“Mommy, My Tummy Hurts!”

mama-to-mama1111It always seems to happen just as you’re getting everyone ready for school, or a family outing, or a visit to Grammy’s house.  If you’re really unlucky, it’s when you’ve finally got all the coats on and the shoes tied, and are all set to  head to the airport for that trip-of-a-lifetime Hawaii vacation.

One of your short guys looks up at you with big, sad eyes and says “Mommy, my tummy hurts”.

You:  Oh, honey.  Does it hurt bad?

Him:  (nods pitifully).

You:  Well, where does it hurt? Are you going to throw up? Do you need to poo?  Is it really bad … maybe you’re hungry?  (Thought bubble: oh no, not now.  Didn’t we just go through this last week?  What is it?  Is it serious? What should I do? Is it safe to ignore it … will it go away again?  Should I call the Dr.? What can SHE do?  Can’t I just give him some Pepto?  Will he throw up in the car?  Is it his appendix?  HELLLPPPP!)

Him:  I don’t know (pleadingly).

This is such a common scene that about 1 in 3 kids sees a doctor for abdominal pain by the time they’re out of elementary school.  The good news is that very few of these kids have something serious.  But that doesn’t make it any less scary and frustrating for their parents.  Part of the problem is that so so many mild ailments can show up as a belly ache.

A child with a cold will swallow a boatload of nasal mucous, which can irritate the stomach lining and cause pain and nausea.  A bug in an unrelated location, like strep throat or a urinary tract infection, can declare itself with a tummy ache.  A stomach virus often begins with generalized hurting before the nastiness starts.

The most likely suspect is constipation, which causes pain when the natural rhythmic contractions of the GI tract come up against hard stool stored in the rectum that needs to come out.  I can’t tell you how many emergency room visits start with a small child writhing in pain, and end with a diagnosis of constipation.  You can often avoid one of these trips by keeping your eye on your kiddo’s diet, adding lots of fiber and fresh fruits and veggies, and encouraging plenty of water.

And then there are those belly aches that have no identifiable cause, and kids who tend to get them regularly (official medical name: recurrent abdominal pain, or RAP).

So here are some clues to help you figure out which flavor your little guy has, take care of the problem, and get on with your day.

First, the ‘sit up and take notice’ symptoms:

  • Has he had recent trauma to the abdomen or surgery in the area?
  • Is the pain localized to a specific location?  Does it get worse if you touch or press that area?
  • If asked to take a small jump and land on his feet, does it hurt more?
  • Has the pain lasted for more than an hour, and is it getting worse?
  • Does he have rectal bleeding?
  • Is he vomiting repeatedly in spite of your best efforts with small sips of fluid?
  • Is the pain so severe that he can’t follow instructions or do typical tasks?
  • Does his belly feel hard or look swollen?
  • Does your mommy gut tell you something’s really wrong?

Any of these call for medical evaluation.  See your doctor or head to urgent care or the ER.

Fortunately, the great majority of belly aches don’t fall into this category.  If he has a cold, fever, or other minor illness going on, consider that as the cause.  If he tends to get stopped up, think constipation.  If none of those fit, it’s probably one of those garden variety, unidentified tummy aches.

If the pain is mild, most can be handled with home remedies.

  • Have your kiddo rest and distract him with a story or quiet game.  Most often pain will go away within 30 minutes.
  • A warm (not hot) pad may help relax tense abdominal muscles.
  • Encourage sips of clear fluids like water, tea, or diluted fruit juice.
  • Try the above while sitting on the potty (him, not you).  Passing stool is always a relief.
  • If you strongly suspect constipation (crampy pain, comes and goes), try a plain children’s glycerine (non-medicated) suppository.  He won’t like it, but it often works to break the log jam. Then consider dietary changes to avoid a recurrent problem.
  • A few well-placed kisses and hugs  (and a band-aid, of course) can make a big difference.

Don’t give your child medicines without talking to your doctor first.  They probably won’t help, and may make matters worse.  If even mild pain lasts more than 24 hours, or if any of the above symptoms show up see your doctor.  Otherwise, slay the worry monster and carry on with business as usual.

Not-so-funny-story:  Our family was spending Christmas weekend at the Disneyland Hotel lots of years ago when the boys were 6 and 4, and daughter was a bun in the oven.  We  got back to our room after a long, fun — well, for them anyway — day in the Magic Kingdom.  Just as we’re all about to go watch the Magic Fountain Extravaganza oldest son says … “Mommy, my tummy hurts”.

Now this is a child who does tend to get stopped up, and we do keep an eye on his fiber and fluid intake, so I’m thinking he’ll spend a few strategic minutes on the toilet and then we’ll all head off to the Water Wonders.  15 minutes later … no action and he’s having obviously painful, non-productive cramps . Another 15 — no go, just hurting and tears.

So I send Daddy and younger son down to enjoy the show, and older and I stay put.  To spare you the ugly details of a long and painful evening,  it was a couple of hours, many sips of watered down apple juice (loosens stool, right?), and several readings of ‘Green Eggs and Ham’ later, when … FINALLY … relief. By the way, the Disneyland Hotel  does not have children’s glycerine suppositories.

And even though I was a pediatric resident at the time, and even though my doctor brain knew this was a clear case of constipation, at the peak of those cramps my mommy brain was scared and freaked out.  Worry monster, worry monster, go away!

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?


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One response to ““Mommy, My Tummy Hurts!””

  1. Jessica

    Thank you! I just found this and I feel like we go through this all the time!

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