Pediatric Acute Abdominal Pain

Abdominal pain in children is quite common. Sometimes urgent medical or surgical attention is required to relief abdominal pain. Parents go crazy over abdominal pain in children. They fear something terrible is going to happen with their children. Believe me, I have seen a lot recently in Pediatrics ward. There is nothing to blame on those parents. they just needs correct information and some medication to relive the pain urgently. “what to do with stomach pain” is the question asked by the parents. Keep in Mind that, Pain is not a diseases. It is a symptom.

When a child is brought in with pain in Abdomen for the first time, careful evaluation is required for an underlying surgical cause. Age of the child and attendant circumstance are helpful in reaching diagnosis. There is a triad of Pain, Vomiting and Fever. Whenever pain is the first symptom to appear, underlying surgical causes should be strongly considered. On the other hand, if fever and vomiting precede the onset of pin, the underlying cause is more like to be in Medical nature.

There are many organs in abdomen. Abdominal pain may arise because of inflammatory lesions of any intra-abdominal organs. It may also arise because of distension of the hollow viscus. In which case the discomfort caused by distension may felt as pain. Increased peristaltic activity of hollow organs may be felt as acute or recurrent colicky pain in Abdomen. Abdominal pain can also referred from structures like pleura, spine etc. They are outside of abdomen, but its dermatome is represented in the abdominal region. Thats why, Basal Pneumonia and caries of thoracic vertebrae are often causes of abdominal pain.

Abdominal pain sometimes presents with vomiting, bleeding manifestation, passage of blood in stool, diarrhea, Jaundice etc. These symptoms suggests underlying bleeding. Bleeding may from esophaegial varies or stomach ulceration. History of steroid, NSAIDS intake in empty stomach confirms the stomach ulceration.

There are some points regarding pain. I remember by PQRSTAAA.

P= Position
Q= Quality
R= Radiation
S= Severity
T= Timing
A=Aggravating factor
A=Alleviating factor
A=Associated Symptoms
These question will be asked by the attending Physicians. It helps to localize the origin of pain. it narrows down the cause and helps to find a Provisional diagnosis. Various pain has different character.

What could cause abdominal pain

There are some serious and some non-serious cause of stomach pain. Necrotizing enterocolitis (NEC), GI perforation are two most common cause in Neonate.

The Less serious causes of abdominal pain include:

• Constipation in irritable bowel syndrome
• Heartburn or acid reflux
• Food Poisoning
• Food allergies
• Lactose intolerance or any other food intolerance.
• Constipation: Abdominal pain resulting from constipation is most often left-sided or suprapubic.

Medical Cause:

• Acute infective colitis
• Acute mesenteric lymphadenitis
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Pneumonia
• Others: Tumors or cancers, Acute Hepatitis, Congestive Heart Failure causing sudden enlargement of Liver, Acute Pyelonephritis ans Constipation.

Surgical causes:

• Acute intussusceptions
• Acute appendicitis
• Acute intestinal obstruction
• Others: Acute cholecystitis, Acute renal colic, Acute Pancreatitis

What to do for stomach pain in children

1. It is better to hospitalize your children before it get worse.
2. Do not feed solid foods
3. Ask your child t lie down for some time.
4. Sitting in Mohammedan Position may reduce pain of Acute Pancreatitis.
5. Drinking sips of water may reduce the pain.
6. Do not feed Caffeine or Carbonated beverages liquids.
7. Do not give Aspirin, Ibuprofen, Paracetamol or similar medicines without first asking your child’s Physicians.

Initial Treatment in Hospital

• Diet: Nothing Per Oral
• Inf. Fluid according to Age and Weight
• Inj. Hyoscine-N-Butyl Bromide or Tiemonium Methyl Sulphate
• Inj. Ranitidine
• Syp. Paracetamol if fever present.

Clinical Case for Medical Students:

Q: A boy of 7 years got admitted in hospital with abdominal distention & haematemesis. How would you preceed to diagnose this case? RU (May-07)

Ans:

Diagnosis of the case
(D/D: Necrotizing enterocolitis, Intussusception)
1.History

• Onset-gradual/ sudden onset.
• Other bleeding manifestation.
• Vomiting-projectile/effortless.
• Amount of blood, colour.
• Any pain in the abdomen.
• Any passage of blood in stool.
• History of steroid, NSAIDS intake in empty stomach.

2.Examination

• Any organomegaly-liver, spleen,
• Sausage shape mass in abdomen.
• Visible peristalsis.
• Stool mixed with blood/ red current jelly.
• Engorged vein over the anterior abdominal wall

3.Investigation

• Complete blood count (CBC)
• X-ray abdomen A/P view
• USG of whole abdomen.
• Upper GIT endoscopy.

Useful Resources:

Acute Abdominal Pain in Children– www.aafp.org

Abdominal pain – children under age 12-www.nlm.nih.gov

Thanks.