — typically constipation, a viral infection, or functional stomach pain for which there is no physical explanation. Only a small proportion have an underlying illness. On this page you can read about the most common causes, when you should seek medical attention, and how the examination and treatment are carried out.

How does stomach pain manifest itself in children?

Stomach pain in children can present itself very differently depending on the child's age. Younger children often have difficulty describing exactly where it hurts, and will typically indicate pain around the belly button, regardless of where in the abdomen the problem actually lies. Very young children may instead pull their legs up under them or cry for a long time and loudly.

The pain can be acute and severe, or it can be recurrent over a longer period of time. Recurrent abdominal pain typically refers to at least three episodes within two to three months, where the pain affects the child's everyday life - for example, school or leisure activities. The pain is often located around the navel and occurs without other signs of illness such as fever or weight loss. Some children also experience nausea, bloating, a change in bowel habits or a rapid feeling of fullness.

What are the most common causes of stomach pain in children?

In children, constipation is one of the most common causes of abdominal pain, both acute and recurrent. Constipation occurs when stool becomes hard and difficult to pass, and can occur in connection with dietary changes, starting school, or periods when the child avoids going to the toilet.

Acute abdominal pain is also often caused by a common viral infection of the gastrointestinal tract, which in addition to pain can cause nausea, vomiting, diarrhea and fever. In younger children, abdominal pain can also occur as a result of illness in other parts of the body, for example, an ear infection or cystitis.

 When stomach pain is recurrent, the vast majority of children have what the Danish Paediatric Society calls functional stomach pain. This means that no physical explanation can be found, even though the pain is completely real for the child. Functional stomach pain is related to how the gut and brain communicate via a network of nerves and neurotransmitters – the so-called gut-brain axis. When this communication is extra sensitive, completely normal sensations from the stomach can be experienced as unpleasant or painful. Stress and worry – both in the child and in the family – can both trigger and intensify the pain, without it meaning that the pain is "only psychological".

Only a small proportion of children with recurrent abdominal pain have an underlying physical illness as the cause.

How is a child examined for abdominal pain?

When your child is examined for stomach pain, the doctor will start by asking about the nature of the pain: where it is located, how long it has lasted, whether it is related to eating or going to the toilet, and whether there are other symptoms. The doctor will then examine the stomach by looking, listening, tapping lightly, and gently pressing on the different areas of the stomach.

For most children with typical, recurring abdominal pain without warning symptoms, this thorough interview and examination is sufficient for the doctor to reassure the family and make a plan. In some cases, however, further examinations may be relevant, for example blood tests or an ultrasound scan of the abdomen, if the doctor wants to rule out other causes. Which examinations are relevant always depends on an individual medical assessment.

How is stomach pain in children treated?

The treatment of stomach pain in children depends entirely on the underlying cause of the pain and is always determined individually by the doctor.

If constipation is the cause, treatment will typically consist of a combination of stool softeners, good toilet habits, and possibly dietary changes. This type of treatment can take time, and it is not unusual for it to continue for several months.

In the case of functional abdominal pain, the most important part of treatment is often to help the child and family understand what causes the pain and how best to manage it in everyday life. This involves taking the child's pain seriously without minimizing it, while simultaneously helping them continue with normal activities, including going to school. For some children, a structured approach focusing on sleep, meals, and stress management can have a good effect. If psychological distress plays a role, it may be relevant to involve other professional groups in the process.

In cases where the abdominal pain is caused by an infection or another specific condition, treatment is directed toward that specific cause.

When should you seek medical attention?

Most stomach aches in children are harmless and do not require emergency medical attention. However, you should contact a doctor if your child has stomach pain along with one or more of the following:

• Blood in the stool
• Prolonged diarrhea or vomiting
• Yellowing of the skin or eyes (jaundice)
• Weight loss or a long-term loss of appetite
• Pain when urinating
• Waking up at night because of the pain
• A suddenly increasing intensity or frequency of pain over time
• A previously potty-trained child suddenly wetting their pants

If you are in doubt, or if the stomach pain continues to worry you and your family, it is always a good idea to have it evaluated by a doctor—even though it often turns out that nothing serious is wrong.

Treatment at Charlottenlund Private Hospital

At Charlottenlund Private Hospital, your child can be thoroughly examined by a specialist in pediatrics. We start with a calm conversation with you and your child, where we get an overall picture of the symptoms, and then an examination of the abdomen. If necessary, we can offer additional examinations so that you can get clarification and a plan for the further course of action. Book an appointment online.

Sources:

- Danish Pediatric Society: Recurrent abdominal pain in children (RAS) – nationwide clinical guideline (2022).