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When is atummy ache
A GUIDE TO MANAGING
STOMACH PAIN AND OTHER
GASTROINTESTINAL CONDITIONS
not just atummy ache?
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STOMACH PAIN DIARRHEA CONSTIPATION GETTING HELP
What is stomach pain?It is 2 a.m. and your child has a tummy ache. Was it caused by something she ate? Is she experiencing cramping, gas or constipation? This is a common childhood scenario, and the reality is every child will have an upset stomach at some point.
Rest assured, while stomach pain can happen for any number of reasons, the discomfort is usually short-term, and children continue to maintain their overall good health.
What causes stomachaches?Our gastrointestinal tract is a complicated system of nerves and muscles that pushes the food we eat through the digestive process. But some children’s nerves are very sensitive. Even normal intestinal activities upset their nerves, causing pain.
In some cases, a stomachache is caused by a very specific problem such as ulcers, heartburn or constipation. In other children, the cause may not be so clear.
An infection caused by a virus, bacteria, stress or fatigue may make the intestinal nerves more sensitive and trigger pain. In some cases, the problem may be genetic, which means it’s a condition that “runs in the family,” so other family members may have a similar history of the problem.
Did you know 10 to 15 percent of all school-aged children report recurrent tummy aches and pains?
These pains can disrupt a child’s everyday life and cause them to lose interest in activities they normally enjoy.
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For infants and toddlers who cannot verbalize their discomfort, here are some signs your child has a tummy ache:
• increased fussiness
• poor eating
• pulling her legs up toward the belly
q Is the pain located throughout the
belly area or consuming at least half
of the stomach?
If so, this form of pain and discomfort
is typically attributed to a stomach
virus, indigestion, gas or constipation.
q Is the pain causing cramping and/or
bloating, and followed by diarrhea?
This type of stomachache is typically
not serious in nature.
q Is the pain localized and severe or
coming in waves?
This type of pain may be associated
with your child’s appendix or
gallbladder, or may be the result of
stomach ulcers.
Tummy ache checklistIf your child is experiencing abdominal pain and able to describe the discomfort, ask her the following questions:
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STOMACH PAIN DIARRHEA CONSTIPATION GETTING HELP
Tummy ache tipsHelpful tummy ache tips to cure a common stomachacheMost of the time, home remedies will alleviate or eliminate a common tummy ache. Here are some tips to help reduce your child’s discomfort caused by a stomachache:
If your child’s pain is getting worse, or the pain lasts longer than 24 hours, call your pediatrician and make an appointment.
DOs
• Have your child relax quietly to see if the abdominal pain goes away.
• Offer sips of water or other clear fluids.
• Suggest that your child try to pass stool.
• Avoid solid foods for a few hours. Then try small amounts of mild foods such as rice, applesauce or crackers.
DON’Ts
Do not give your child foods or drinks that are irritating to the stomach including:
• caffeine
• carbonated beverages
• citrus
• dairy products
• fried or greasy foods
• high-fat foods
• tomato products
DO NOT give aspirin, ibuprofen (Advil®), acetaminophen (Tylenol®) or similar medicines without first asking your child’s health care provider.
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When should you call the doctor about stomach pain?
For mild stomach pains, you can typically employ home care remedies and wait for your child to get better.
Contact your child’s pediatrician when:
• stomach pain lasts more than a week, even if it comes and goes
• stomach pain is getting more severe and frequent, or if your child is nauseous and vomiting with the pain
• your child experiences a burning sensation during urination
• your child has diarrhea for more than 2 days
• your child has been vomiting for more than 12 hours
• your child has a fever over 100.4 degrees Fahrenheit
• your child has had a poor appetite for more than 2 days
• your child is experiencing unexplained weight loss
You should seek medical help immediately if your child:
• is younger than 3 months and has diarrhea or vomiting
• is unable to pass stool, especially if the child is also vomiting
• is vomiting blood or has blood in the stool (especially if the blood is maroon or dark, tarry black)
• has sudden, sharp abdominal pain
• has a rigid, hard belly
• has had a recent injury to the abdomen
• is having trouble breathing
• is currently being treated for cancer
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STOMACH PAIN DIARRHEA CONSTIPATION GETTING HELP
How Boston Children’s Hospital treats stomach painWhether your child is experiencing frequent or chronic stomach pain or upset, or ongoing bouts of diarrhea or constipation, Boston Children’s Hospital’s Division of Gastroenterology, Hepatology and Nutrition is here to help.
