Stomach Pain in Children: Causes, Symptoms & When to Worry

Why Do Children Get Stomach Pain So Often?

Children experience stomach pain frequently because their digestive systems are still developing, they may have difficulty expressing what they feel, and their bodies respond to stress and illness differently than adults. The good news is that most causes are not serious and resolve quickly with simple care.

Stomach pain, or abdominal pain, is one of the most common complaints in childhood. Studies show that up to 25% of school-age children experience recurrent abdominal pain at some point during their development. Understanding why children get stomach pain so frequently can help parents respond appropriately and know when to seek medical care.

The pediatric digestive system differs from adults in several important ways. Children's intestines are more sensitive to changes in diet, stress, and illness. Their immune systems are still learning to distinguish between harmful and harmless substances, which can lead to more frequent reactions. Additionally, the gut-brain connection is particularly strong in children, meaning emotional states directly affect digestive function.

Young children face a unique challenge: they often cannot accurately describe or locate their pain. This developmental limitation means that a child who says their "tummy hurts" might actually be experiencing pain from a sore throat, ear infection, or even emotional distress. The abdomen becomes a general location where many types of discomfort are perceived and reported.

How Children Describe Pain at Different Ages

Understanding how children express pain at different developmental stages is crucial for parents and caregivers. Research in pediatric pain assessment has shown consistent patterns in how children communicate their discomfort.

Children under three years of age typically cannot verbalize their pain at all. Instead, they may become irritable, refuse to eat, draw their knees to their chest, or simply cry without apparent cause. When asked where it hurts, toddlers almost universally point to their stomach, even when the pain originates elsewhere in the body.

Between ages three and six, children begin to develop language skills to describe pain, but their understanding of anatomy remains limited. Children in this age group almost always point to the center of their abdomen, near the navel, regardless of where the pain actually originates. This is because young children perceive the belly button as the "center" of their body.

Only after age seven do most children develop the ability to distinguish between left and right sides, upper and lower abdomen, or localize pain more specifically. Even then, the accuracy varies based on the child's cognitive development and experience describing physical sensations.

What Are the Most Common Causes of Stomach Pain in Children?

The most common causes of stomach pain in children are constipation and gas, viral infections (including common colds and stomach flu), functional abdominal pain related to stress, and dietary sensitivities. In about 90% of cases of chronic abdominal pain, no specific medical cause is found, and the condition is classified as functional.

Understanding the various causes of stomach pain helps parents identify patterns and determine when home care is appropriate versus when medical evaluation is needed. While serious conditions can cause abdominal pain, the vast majority of cases in children stem from common, treatable causes.

The digestive system in children is particularly sensitive to disruptions. Even minor changes in diet, routine, or emotional state can trigger abdominal discomfort. This sensitivity decreases as children grow older and their digestive systems mature, which is why stomach complaints typically become less frequent in adolescence.

Constipation and Gas

Constipation represents the single most common cause of stomach pain in children of all ages, from infants to teenagers. When stool accumulates in the large intestine, it causes distension, cramping, and discomfort. The buildup of gas that accompanies constipation adds to the pain.

Children may develop constipation for various reasons: insufficient fiber intake, inadequate fluid consumption, ignoring the urge to use the bathroom, changes in routine (such as starting school), or fear of using unfamiliar toilets. The pain from constipation often comes and goes, may worsen after meals, and typically improves after a bowel movement.

Signs that constipation may be causing your child's stomach pain include infrequent bowel movements (less than three per week), hard or pellet-like stool, straining during defecation, abdominal bloating, and loss of appetite. Some children may also have small amounts of leakage in their underwear if stool has become impacted.

Viral Infections

Viral infections commonly cause stomach pain in children through two mechanisms. First, the common cold and other respiratory viruses can affect the intestinal lining, causing discomfort and altered bowel function. Swollen lymph nodes in the abdomen (mesenteric adenitis) can also cause significant pain that mimics more serious conditions.

