Frequent Stomach Aches in Kids: When to Worry

"My tummy hurts" may be one of the most common things a parent hears. When it happens once, it is usually gas, hunger or a passing bug. When it happens again and again, over weeks or months, it is natural to worry that something serious is being missed. The reassuring news is that most repeat stomach aches in children are not caused by a dangerous illness. Knowing the common causes, the warning signs, and how to track what is happening will help you and your pediatrician sort it out.

Common causes of repeat stomach aches

Constipation

Constipation is one of the most frequent causes of belly pain in children. Kids do not always report hard or infrequent stools, and many parents stop keeping track once a child uses the toilet alone. Pain from constipation often comes and goes, may be worse after meals, and often improves after a bowel movement.

Functional abdominal pain

Many children have stomach aches that keep coming back without any sign of disease on exam or tests. Doctors call this functional abdominal pain. It is very common in school-age kids. The pain is often around the belly button, comes in episodes, and does not affect growth.

The pain is real. Your child is not making it up. The nerves of the gut can become extra sensitive, so normal digestion, gas or stress feels painful. This connection between the gut and the brain is the same reason many adults get a "nervous stomach."

Stress and worry

Anxiety about school, friendships, family changes, sports or a new sibling can show up as stomach aches. A pattern of pain on school mornings, before tests, or on Sunday nights can be a clue. Stress does not have to be dramatic to cause symptoms, and kids often cannot name what is bothering them.

Food-related causes

• Lactose intolerance, which can cause gas, cramps, bloating and loose stools after dairy
• Too much juice, soda or sugar-free candy, which can cause gas and loose stools
• Large, fatty or spicy meals, or eating too fast
• Celiac disease, a reaction to gluten that can cause belly pain, diarrhea, poor growth or tiredness
• Food allergy, which usually causes symptoms soon after eating a specific food

Other causes

Belly pain can also come from a bladder infection, strep throat, abdominal migraines (episodes of belly pain often with nausea, sometimes in children with a family history of migraine), or reflux. Your pediatrician will think about these based on your child's other symptoms.

Red flags that need a closer look

Most repeat stomach aches can be managed in a regular office visit. But some signs suggest a problem that needs prompt attention. Tell your pediatrician soon if your child has:

• Weight loss, or is not growing or gaining as expected
• Blood in the stool, or black, tarry stools
• Pain that wakes them from sleep
• Fever along with the belly pain
• Pain that is mainly away from the belly button, especially in the lower right side
• Repeated vomiting, or vomit that is green or contains blood
• Ongoing diarrhea, especially at night
• Trouble or pain with swallowing
• Mouth sores, joint pain or swelling, or unexplained rashes
• Delayed puberty
• A family history of inflammatory bowel disease, celiac disease or ulcers

A word about appendicitis

Appendicitis is a sudden problem, not a pattern of repeat aches. The pain often starts near the belly button and moves to the lower right side. It gets worse over hours, hurts more with walking, coughing or bumps in the car, and often comes with fever, vomiting and loss of appetite. This needs to be seen the same day.

Keeping a symptom diary

A simple diary is one of the most useful things you can bring to an appointment. Track it for two to three weeks on paper or in a notes app. Write down:

• When the pain happens: date, time of day, and whether it was a school day or weekend
• Where it hurts: ask your child to point with one finger
• How bad it is, using a 0 to 10 scale or a set of faces for younger kids
• How long it lasts
• What your child ate in the few hours before
• Bowel movements: how often and what they look like
• Other symptoms: nausea, vomiting, headache, fever, diarrhea
• What was happening: a test, a fight with a friend, a game, a trip
• What helped: rest, a bowel movement, a heat pack, distraction

Patterns often jump out on paper that were hard to see day to day. You can learn more about belly pain on MedlinePlus's abdominal pain page.

Helping your child day to day

• Believe and acknowledge the pain without making it the center of attention.
• Keep routines going. Staying in school and activities, when possible, helps children cope better than staying home, which can make worry worse. Talk with your pediatrician if your child is missing a lot of school.
• Offer regular meals with fruits, vegetables, whole grains and water. Limit juice and soda.
• Protect sleep. Tired kids feel pain more.
• Teach calming skills such as slow belly breathing, a warm (not hot) heat pack, or a quiet activity to shift focus.
• Talk about feelings. If stress seems to play a role, a school counselor or therapist can teach coping skills that ease both worry and belly pain. The American Academy of Pediatrics' HealthyChildren.org has guidance on stress and anxiety in children.

Avoid giving pain medicines regularly for repeat stomach aches unless your pediatrician advises it. Never give aspirin to children.

When to call us

Call your A thru Z Pediatrics office if:

• Your child has stomach aches that keep coming back for more than a couple of weeks
• You notice any of the red flags above
• Pain is keeping your child from school, sleep or activities
• You are worried, even if you cannot say exactly why

Call 911 or go to the nearest ER if your child has severe pain that will not ease, pain in the lower right belly with fever or vomiting, a hard or swollen belly, green or bloody vomit, blood in the stool with dizziness, or seems very ill or hard to wake.

To talk through a pattern of stomach aches, you can request a visit online.