Stomach Pain in Children: Causes, Warning Signs & Treatment

What Causes Stomach Pain in Children?

The most common causes of stomach pain in children are constipation, gas and bloating, viral gastroenteritis (stomach flu), and functional abdominal pain related to stress. Less common but more serious causes include appendicitis, urinary tract infections, and inflammatory bowel disease. In most cases, the pain resolves on its own within 24-48 hours.

Stomach pain, also known as abdominal pain or "tummy ache," is one of the most frequent complaints in childhood. Studies show that 10-20% of school-age children experience recurrent abdominal pain at some point. Understanding the potential causes helps parents determine when home care is appropriate and when medical attention is needed.

The digestive system in children is still developing, making them more susceptible to discomfort from dietary changes, stress, and infections. Additionally, young children often have difficulty describing their symptoms accurately, which can make diagnosis challenging. A child may say their "tummy hurts" when the actual problem is located elsewhere, such as in the throat, ears, or even emotional distress.

The good news is that the vast majority of stomach pain episodes in children are caused by benign, self-limiting conditions. The gastrointestinal tract is remarkably resilient, and with appropriate supportive care, most children recover quickly without any long-term consequences.

Constipation - The Leading Cause

Constipation is the single most common cause of abdominal pain in children, accounting for a significant portion of pediatric gastroenterology visits. When stool accumulates in the colon, it causes distension, cramping, and discomfort that children often describe as a stomachache. The pain is typically intermittent, may be relieved after a bowel movement, and is often located around the navel or lower abdomen.

Many parents are surprised to learn their child is constipated because the child may still have daily bowel movements. However, if the stool is hard, pellet-like, or the child strains significantly, functional constipation may still be present. Contributing factors include inadequate fiber intake, insufficient fluid consumption, sedentary lifestyle, and reluctance to use unfamiliar toilets (such as at school).

Gas and Bloating

Excess gas in the intestines is another extremely common cause of abdominal discomfort in children. Gas can accumulate from swallowed air (especially in children who eat quickly or drink through straws), fermentation of undigested carbohydrates, or consumption of gas-producing foods like beans, cabbage, and carbonated beverages.

The pain from gas is typically crampy and comes in waves. Children may experience relief after passing gas or having a bowel movement. Unlike more serious conditions, gas pain doesn't cause fever, isn't associated with weight loss, and doesn't wake children from sleep.

Viral Gastroenteritis (Stomach Flu)

Viral infections affecting the stomach and intestines are extremely common in childhood, particularly in daycare and school settings. The rotavirus and norovirus are the most frequent culprits, causing inflammation of the gastrointestinal lining that results in stomach pain, nausea, vomiting, and diarrhea.

Children with gastroenteritis typically develop symptoms suddenly and may have fever, decreased appetite, and general malaise. The illness usually runs its course within 24-72 hours, though diarrhea may persist for several days. The primary concern during this time is preventing dehydration, especially in younger children who can become dehydrated quickly.

Functional Abdominal Pain

Functional abdominal pain (FAP) refers to recurrent stomach pain that occurs without any identifiable physical cause. This condition, diagnosed using the Rome IV criteria, affects approximately 10-15% of school-age children and can be quite debilitating despite normal test results.

The pain in FAP is real - not imagined or "made up." It results from heightened sensitivity of the gut-brain axis, meaning the child's nervous system amplifies normal intestinal sensations into painful experiences. Stress, anxiety, and life changes often trigger or worsen symptoms. Treatment focuses on reassurance, stress management techniques, dietary modifications, and in some cases, cognitive behavioral therapy.

When Should You Seek Medical Care for Stomach Pain?

Seek immediate medical care if your child has severe pain that worsens or moves to one side, high fever with abdominal pain, bloody or black stools, persistent vomiting (especially green bile), a swollen rigid abdomen, pain in the groin or testicles, or appears very unwell or lethargic. For recurring pain without these warning signs, schedule a routine appointment.

Most children with stomach pain do not need to see a doctor and will recover with simple home care. However, certain symptoms are "red flags" that indicate potentially serious conditions requiring prompt medical evaluation. As a parent, knowing these warning signs can help you make informed decisions about when to seek care.