Gastroenteritis, commonly called "stomach flu," causes nausea, vomiting, diarrhea, and cramping abdominal pain. Most cases are caused by viruses like norovirus or rotavirus and resolve within one to three days. The primary concern with gastroenteritis is dehydration, particularly in young children who may refuse fluids due to nausea.

Children with viral infections often experience additional symptoms beyond stomach pain, including fever, fatigue, decreased appetite, and general malaise. The presence of these accompanying symptoms can help distinguish viral illness from other causes of abdominal pain.

Functional Gastrointestinal Disorders

Functional abdominal pain is diagnosed when a child experiences recurrent stomach pain without any identifiable structural or biochemical abnormality. According to the ROME IV criteria, this diagnosis applies when pain occurs at least four times per month for at least two months and significantly affects daily activities.

Despite the term "functional," this type of pain is very real and can significantly impact a child's quality of life. The condition involves heightened sensitivity of the intestinal nerves and abnormal processing of pain signals in the brain. Stress, anxiety, and emotional factors often trigger or worsen symptoms.

Irritable bowel syndrome (IBS) is a specific type of functional gastrointestinal disorder that can occur in children. Symptoms include cramping pain that improves after bowel movements, alternating constipation and diarrhea, bloating, and mucus in stool. The condition often runs in families and may be triggered by certain foods, stress, or infections.

Food-Related Causes

Dietary factors can trigger stomach pain through several mechanisms. Lactose intolerance, which is particularly common in children of non-Northern European descent, causes gas, bloating, cramping, and diarrhea after consuming dairy products. Symptoms typically begin within 30 minutes to two hours after eating lactose-containing foods.

Celiac disease, an autoimmune condition triggered by gluten, affects approximately 1 in 100 children worldwide. Symptoms include stomach pain, bloating, diarrhea or constipation, poor appetite, weight loss, and fatigue. Unlike lactose intolerance, celiac disease causes intestinal damage and requires lifelong dietary modification.

Food allergies differ from intolerances in that they involve the immune system and can cause more severe reactions. While classic allergic reactions involve hives, swelling, and breathing difficulties, food allergies can also cause isolated gastrointestinal symptoms including stomach pain, vomiting, and diarrhea.

How Can I Help Relieve My Child's Stomach Pain at Home?

Home care for stomach pain includes having your child try to use the toilet, applying a warm (not hot) compress to the abdomen, ensuring adequate hydration, offering bland foods, and providing comfort and distraction. Avoid abdominal massage if the stomach feels hard or is very tender to touch.

When your child complains of stomach pain, your response can significantly influence their comfort and recovery. Most episodes of abdominal pain in children can be managed successfully at home with simple measures. The key is to provide comfort while monitoring for warning signs that might indicate a more serious condition.

Before attempting any home remedies, take a moment to assess your child's overall condition. Are they playing normally between episodes of pain? Do they have a fever? Are there other symptoms like vomiting, diarrhea, or blood in stool? This initial assessment helps determine whether home care is appropriate or medical evaluation is needed.

Encouraging Bowel Function

Since constipation is the most common cause of stomach pain, encouraging your child to sit on the toilet is often the most effective first step. Have them sit for 5-10 minutes and try to pass gas or have a bowel movement. For young children who cannot reach the floor, provide a small stool for their feet—this positioning helps align the bowel for easier elimination.

Creating a relaxed bathroom environment is important. Don't rush your child or make them feel pressured. Some children avoid using the bathroom at school or other public places, which contributes to constipation. Establishing regular toilet times at home, particularly after meals when the gastrocolic reflex naturally stimulates bowel activity, can help prevent constipation-related pain.

For children with recurrent constipation, dietary modifications are essential. Increase fiber intake through fruits (especially pears, prunes, and apples), vegetables, and whole grains. Ensure adequate fluid intake—water is best. Limit binding foods like bananas, rice, applesauce, and toast during episodes of constipation.