Ranked the #1 pediatric gastroenterology division in the nation by U.S. News & World Report 2015–16, our expertly trained team works with you and your child to find the relief she needs. Most stomachaches can be capably managed by a pediatrician. In the cases where a referral is necessary, we proudly provide individualized treatment plans and access to more specialized care than any other hospital.
Click here for a list of Boston Children’s locations near you.
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To best understand the root of your child’s stomach pain, a member of our clinical staff will take a careful history of how and when your child’s pain started, the type of pain your child is experiencing, and ask how it has progressed over time.
We may perform blood, urine and stool tests to rule out specific medical conditions associated with recurrent pain. We will also ask if your child has any history of food intolerances.
We only perform more in-depth tests, such as x-rays or endoscopy, if your child’s medical history, exam or lab tests raise further questions.
Once we have determined a proper diagnosis, the care team will create a treatment plan that’s right for your child and family. With the right treatment, most children with stomach pain continue to grow well and gain weight.
In some cases, abdominal pain might affect a child’s ability to attend school or perform their normal activities. In such cases, we can provide additional support through our multidisciplinary team, which includes dietitians and psychologists.
To make an appointment or to speak with a member of our clinician staff, contact the Division of Gastroenterology, Hepatology and Nutrition at Boston Children’s: 617-355-6058.
How Boston Children’s Hospital treats stomach pain | continued
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STOMACH PAIN DIARRHEA CONSTIPATION GETTING HELP
What is diarrhea?Diarrhea is often an uncomfortable part of the tummy ache equation. Diarrhea is watery stool, an increased frequency of bowel movement, or both. In most cases, diarrhea in children lasts no more than a few days and goes away on its own. These short-term (or acute) cases of diarrhea are usually related to bacterial or viral infections.
In other cases, diarrhea may last for weeks at a time; this is called chronic diarrhea. Chronic diarrhea may also be caused by infections, such as giardia, but is more likely to be caused by a chronic medical condition, such as irritable bowel syndrome, or an inflammatory condition such as ulcerative colitis, Crohn’s disease or celiac disease.
Chronic diarrhea in children may indicate a larger health problem. If your child has diarrhea for more than a few days, consult your pediatrician.
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STOMACH PAIN DIARRHEA CONSTIPATION GETTING HELP
When should you call the doctor about diarrhea?For mild diarrhea, you can typically use home care remedies and wait for your child to get better.
If your newborn (under 3 months old) has diarrhea, call your pediatrician immediately.
Also, contact your child’s physician if your child has:
• blood, mucus or puss in the stool
• more than 8 stools in 8 hours
• vomiting that continues for more than 12 hours
• fever and diarrhea lasting more than 2 to 3 days
• stomach pain or abdominal cramping
• diarrhea that develops within 1 week of travel outside of the United States or after a camping trip (the diarrhea may be due to bacteria or parasites that require treatment)
• weight loss
• significant drop in activity level (e.g., not sitting up at all or not looking around)
Severe and/or chronic diarrhea may indicate a serious disease, and it is important to consult your child’s health care provider if the symptoms persist or affect daily activities.
If diarrhea persists, contact your child’s pediatrician. If your pediatrician recommends an appointment with a gastroenter-ology physician, please call us at 617-355-6058.
Click here for a list of Boston Children’s locations near you.
