As parents, we usually know what to do if our kids complain of a stuffy nose or a fever. But when we hear, “My tummy hurts,” it gets more complicated. The abdomen is large and full of mysterious plumbing, and an ouchie could be anything from gas to appendicitis. How do you know if you should keep him home or pack him off to school?
“It’s hard for kids to really explain belly pain to their parents,” says Lawrence Rosen, M.D., chair of the American Academy of Pediatrics Section on Integrative Medicine.
One way to figure it out: Train the patient to help you diagnose. “When I’d ask my kids where it hurt, they’d rub their hands over their entire tummy, which didn’t help,” says Rallie McAllister, M.D., a family physician in Lexington, KY, and co-author of The Mommy MD Guide to the Toddler Years. “Now they use one finger to point. If it’s the upper abdomen, it’s likely a stomach bug. If she points low, it could be her colon, and she’s constipated.” To figure out the wheres and whys of your child’s belly woes, we asked the experts to lead the way.
THE PROBLEM: "It hurts to go potty!"
It's most likely: Constipation
What's Going On: The condition can often kick in when a child starts school — he may feel embarrassed to use a shared bathroom, notes Dr. Rosen, who is also the co-author of Treatment Alternatives for Children. Holding in a bowel movement can also make it difficult to pass later. Other common triggers: When your child is lacking in the hydration or fiber department or is eating lots of high-fat (and slowly digested) foods, the colon may absorb too much water from the stool, making it dry and hard — which leaves your child plugged up. “Of course, not having daily bowel movements doesn’t mean your child is constipated,” says Dr. Rosen. “For some, every three to four days is fine. But once your child changes his normal pattern or drops below three movements a week, you’re flirting with constipation.”
Tell-Tale Signs: Fewer bowel movements, hard and dry stool, possible bloody poop, even possible bed wetting
Easy Rx: Over the course of a week, work toward filling half your child’s plate with fiber-rich fruits and vegetables, like raspberries, peas, and black beans, says Rachel Begun, R.D., spokesperson for the Academy of Nutrition and Dietetics.
- Up fluids by four to six cups of water a day.
- Try flaxseeds. Dr. Rosen sprinkles two teaspoons of flaxseeds into his children’s smoothies to help keep things moving.
THE PROBLEM: "Everything looks all watery!"
It's most likely: Diarrhea
What's Going On: Having the runs occasionally is common in kids. But when kids pass loose stools three or more times a day, it’s most often brought on by gastroenteritis, a viral infection of the stomach and intestines (a.k.a. a stomach bug). Certain meds (like antibiotics), food poisoning, bacterial infections, and parasites from contaminated food or water also bring on the runs. “Diarrhea is very common,” says Dr. Rosen. “If it happens a lot, it could mean food allergies or a gastrointestinal condition like celiac disease.” (See “Fast Facts About Celiac Disease” below.)
Tell-Tale Signs: Loose, watery stools, cramps
Easy Rx: One of the best antidotes for diarrhea is probiotics. “Probiotics crowd out bad organisms in the gut with good, healthy organisms, and they heal inflammation,” says Benjamin Kligler, M.D., vice chair and research director of the Continuum Center for Health and Healing at the Beth Israel Medical Center in New York City. “But you need to get a powder or liquid probiotic supplement to do the job.” Try Florajen4Kids capsules or look for one with Lactobacillus GG, Lactobacilllus reuteri, and/or Saccharomyces boulardii, with bacteria in the 5 to 10 billion range. Or try that old standby, the low-fiber BRAT diet of bananas, rice, applesauce, and toast.
THE PROBLEM: "My tummy feels kinda wiggly."
It's most likely: A case of the butterflies
What's Going On: Vague belly pain is something a lot of kids between the ages of 2 and 8 say they have when they need attention or they’re feeling stressed, says Dr. Kligler. “That’s the place where they experience worry."
Tell-Tale Signs: They’re nervous about something — a test, a friend, a new experience.
Easy Rx: Tummy rubs can soothe a nervous belly, says Dr. Kligler. But they can do more than that. A study found that massages reduced the severity of gastrointestinal symptoms and helped bring on bowel movements. They activate the body’s nervous and digestive system, increasing stomach secretions that help break down food.
- Offer a calming cup of peppermint or chamomile tea. Both help stop stomach spasms and are comforting.
- Click here to find out how to soothe school-related jitters.
THE PROBLEM: "My belly feels hard and I can't stop tooting!"
It's most likely: Gas
What's Going On: Gas develops when there’s air trapped in the stomach or in the lower abdomen. Most people let loose with a toot or burp about 10 times a day. But persistent gas is often related to a child’s diet, says Dr. McAllister. “He could be intolerant to certain foods, such as dairy products, or sensitive because you’ve made a change to the way he eats, like going from a low-fiber diet to a high-fiber one.” Other culprits include: Eating too fast, carbonated drinks, and certain foods like onions and beans.
Tell-Tale Signs: Gassy kids often feel pressure in their belly or bowels.
Easy Rx: “Changing position can be enough to release the painful pressure,” says Dr. Kligler. “For little kids, I like to have them lie on their backs, put their legs up, and do bicycle pedals to get the gas out.”
- Chamomile tea can help relax muscles in the intestines and stomach.
- Keep a journal of everything your child eats and drinks (and when) to figure out his triggers.
Call the M.D.!
If your kid’s bellyache is accompanied by lethargy, a high fever, or vomiting, see your doctor. Do the same for the symptoms below.
Bellyache + painful urination (might) = a urinary tract infection
Bellyache + a sore throat and/or fever (might) = strep throat
Bellyache + constant pain in the center of the belly that moves down to the right side and feels tender (might) = appendicitis
Bellyache + cramps and/or diarrhea that regularly occur after eating certain foods (might) = allergy, food intolerance
Bellyache + blood or mucus in your child's stool (might) = irritable bowel syndrome, allergy, ulcer, food intolerance, hemorrhoids
Bellyache + diarrhea that occurs within one week of travel outside the United States (might) = bacterial pathogens or parasites found in foreign countries
Bellyache + cramps and/or severe diarrhea (might) = food poisoning
Fast Facts About Celiac Disease
With gluten-free food everywhere these days, you’d think millions of kids suffer from celiac disease, a digestive disorder. We asked pediatric gastroenterologist Michelle Pietzak, M.D., for the scoop:
- Celiac disease is pretty rare. It affects about one percent of the population. But the odds go up if it runs in your family.
- Celiac is an autoimmune disease, not an allergy. The body attacks the intestines after being exposed to gluten, a protein that’s found in wheat, rye, and barley. Kids with celiac don’t absorb nutrients as well and may be malnourished as a result.
- There are a lot of symptoms: chronic diarrhea, constipation, bloating, loss of appetite, failure to gain weight, and tiredness.
- Gluten isn’t just in bread and pasta. It’s hidden in a whole host of products, even soy sauce, salad dressings, and Play-Doh.
- Celiac disease can’t be cured. But kids on a strict gluten-free diet can lead a healthy, active life, and grow to normal height.