Applying Warmth

Heat application can help relax intestinal muscles and ease cramping pain. Use a warm (not hot) compress, heating pad, or wheat bag wrapped in a towel. Apply to the abdomen for 15-20 minutes at a time. The warmth increases blood flow to the area and can provide significant comfort.

Always check the temperature before applying any heat source to your child's skin. Children's skin is more sensitive than adults', and burns can occur quickly. Never apply heat directly without a protective layer, and do not allow your child to fall asleep with a heating pad.

Gentle Abdominal Massage

For children with gas or mild constipation, gentle abdominal massage can help move gas and stool through the intestines. Use gentle, circular motions in a clockwise direction (following the path of the large intestine). Start at the lower right abdomen, move up, across, and down to the lower left.

Only attempt massage if your child finds it comfortable. If the stomach feels hard, is visibly distended, or if your child pulls away in pain, stop immediately. Massage should never cause increased discomfort.

Hydration and Diet

Maintaining hydration is important, especially if your child has vomiting or diarrhea. Offer small, frequent sips of water or clear fluids rather than large amounts at once. Avoid sugary drinks, which can worsen diarrhea, and carbonated beverages, which can increase gas.

When your child feels ready to eat, offer bland, easily digestible foods. Good options include plain crackers, toast, rice, bananas, and clear broths. Avoid fatty, spicy, or highly seasoned foods until the stomach has settled. Don't force your child to eat if they're not hungry—a temporary decrease in appetite is normal during stomach upset.

When Should I Take My Child to the Doctor for Stomach Pain?

Seek immediate medical care if your child has severe pain with fever, blood in vomit or stool, persistent vomiting (especially green/bile-colored), pain that moves to the right lower abdomen, a hard or rigid abdomen, swelling in the groin or scrotum, or appears very ill or lethargic. For less urgent concerns, contact your healthcare provider if symptoms persist for more than 24-48 hours or keep recurring.

While most stomach pain in children resolves on its own, certain symptoms require prompt medical evaluation. Understanding these warning signs helps parents make appropriate decisions about seeking care. When in doubt, it's always better to have a child evaluated than to wait with a potentially serious condition.

The urgency of seeking care depends on the combination of symptoms, the child's age, and overall appearance. A child who is playing happily between episodes of cramping is very different from a child who lies still and appears ill. Trust your parental instincts—you know your child best and can often sense when something is seriously wrong.

Warning Signs of Appendicitis

Appendicitis is one of the most important conditions to recognize because early treatment prevents serious complications. The appendix is a small, finger-shaped pouch attached to the large intestine in the lower right abdomen. When it becomes inflamed and infected, it can rupture if not treated promptly.

Appendicitis typically begins with decreased appetite and vague discomfort around the navel. Over 12-24 hours, the pain characteristically moves to the right lower quadrant of the abdomen and becomes more localized and intense. Movement, coughing, or pressing on the area worsens the pain.

Children with appendicitis often have low-grade fever (38-38.5°C or 100.4-101.3°F), nausea, and sometimes vomiting. They may prefer to lie still rather than move around. Walking may cause a limp or hunched posture. The pain progressively worsens rather than improving, which distinguishes appendicitis from many viral illnesses.

Other Serious Conditions

While less common than constipation or viral illness, several other conditions can cause abdominal pain requiring medical attention:

Intussusception occurs when one portion of intestine telescopes into another, causing obstruction. It's most common in children under three years old. Symptoms include sudden, severe cramping pain that comes and goes in waves, with the child drawing their knees up during episodes. Stools may contain blood and mucus, resembling "currant jelly."

Testicular torsion affects boys and adolescents when the testicle rotates on its cord, cutting off blood supply. It causes sudden, severe pain in the scrotum or lower abdomen, with swelling and redness. This is a surgical emergency requiring immediate treatment to save the testicle.