The decision to seek medical attention should take into account not just the specific symptoms, but also your child's overall appearance and behavior. A child who is playing normally between episodes of stomach pain is much less concerning than a child who lies still, refuses to play, and appears pale or listless. Trust your parental instincts - you know your child best, and if something seems seriously wrong, it's always appropriate to seek medical advice.

The timing and pattern of symptoms also provide important clues. Pain that wakes a child from sleep is more concerning than pain that only occurs during the day. Pain that consistently occurs at the same time (such as before school) may suggest anxiety-related issues, while pain that occurs randomly at various times warrants closer investigation.

When to Contact Your Healthcare Provider (Non-Emergency)

For symptoms that don't require emergency care but still warrant medical evaluation, contact your healthcare provider during regular office hours. These situations include:

• Recurrent stomach pain that occurs at least weekly for more than two months
• Pain that interferes with daily activities, school attendance, or sleep
• Unexplained weight loss or failure to gain weight appropriately
• Pain accompanied by joint pain, skin rashes, or mouth sores
• Family history of inflammatory bowel disease, celiac disease, or peptic ulcers
• Pain that occurs with every meal or is related to specific foods

How Can You Help Relieve Your Child's Stomach Pain at Home?

For mild stomach pain, encourage your child to sit on the toilet to pass gas or stool (use a footstool for small children). Offer small sips of clear fluids. Apply a warm compress to the belly for comfort. Let your child rest in a comfortable position. Avoid giving food until symptoms improve. Gentle abdominal massage may help if the stomach is soft and not tender.

When your child complains of a stomachache and there are no warning signs of a serious condition, several home remedies can provide comfort and help symptoms resolve more quickly. The key principles are supporting natural digestive function, preventing dehydration, and providing comfort measures.

Creating a calm, reassuring environment is important because anxiety can worsen gastrointestinal symptoms. Children are perceptive and may pick up on parental worry, which can increase their own distress. A matter-of-fact, gentle approach helps children feel safe and can actually reduce the intensity of their symptoms.

It's worth noting that different causes of stomach pain may respond to different remedies. Pain from constipation will improve with increased fluids and toilet sitting, while pain from overeating may resolve with rest and time. Observing what seems to help your child can provide clues about the underlying cause.

Encourage Toilet Use

Since constipation and gas are the most common causes of childhood stomach pain, having your child sit on the toilet is often the most effective first step. Even if your child doesn't feel the urge to go, sitting in the proper position can help relax the pelvic floor muscles and facilitate passage of stool or gas.

For younger children whose feet don't reach the floor, use a step stool so their knees are higher than their hips - this position straightens the rectal angle and makes bowel movements easier. Encourage relaxed sitting for 5-10 minutes without straining. Regular toilet time after meals can help establish healthy bowel habits and prevent future episodes.

Hydration and Diet

Offer small, frequent sips of clear fluids such as water or diluted apple juice. Avoid large volumes at once, which can worsen nausea. For children with vomiting or diarrhea, oral rehydration solutions (available at pharmacies) help replace lost electrolytes more effectively than plain water or juice.

While your child has stomach pain, avoid dairy products, fatty or fried foods, and foods high in fiber or sugar. Once the pain begins to improve, start with bland foods like crackers, toast, rice, or bananas. Resume normal diet gradually as tolerated.

Comfort Measures

A warm (not hot) compress or heating pad placed on the abdomen can provide soothing relief for many types of stomach pain. The warmth helps relax tense abdominal muscles and can reduce cramping sensations. Always wrap heating pads in a towel and supervise their use to prevent burns.

Gentle circular massage of the abdomen in a clockwise direction (following the path of the colon) may help with gas and constipation-related pain. However, do not massage if the abdomen is rigid, very tender, or swollen - these signs may indicate a more serious condition.

What Are the Specific Causes of Stomach Pain in Children?