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How Boston Children’s Hospital treats diarrheaAt Boston Children’s Hospital, our expert team of physicians and nursing staff is dedicated to caring for and finding the best treatment options for your child.
The first step in the treatment of diarrhea typically begins with replacing lost fluids.
To replace the body fluids lost due to diarrhea, children should drink fluids liberally. If they are dehydrated, a glucose-electrolyte solution (for example, Pedialyte® or Infalyte®) should be given to help the body absorb fluid more easily. These fluids have the right balance of water, sugar and salts, and some are available as ice pops.
If your child’s diarrhea is getting worse, or the accompanying pain lasts longer than 24 hours, call your pediatrician and make an appointment.
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A common result of diarrhea is dehydration. Seek medical help immediately if your child shows signs of dehydration.
Signs of dehydration include:
• dry and sticky mouth
• no urine for six hours
• no tears when crying
• sunken eyes
Additional hydration considerations for treating diarrhea include:
• Avoid juice or soda because these drinks may make diarrhea worse.
• Too much plain water at any age can be dangerous.
• Do not give plain water to infants.
• If you are bottle-feeding or breastfeeding your child, continue to do so.
If a bacterial infection is identified as a cause, antibiotics may also be prescribed.
For more information, contact Boston Children’s Division of Gastroenterology, Hepatology and Nutrition at 617-355-6058.
How Boston Children’s Hospital treats diarrhea | continued
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What is constipation?Constipation in children is defined as:
• a decrease in frequency of bowel movements, compared to a child’s usual pattern (some health care providers define constipation as fewer than 3 bowel movements per week)
• the passage of hard, oftentimes large-caliber, dry bowel movements
• bowel movements that are difficult or painful to push out
Contact your child’s health care provider if you have any questions or concerns about your child’s bowel habits or patterns or if constipation persists.
We recommend talking to your child’s health care provider if:
• Episodes of constipation last longer than 2 weeks.
• Your child’s discomfort prevents them from participating in normal activities.
• Normal pushing is not enough to expel a stool.
• Liquid or soft stool leaks out of the anus.
• Small, painful tears appear in the skin around the anus.
• Hemorrhoids develop.
• Abdominal pain, fever or vomiting occur.
What are the types of constipation in children?
Constipation is typically described as being either organic or functional.
Functional constipation means there is no identifiable cause. Functional constipation is the most common form of constipation, and while it is a concern, typically there is not a serious medical condition associated with it.
Organic constipation is caused by a diagnosed
medical condition, like colon disease
or a neurological problem.
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How Boston Children’s Hospital treats constipationTo best understand the cause of your child’s constipation, a clinician from the Division of Gastroenterology, Hepatology and Nutrition will assess how serious your child’s constipation is by asking if your child:
• has hard or small stools that are difficult or painful to pass
• consistently skips days without having normal bowel movements
• has uncharacteristically large stools
• has stomach pain, poor appetite, crankiness and/or bleeding from the anus
In most cases, there is no need for testing prior to treatment for constipation in children. However, depending on the severity of the problem, your doctor may order x-rays or other tests to properly diagnose the source of the constipation.
Once the root and severity of your child’s constipation have been determined, a treatment plan will be designed based on your child’s age and personality. For some, constipation can be corrected by changes in diet, like increasing their intake of water, fiber or fresh fruit. Other children may need medications like laxatives or stool softeners to help them go.
In rare cases, children may need to have an excessive build-up of stool “flushed” from their colon. This usually is done with laxatives, suppositories or enemas if needed.
For more information on constipation or to speak with a member of Boston Children’s Division of Gastroenterology, Hepatology and Nutrition, please call 617-355-6058.
FACT Almost 5 percent of all pediatrician visits are in some way related to constipation, and at least 25 percent of visits to pediatric gastroenterology specialists are due to problems with constipation.
FACT Constipation results in 2.5 million health care provider visits every year.
