Tummy aches: How to know when there's a problem

October 12, 1999
Web posted at: 11:27 AM EDT (1527 GMT)

In this story: Pain that needs immediate attention RELATEDS

By Daphne Miller, M.D.

(WebMD) -- The words "my belly hurts" have a way of striking terror in the hearts of parents. They immediately imagine their child being rushed into the operating room with a ruptured appendix or other emergency. However, most belly pain in children has no identifiable cause. This is even the case for children who complain of belly pain on a regular basis, a syndrome that many doctors refer to as recurrent abdominal pain (RAP).

As a parent, it is important to distinguish between belly pain that needs immediate medical attention and belly pain that can wait for a regular doctor's appointment. Of course, there are no hard and fast rules, so if you have any uncertainty, call your doctor for advice.

Pain that needs immediate attention

Children with belly pain should be evaluated right away if they have:

On the other hand, a child who reports vague belly pain all over the belly, without any of the symptoms above, can usually wait a day or two before going to the doctor. In the meantime, the pain usually gets better on its own.

It's important to note that these guidelines apply to children who can talk. To be on the safe side, you should contact your doctor right away if your child is preverbal and cries whenever you touch his or her belly.

Finding a cause is difficult. Up to 15 percent of school-aged children experience RAP, says an April 1989 study from the Journal of Consult Clinical Psychology. RAP is defined as episodic attacks of abdominal pain over a period of at least three months. When doctors first see a child with RAP, they usually take a careful history and perform a thorough physical exam. In most instances, the history and physical reveal enough information to identify anything serious that could be going on inside the child's belly. Rarely are laboratory tests needed.

Only about 10 percent of children with RAP end up having an identifiable problem, according to a July 1990 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Many parents walk away from the doctor's office feeling disappointed that the doctor did not make a definitive diagnosis. It seems hard to believe that a child could be in so much pain without there being something seriously wrong.

The pain is real and troubling, but it is not caused by something that can be seen with an X-ray (or other test) or treated with surgery or drugs. Many RAP experts theorize -- and a number of studies suggest -- that the pain is actually an expression of psychological stresses in a child's life or a plea for attention.

Because the cause may be psychological, there are certain factors that children with RAP have in common. Some of them include:

With this in mind, often the best treatments are not physical, but behavioral. A parent with a child who has RAP might try the following:

Most importantly, do not be frustrated when your doctor does not find a definitive cause of the belly pain. Instead, consider this news as a positive diagnosis and convey this enthusiastically to your child. Often times, reassuring your child that nothing is seriously wrong is the first step toward a cure.

RELATEDS AT :

Stomach flu

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RELATED SITE:

The Nemours Foundation: My Stomach Hurts!

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