Beyond constipation and gastroenteritis, specific causes include infant colic (under 6 months), functional gastrointestinal disorders (IBS), food intolerances (lactose, gluten), mesenteric lymphadenitis (swollen abdominal lymph nodes), appendicitis, urinary tract infections, and in teenagers, menstrual-related pain or endometriosis.

Understanding the wide range of conditions that can cause abdominal pain in children helps parents recognize patterns and communicate effectively with healthcare providers. While this information is educational, diagnosis should always be made by a qualified medical professional based on clinical examination and, when necessary, appropriate testing.

Infant Colic

Babies under 6 months of age may experience periods of intense crying and apparent abdominal discomfort known as colic. Colicky babies often cry inconsolably for hours, typically in the late afternoon or evening, and may draw their legs up toward their abdomen or arch their back. The crying follows a pattern, occurring at roughly the same time each day.

While the exact cause of colic remains unclear, it's believed to involve intestinal discomfort, possibly from immature digestive systems or gas. Colic typically peaks around 6 weeks of age and resolves by 3-4 months. Comfort measures include gentle motion, white noise, warm baths, and ensuring proper feeding technique to minimize air swallowing.

Food Intolerances

Lactose intolerance is particularly common in children of African, Asian, Hispanic, and Indigenous ancestry, typically developing after age 5. When lactose (milk sugar) isn't properly digested, bacteria ferment it in the colon, producing gas, bloating, cramping, and diarrhea. Symptoms occur 30 minutes to 2 hours after consuming dairy products.

Celiac disease (gluten intolerance) is an autoimmune condition where gluten consumption damages the small intestine. Symptoms may include abdominal pain, bloating, diarrhea or constipation, poor appetite, weight loss, and fatigue. Celiac disease is diagnosed through blood tests and intestinal biopsy and requires lifelong gluten avoidance.

Mesenteric Lymphadenitis

Often occurring after or during a viral infection, mesenteric lymphadenitis involves swelling of the lymph nodes in the abdomen. The enlarged nodes cause pain that can mimic appendicitis, often located in the right lower abdomen. Children may also have mild fever. The condition resolves on its own as the underlying infection clears, though it may cause prolonged discomfort for several weeks.

Appendicitis

Appendicitis is inflammation of the appendix and represents a true surgical emergency. The classic presentation begins with vague pain around the belly button that gradually moves to the right lower quadrant of the abdomen over 12-24 hours. Children typically have decreased appetite, may vomit after pain onset, and often develop a low-grade fever.

Physical signs include tenderness when pressing on the right lower abdomen, pain with walking or jumping, and preference for lying still. If appendicitis is suspected, seek emergency care immediately - delayed treatment increases the risk of rupture, which can cause life-threatening infection.

Urinary Tract Infection

UTIs can cause abdominal pain along with burning or pain during urination, frequent urination, bedwetting in previously toilet-trained children, and foul-smelling or cloudy urine. Some children, especially younger ones, may have only fever and stomach pain without obvious urinary symptoms. Untreated UTIs can spread to the kidneys, causing more severe illness with flank pain and high fever.

Inflammatory Bowel Disease

Crohn's disease and ulcerative colitis are chronic inflammatory conditions that can begin in childhood. Symptoms include recurring abdominal pain, diarrhea (which may contain blood or mucus), weight loss, fatigue, and delayed growth. Joint pain and skin problems may also occur. These conditions require specialist care and long-term management but can be well-controlled with appropriate treatment.

How Is Stomach Pain in Children Diagnosed?

Diagnosis begins with a detailed history and physical examination. The doctor will ask about pain location, timing, associated symptoms, diet, and bowel habits. Tests may include urinalysis, stool tests, blood work, and imaging such as ultrasound or X-ray. Many cases are diagnosed clinically without extensive testing.

When you bring your child to a healthcare provider for stomach pain, the evaluation will follow a systematic approach designed to identify serious conditions while avoiding unnecessary tests. Coming prepared with detailed information about your child's symptoms will help the provider make an accurate diagnosis more efficiently.

