Abdominal pain is one of the most common complaints in young children. However, determining if a “tummy ache” is a  minor event or a symptom of a more serious condition can present a challenge for parents, pediatricians and early care and education professionals.

While complaints of abdominal pain are common, most complaints are minor and the tummy pain resolves on its own without treatment. However, it also can be a sign of a more serious problem.

The young child who develops sudden sharp, disabling tummy pain, or complains of pain along with chronic constipation should always be taken seriously. This contrasts with the child who only complains of abdominal pain when offered vegetables at lunchtime.

Possible Causes of Abdominal Pain

Constipation occurs when bowel movements occur less frequently than usual or when stools are hard, dry, and difficult to pass. The child may complain of abdominal pain and cramping, and may have small amounts of stool in his/her underwear.

Constipation can be a minor annoyance that occurs once in a while, such as after a young child eats too much. It also can be a more chronic, frequent problem. Children can develop constipation as a result of withholding stool. They may be fearful of having a painful bowel movement or may not want to interrupt playtime.

Other causes include a low-fiber diet or stress over potty training. A child with constipation should see a health care provider if symptoms last more than two weeks. Often, changing the diet and adopting healthy bowel habits is enough to cure constipation.

Appendicitis causes pain that starts around the belly button and travels down to the right lower side of the abdomen. The child may also have a fever, nausea and vomiting. Appendicitis is very serious in young children, as it tends to “rupture” in children under age four, making it a true medical emergency.

Gastroenteritis is an infection of the intestines caused by many types of viruses. It is spread by unwashed hands or sharing of food, drink, or utensils of infected persons.

Symptoms include abdominal pain, watery diarrhea, vomiting, headache, fever, and chills. While most cases of gastroenteritis in children resolve with rest and fluids, the child who is very dehydrated may require hospitalization for intravenous fluids.

Food borne illness (commonly called “food poisoning”) generally is caused by the spread of harmful bacteria, but also can be caused by viruses and parasites. The child may complain of nausea and abdominal pain. Vomiting and diarrhea, which start just hours after eating the contaminated food, can lead to dehydration.

Fortunately, food poisoning usually is mild and resolves without treatment within 1-10 days. However, some cases can be life-threatening and require hospitalization. High fever, bloody stool, and severe and prolonged vomiting require immediate medical attention. Treatment includes replacing lost fluids and electrolytes.

Just as stress can cause stomach troubles for adults, children also can develop stress-related stomach aches. Be aware of the child’s home and childcare situation. Problems at home such as marital troubles, a suddenly unemployed parent, or an illness or death of a beloved grandparent can cause anxiety that might lead to a tummy ache. Likewise, changing childcare providers or even changes in the room environment may be stressful.

Tips for Parents and Caregivers

Young children generally have a poor sense of the location or severity of their pain. While a four-year-old may tell you he is having tummy pain, a toddler probably will not. Toddlers do not separate emotional from physical distress. The young child’s stomach ache may represent hunger, fatigue, or a need to use the bathroom.

The childcare provider caring for a child who appears to have abdominal pain should always contact the parent and provide them with important information about the child’s pain such as:

• Did the pain come on suddenly or gradually?
• Where is the pain located? (Ask the child to point to the area.)
• Does the child have a fever, nausea, vomiting, and/or diarrhea?
• Did the pain precede vomiting, or did vomiting begin first?
• Is the abdomen enlarged?
• Did the child refuse to eat?
• What did the child eat? Did the complaint begin before or after eating?
• Is the pain a dull ache or severe cramping (child is “doubled over” or “guarding” a painful area).
• How does the child explain the pain? Example: “My tummy is bubbling!”

It is important to recommend to parents that if the child has any of the following symptoms they should seek immediate medical attention:

• Frequent episodes of vomiting.
• Vomiting blood.
• Inability to keep liquids down for 24 hours.
• Severe diarrhea for more than three days.
• Blood in bowel movements.
• Extreme pain or severe abdominal cramping (i.e., pulling knees up to the chest).
• An oral temperature above 101.5˚F.

Signs or symptoms of dehydration such as excessive thirst, dry mouth, little or no urination, severe weakness, dizziness or lightheadedness.

When to Exclude a Child

Every child has a tummy ache now and then. How does a parent know when to exclude the child from childcare?

Without question, the young child who complains of abdominal pain and also has a fever, vomiting, or diarrhea should be seen by his/her health care provider and excluded until the symptoms resolve. Follow your childcare program’s policies for exclusion so that the ill child is kept at home reducing the opportunity for a stomach virus to spread to other children.

On the other hand, a child who has one episode of loose stool or vomiting, has no other symptoms, and is able to participate in daily activities may attend as long as symptoms do not worsen.

Tummy troubles are common in young children. Knowing what may cause an upset stomach can help you both comfort the child as well as know when a child might need to see a healthcare provider or stay at home for a few days.

Elaine Abrams, RN, CHES, MPH
Community Health Coordinator, Nursing & Home Care, Wilton, CT

Internet Resources

Caring for Our Children, National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, nrc.uchsc.edu/SPINOFF/IE/ExcInc.htm

Centers for Disease Control and Prevention Food Safety, www.cdc.gov/foodsafety

Centers for Disease Control and Prevention Division of Viral Diseases, www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm

National Institute of Diabetes and Digestive and Kidney Diseases (NIH), www.niddk.nih.gov

Partnership for Food Safety Education, www.fightbac.org