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Allergic Colitis A cow milk allergy.
Celiac Disease A lifelong intolerance to gluten—a protein found in wheat, barley, rye and also in oats that have been contaminated with gluten from other products.
Childhood Obesity When a child is significantly overweight. Obesity can increase a child’s risk for serious and chronic medical problems, such as constipation, type 2 diabetes, high blood pressure (hypertension) and others.
Crohn’s Disease A form of inflammatory bowel disease (IBD) in which one or more parts of your child’s intestinal tract become inflamed.
Encopresis Fecal soiling or accidental bowel movements.
Eosinophilic Esophagitis (EE) An allergic reaction that causes inflammation and damage to the esophagus, the muscular tube that connects mouth to stomach.
Eosinophilic Gastrointestinal Disorders (EGIDs) Rare conditions that can occur when there are high levels of eosinophils in one or more parts of the digestive system. Eosinophils are a type of white blood cell that is involved in allergic reactions.
Food Allergy An abnormal response to a certain food.
Functional and/or Intractable Abdominal Pain Abdominal pain often accompanied by diarrhea, constipation or both, which can be related to irritable bowel syndrome (IBS).
Gastroesophageal Reflux (GER) Causes the return of acidic stomach juices, or food and fluids, from the stomach back up into the esophagus.
Hepatitis B Virus (HBV) Irritation and swelling (inflammation) of the liver due to infection with the hepatitis B virus (HBV).
Hepatitis C A liver disease affecting 3 percent of all children worldwide.
Hyperbilirubinemia and Jaundice A condition in which there is too much bilirubin in your baby’s blood.
Inflammatory Bowel Disease A chronic condition where parts of the intestinal tract become inflamed.
Jaundice A condition that makes a baby’s skin and the white part of the eyes look yellow.
Stomach and Duodenal Ulcers An open sore or lesion usually found on the skin or mucous membrane. An ulcer in the lining of the stomach or duodenum is referred to as a peptic ulcer.
Short Bowel Syndrome (SBS) A serious condition where a child does not have enough small intestine, which may lead to dehydration and malnutrition.
Ulcerative Colitis A form of inflammatory bowel disease (IBD) where one or more parts of the intestinal tract become inflamed.
Related conditions
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LocationsPediatric care close to home
Boston Children’s Hospital 300 Longwood Avenue Boston, MA 02115
North of Boston
Boston Children’s at Lexington 482 Bedford Street Lexington, MA 02420
Boston Children’s at Peabody 10 Centennial Drive Peabody, MA 01960
Winchester Family Medical Center 500 Salem Street Route 62 Wilmington, MA 01887
South of Boston
Boston Children’s Physicians Brockton Medical Office Building Suite 220E 830 Oak Street Brockton, MA 02301
Milford Regional Medical Center 3rd Floor 14 Prospect Street Milford, MA 01757
Boston Children’s Physicians North Dartmouth 500 Faunce Corner Road North Dartmouth, MA 02747
Boston Children’s Physicians Norwood Draper Building, 1st Floor 800 Washington Street Norwood, MA 02062
Boston Children’s Physicians Weymouth Stetson Medical Building Suite 218 541 Main Street Weymouth, MA 02190
West of Boston
Boston Children’s at Waltham 9 Hope Avenue Waltham, MA 02453
Boston Children’s Physicians Worcester 21 Eastern Avenue Worcester, MA 01605
As a leading pediatric hospital, Boston Children’s is committed to providing expert and compassionate care to our patients. We have been advancing medicine and improving child health for more than 140 years and proudly have several satellite locations throughout our community of care, including:
Click here for a list of Boston Children’s locations near you.
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Click here for a list of Boston Children’s locations near you.
When a tummy ache is more than just a tummy ache, call 617-355-6058 or visit bostonchildrens.org/GI
THIS BOOKLET IS AVAILABLE AT
BOSTONCHILDRENS.ORG/ TUMMYACHE
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