Abdominal pain is extremely common in children. The most helpful approach is structured:
- Rule out emergencies
- Identify constipation and common benign causes
- Recognize when targeted testing is appropriate
1) Triage: when to seek urgent assessment
Urgent/Emergency if any of the following:
- Severe or worsening pain, rigid/hard belly, guarding
- Bilious vomiting or persistent vomiting
- Blood in vomit, black stools, large rectal bleeding
- Fever + worsening pain with unwell appearance
- Localized right lower quadrant pain (appendicitis concern)
- Testicular pain/swelling
- Dehydration, lethargy, altered behavior
- Under 3 months with significant pain/irritability
2) Age-specific common causes
Toddlers (1–4)
- Constipation
- Viral illness
- UTI
- Intussusception (episodic severe pain)
- Appendicitis (less classic)
School age (5–12)
- Constipation
- Functional abdominal pain / IBS
- Dyspepsia/reflux
- Celiac disease or IBD if red flags
Teens
- Constipation, IBS, reflux/gastritis
- Menstrual-related pain
- IBD and other inflammatory causes if systemic symptoms
3) Constipation algorithm (parent-friendly)
Consider constipation if any:
- Hard stools, painful stooling, withholding
- Soiling/overflow
- Belly pain improves after stooling
- Large stools or infrequent stools
Practical steps:
- Water + fiber gradually
- Toileting after meals with feet supported
- Discuss stool-softening therapy with clinician (often needed longer than expected)
Constipation treatment failure is usually due to:
- stopping too early
- under-dosing
- not addressing withholding and routine
4) When to test for celiac disease
Consider screening when abdominal pain is recurrent plus:
- poor growth, weight loss
- anemia (especially iron deficiency)
- chronic diarrhea, bloating
- strong family history or autoimmune comorbidity
Do not stop gluten before testing.
5) When to evaluate for IBD
Higher suspicion when:
- blood in stool, chronic diarrhea, nocturnal stooling
- weight loss, fatigue, anemia
- persistent fevers
- perianal disease
Quick summary
- Most abdominal pain is benign, constipation is common and treatable.
- Red flags guide urgent care and targeted testing.
- Celiac/IBD testing is most useful when symptoms are persistent or systemic.
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