Abdominal Pain in Children – What to Watch For

Abdominal pain is one of the most common complaints in childhood – sometimes completely harmless, but in other cases, it may signal a serious health problem. How can parents distinguish when the pain is a cause for concern and when it is just a temporary discomfort? On this topic, we speak with Dr. Petrana Doinova, pediatric surgeon at VITA KIDS Child Health Center, who shares her extensive experience and highlights the key symptoms and recommended actions when a child complains of stomach pain.

What most often causes abdominal pain in children? What are the underlying causes?

Abdominal pain in childhood is a frequent, non-specific symptom, usually self-limiting and most often associated with gastroenteritis or viral infections. However, many pediatric diseases may present with abdominal pain. Examples include: inflammations of the upper respiratory tract; gastrointestinal diseases; infectious diseases (measles, mononucleosis, hepatitis, infectious enterocolitis); urinary tract disorders; endocrine and gynecological conditions; collagenoses; hematological diseases; intestinal parasites; drug-related or food intoxications; allergic diseases.

The main conditions considered as “acute surgical abdomen” in childhood are inflammatory diseases, most commonly acute appendicitis, intestinal obstruction, and abdominal trauma.

How can parents distinguish ordinary abdominal pain from pain requiring urgent medical attention?

Parents should pay attention to whether the pain appeared suddenly, whether it is constant or occasional, and whether it is related to food or excessive physical activity. It is also very important to monitor the child’s bowel movements.

Many children avoid using the toilet in kindergarten or school, which can lead to chronic constipation and subsequent problems. Parents should also observe the child’s emotional state – sometimes abdominal pain can be a way of attracting attention or expressing reluctance to attend school. If the child is otherwise active, has an appetite, and there are no alarming symptoms such as vomiting, high fever, or diarrhea, parents may wait for the symptoms to resolve spontaneously.

When should urgent medical help be sought?

If abdominal pain is constant, increasing in intensity, and accompanied by other symptoms such as high fever, nausea, diarrhea, constipation, or changes in the child’s general condition (lethargy, pallor, refusal to eat) – urgent consultation with a pediatrician and pediatric surgeon is required.

What does the diagnostic process involve?

Diagnosis begins with gathering detailed information about the nature of the abdominal pain: sudden or colicky, associated with persistent vomiting, constipation, fever, or localized in a specific area. The doctor also evaluates changes in behavior, appetite, sleep, and stool patterns.

A complete physical exam follows, looking for signs of non-surgical illness (airway infections, skin rashes, dehydration) and examining the abdomen for distension, tenderness, muscular guarding, and bowel sounds. If a surgical condition is suspected, rectal examination may be performed.

Laboratory tests (blood count, urine, biochemistry) and imaging (X-ray, ultrasound) provide further clarity. CT scans are used only in rare, diagnostically complex cases.

Which conditions most often require surgery?

“Acute surgical abdomen” in children mainly includes three groups:

- Inflammatory conditions such as acute appendicitis (up to 70% of surgical abdominal cases), Meckel’s diverticulitis, and less commonly, acute cholecystitis, pancreatitis, or perforated ulcers in older children.

- Acute intestinal obstruction – congenital (due to malformations) or acquired (post-surgery adhesions, intussusception, strangulated hernia).

- Abdominal organ injuries after trauma.

Do you have a case from your practice that stood out?

With over 40 years of experience as a pediatric surgeon, I have seen many cases where the initial diagnosis needed revision. Often, children with symptoms strongly suggesting a surgical condition were found to have entirely different causes after observation and additional tests – ones not requiring surgery.

What advice would you give parents?

My first advice is: do not panic if your child suddenly complains of abdominal pain. Observe them for a few hours, ask what they ate, when they last used the toilet, and whether they had any abdominal trauma while playing. If additional symptoms appear – fever, diarrhea, sore throat, cough, or rash – the child should first be seen by a pediatrician.

If the abdominal pain does not subside within a few hours or after fever resolution, the child should be examined by a pediatric surgeon. Parents must avoid self-treatment at home. Giving painkillers or antibiotics before medical evaluation can mask symptoms and delay the correct diagnosis.