Urinary tract infections can cause lower abdominal pain, burning with urination, frequent urination, and sometimes fever. Girls are more commonly affected. Urine may be cloudy, bloody, or have a strong odor. UTIs require antibiotic treatment to prevent kidney infection.

When to Contact Your Healthcare Provider

Contact your child's doctor or healthcare provider within 24-48 hours if your child experiences stomach pain that doesn't improve with home care, recurring episodes of stomach pain that interfere with daily activities, weight loss or poor growth, blood in stool (even small amounts), chronic diarrhea or constipation, or pain that wakes them from sleep.

What Happens During a Medical Evaluation for Stomach Pain?

A medical evaluation includes a detailed history of symptoms, physical examination focusing on the abdomen, and potentially tests such as blood work, urine analysis, stool samples, or imaging studies like ultrasound. The goal is to identify any serious conditions while avoiding unnecessary testing in children with likely functional or self-limited causes.

When you bring your child to a healthcare provider for stomach pain, the evaluation typically begins with a comprehensive history. Being prepared with detailed information about your child's symptoms helps the provider make an accurate assessment and appropriate recommendations.

Before your appointment, think about and be ready to describe when the pain started and whether it has changed over time, exactly where the pain is located and whether it moves, what makes the pain better or worse (eating, bowel movements, rest, distraction), associated symptoms like fever, vomiting, diarrhea, or constipation, any recent dietary changes, illnesses, or stressful events, and your child's typical bowel habits and any recent changes.

Physical Examination

The physical examination includes a general assessment of your child's appearance and vital signs, followed by a focused abdominal examination. The provider will look at the abdomen for distension or visible abnormalities, listen with a stethoscope for bowel sounds, and gently feel different areas to assess for tenderness, masses, or organ enlargement.

Depending on symptoms, the examination may include checking the groin for hernias, examining the genitals (particularly in boys with abdominal or groin pain), and possibly a rectal examination to check for stool impaction or blood.

Diagnostic Tests

Not all children with stomach pain require testing. Many cases can be diagnosed based on history and examination alone. When tests are needed, common options include:

Urine analysis checks for urinary tract infection, which is a common cause of abdominal pain, especially in girls. Blood tests may evaluate for infection, inflammation, or organ function depending on suspected causes. Stool samples can detect blood, infection, or parasites.

Abdominal ultrasound is safe, painless, and provides valuable information about organs and structures without radiation exposure. It's particularly useful for evaluating appendicitis, intussusception, and kidney problems. X-rays may show patterns of constipation, intestinal obstruction, or other abnormalities.

What Conditions Can Cause Stomach Pain in Children?

Stomach pain in children can be caused by many conditions ranging from common and benign (constipation, viral infections, stress) to rare but serious (appendicitis, intussusception, inflammatory bowel disease). Understanding the full range of possible causes helps parents recognize when symptoms might indicate something more than a simple stomach ache.

While most stomach pain in children stems from common, non-serious causes, a comprehensive understanding of possible conditions helps parents and caregivers respond appropriately. This section explores various causes of pediatric abdominal pain, from everyday occurrences to conditions requiring medical intervention.

Infant Colic

Colic affects up to 20% of infants during their first few months of life. It's characterized by episodes of intense, inconsolable crying lasting three or more hours per day, occurring at least three days per week, for three or more weeks. The crying often occurs in the late afternoon or evening and follows a predictable pattern.

During colic episodes, infants may draw their legs up toward their abdomen, have a tense belly, pass gas, and appear to be in distress. Despite extensive research, the exact cause of colic remains unknown, though theories include immature digestive systems, gas, and overstimulation. Colic typically resolves by age 3-4 months without long-term effects.

Mesenteric Adenitis (Swollen Abdominal Lymph Nodes)

When lymph nodes in the abdomen become swollen due to infection—typically viral—the condition is called mesenteric adenitis or "gland belly." It often follows or accompanies a cold, sore throat, or other viral illness. The swollen lymph nodes cause abdominal pain that can mimic appendicitis.