The diagnostic process begins with listening carefully to the history of symptoms. The healthcare provider will want to know: When did the pain start? Is it constant or does it come and go? What makes it better or worse? Are there other symptoms like fever, vomiting, or changes in bowel habits? What has your child eaten recently? Has there been any recent illness or stress? Is there a family history of gastrointestinal conditions?

Physical Examination

The physical exam provides crucial information. The provider will observe your child's general appearance - a child who is running around the waiting room is likely less seriously ill than one who lies still and avoids movement. They will feel (palpate) the abdomen to assess tenderness, muscle guarding, and masses. Listening with a stethoscope reveals bowel sounds that provide clues about intestinal function.

For younger children who can't describe their symptoms, the provider may use distraction techniques during the examination. Watching the child's face while pressing on the abdomen, rather than relying on verbal responses, provides more reliable information about pain location.

Diagnostic Tests

Many cases of stomach pain in children are diagnosed based on history and examination alone, without any tests. However, when the cause is unclear or serious conditions need to be ruled out, the following tests may be ordered:

• Urinalysis: A simple urine test that can detect urinary tract infections, a common cause of abdominal pain that may not cause typical urinary symptoms in children
• Stool tests: To check for blood, infections, parasites, or inflammatory markers
• Blood tests: Complete blood count, inflammatory markers (CRP, ESR), liver and kidney function, and specific tests like celiac antibodies when indicated
• Abdominal X-ray: Can show constipation (fecal loading), intestinal obstruction, or certain other abnormalities
• Ultrasound: A non-radiation imaging technique excellent for evaluating appendicitis, kidney problems, ovarian issues, and other abdominal conditions in children

How Is Stomach Pain in Children Treated?

Treatment depends on the underlying cause. Constipation is treated with increased fluids, fiber, and sometimes laxatives. Gastroenteritis requires hydration and supportive care. Functional abdominal pain benefits from reassurance, dietary changes, stress management, and sometimes psychological therapy. Conditions like appendicitis require surgical intervention.

The treatment approach for stomach pain in children varies widely depending on the diagnosis. For the majority of cases involving benign conditions like constipation or viral illness, treatment focuses on symptom relief and supporting the body's natural healing process. More serious conditions require specific medical or surgical interventions.

Regardless of the cause, certain principles apply to all treatment plans. These include maintaining adequate hydration, ensuring appropriate nutrition as tolerated, providing comfort measures, and monitoring for any changes in symptoms that might indicate a need for reassessment.

Treating Constipation

Management of constipation involves both immediate relief and long-term prevention. For acute constipation, the provider may recommend osmotic laxatives like polyethylene glycol (PEG), which soften stool by drawing water into the intestines. For severe impaction, sometimes a cleanout regimen is needed first.

Long-term management focuses on dietary changes (increased fiber from fruits, vegetables, and whole grains), adequate fluid intake (water primarily), regular physical activity, and establishing consistent toilet routines. Behavioral modifications, such as scheduled toilet time after meals, help prevent recurrence.

Managing Functional Abdominal Pain

Treatment of functional abdominal pain requires a multidisciplinary approach. First and most importantly, parents and children need reassurance that the pain is real but not caused by a dangerous disease. This validation is therapeutic in itself.

Lifestyle modifications include regular meals, adequate sleep, physical activity, and stress reduction techniques. Some children benefit from keeping a symptom diary to identify triggers. Dietary changes such as reducing gas-producing foods, limiting caffeine, and in some cases following a low-FODMAP diet may help.

When symptoms are significantly affecting quality of life, additional interventions may be recommended. Cognitive behavioral therapy (CBT) has strong evidence for reducing pain and improving function. Occasionally, medications such as antispasmodics, low-dose antidepressants, or probiotics are prescribed.

Surgical Conditions

Certain conditions causing stomach pain require surgical treatment. Appendicitis is treated with appendectomy, which is now often performed laparoscopically (minimally invasive). Early surgery before rupture results in excellent outcomes with rapid recovery.

Intussusception (where one part of the intestine telescopes into another) may sometimes be treated non-surgically with an air or barium enema that pushes the intestine back into place. If this is unsuccessful or the intestine has been damaged, surgery is required.