Unlike appendicitis, mesenteric adenitis often affects a broader area of the abdomen and may come and go. Children typically have signs of viral infection like mild fever, sore throat, or runny nose. The condition resolves as the infection clears, usually within 1-2 weeks, though some children experience prolonged discomfort.

Inflammatory Bowel Disease

Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBD) that can begin in childhood. These chronic conditions cause inflammation of the digestive tract, leading to abdominal pain, diarrhea (often bloody), weight loss, fatigue, and sometimes joint pain or skin problems.

IBD symptoms often wax and wane, with periods of active disease (flares) alternating with periods of remission. Early diagnosis and treatment are important to control inflammation, manage symptoms, and prevent complications. Children with suspected IBD should be evaluated by a pediatric gastroenterologist.

Menstrual-Related Pain

After puberty begins, menstruation becomes an important cause of recurrent abdominal pain in girls and adolescents. Dysmenorrhea (painful periods) causes cramping lower abdominal pain that typically begins just before or with the start of menstruation and improves within 1-3 days.

Primary dysmenorrhea is caused by prostaglandins released from the uterine lining and is very common. Secondary dysmenorrhea results from underlying conditions like endometriosis, where tissue similar to the uterine lining grows outside the uterus. Endometriosis can cause severe pain before and during periods and may require specialized treatment.

Psychological and Stress-Related Pain

The gut-brain connection means that emotional states directly affect gastrointestinal function. Anxiety, stress, depression, and other psychological factors can cause very real abdominal pain. This is not "imaginary" pain—the nerves in the gut are responding to signals from the brain, producing genuine physical symptoms.

Children may experience stress-related stomach pain in connection with school (exams, bullying, social difficulties), family problems (parental conflict, divorce, sibling issues), changes (moving, new school, new sibling), or performance pressure (sports, academics). Addressing the underlying psychological factors is essential for resolving the physical symptoms.

How Is Stomach Pain in Children Treated?

Treatment depends on the underlying cause. Constipation is managed with dietary changes, increased fluids, and sometimes laxatives. Functional pain may require dietary modifications, stress management, and sometimes medications. Serious conditions like appendicitis require surgical intervention. Most stomach pain resolves with simple supportive care.

The approach to treating stomach pain in children varies widely based on the identified or suspected cause. For most common causes, treatment focuses on relieving symptoms while the underlying condition resolves. More serious conditions may require specific medical or surgical interventions.

Treating Constipation

Management of constipation-related stomach pain involves both acute relief and prevention of recurrence. For immediate relief, children may need stool softeners or osmotic laxatives to help move hardened stool. Your healthcare provider can recommend appropriate over-the-counter or prescription options based on your child's age and severity of constipation.

Long-term prevention requires dietary and behavioral changes. Increase fiber intake through fruits, vegetables, and whole grains. Ensure adequate fluid consumption—water is best. Establish regular toilet times, especially after meals. Encourage physical activity, which promotes healthy bowel function. Address any toilet-related anxiety or avoidance behaviors.

Managing Functional Abdominal Pain

Treatment of functional abdominal pain is multifaceted and may include dietary modifications (identifying and avoiding trigger foods), regular meal and sleep schedules, stress reduction and coping strategies, gradual return to normal activities despite pain, psychological support or cognitive behavioral therapy, and in some cases, medications to reduce pain sensitivity or treat associated anxiety.

It's important to validate the child's pain while avoiding excessive focus on symptoms. The goal is to help the child function normally despite some discomfort, rather than allowing pain to restrict activities. Family involvement and support are crucial for success.

When Surgery Is Needed

Certain conditions causing stomach pain require surgical treatment. Appendicitis is treated by surgical removal of the appendix (appendectomy), usually performed laparoscopically. Intussusception may resolve with an enema procedure but sometimes requires surgery. Incarcerated hernias and testicular torsion are surgical emergencies requiring immediate intervention.

Frequently Asked Questions