🤕🧒 Abdominal Pain in Children

A detailed parent guide: what to do today, red flags, constipation plan, and when to test for celiac disease or inflammatory bowel disease

✅ Quick note: Belly pain is extremely common in children. Most causes are not dangerous, but some need urgent care. The safest approach is:

1. Rule out emergencies,
2. Check constipation and common benign causes,
3. Do targeted testing only when it makes sense.

🧾 Quick “At-a-glance” box

✅ Condition: Abdominal pain in children
Common parent terms: Stomach ache, tummy pain, cramps, “my belly hurts”

What it is (2–3 lines): Abdominal pain can come from the stomach/intestines, constipation, infections, urinary issues, inflammation, or the gut–brain connection. In many children the pain is functional (real pain, normal tests). The key is spotting red flags and treating common causes early—especially constipation.

Who it affects (typical ages): All ages; very common in toddlers and school-age children.

✅ What parents should do today:

• Check for red flags (below).
• Check for constipation clues (hard stools, withholding, infrequent stooling).
• Start a simple home plan: hydration, gentle foods, track symptoms, and consider constipation steps.

⚠️ Red flags that need urgent / ER care:

• Severe or worsening pain with a hard/rigid belly or guarding
• Green (bilious) vomiting, repeated vomiting, or blood in vomit
• Black/tarry stools or large amounts of rectal bleeding
• Fever plus worsening pain and a child who looks very unwell
• Right-lower belly pain (appendicitis concern), testicular pain/swelling
• Dehydration, lethargy, altered behavior
• Age under 3 months with significant pain/irritability

🟡 When to see the family doctor/clinic:

• Pain lasting > 1–2 weeks, recurring weekly, or affecting school/play
• Poor growth, weight loss, persistent vomiting, chronic diarrhea
• Blood in stool, nocturnal symptoms (waking at night), persistent fevers
• Strong family history of celiac disease or inflammatory bowel disease

🧠 What it is (plain language)

Belly pain is a symptom, not a diagnosis. It can come from:

• Constipation (very common)
• Viral illnesses and mild infections
• Gas, reflux, indigestion
• Urinary tract infection
• Appendicitis or other urgent problems (less common)
• Celiac disease or inflammatory bowel disease (uncommon, but important when red flags are present)
• Functional abdominal pain (real pain related to gut sensitivity + stress + gut–brain signaling, with normal testing)

What part of the body is involved? (small diagram required)

Common myths vs facts

• Myth: “If tests are normal, the pain isn’t real.”
  Fact: Functional pain is real and common; the gut can be extra sensitive.
• Myth: “Constipation always means no stool for days.”
  Fact: Some children stool daily but are still constipated (hard stool, incomplete emptying, withholding).
• Myth: “Appendicitis is always obvious.”
  Fact: It can look different in young children and may start around the belly button.

🧩 Why it happens (causes & triggers)

Common causes

• Constipation and stool withholding
• Viral gastroenteritis or viral illness
• Gas and bloating
• Indigestion/reflux symptoms
• Anxiety/stress-related gut symptoms
• Urinary tract infection (especially with urinary symptoms or fever)

Less common but important causes (brief)

• Appendicitis
• Intussusception (especially toddlers with episodic severe pain)
• Celiac disease
• Inflammatory bowel disease
• Gallbladder disease (more in teens)
• Gynecologic causes in teens (period-related pain, ovarian cysts)
• Testicular torsion in boys (urgent)

Triggers that worsen symptoms

• Skipping breakfast, dehydration
• Stressful mornings/school stress
• Constipation triggers (low fiber, low fluids, withholding)
• Large heavy meals or very greasy foods
• Poor sleep

Risk factors

• Prior constipation, painful stooling, withholding behavior
• Family history of celiac disease or inflammatory bowel disease
• Poor growth/weight loss
• Chronic diarrhea, blood in stool
• Allergies/eczema/asthma may co-exist with functional gut disorders (not a diagnosis on its own)

👀 What parents might notice (symptoms)

Typical symptoms (most common first)

• Belly pain around the belly button (common in functional pain)
• Intermittent cramps
• Bloating and gas
• Nausea without persistent vomiting
• Pain that comes and goes, often worse during stress or mornings
• Constipation clues (hard stools, withholding, painful stooling)

Symptoms by age group

Infants (0–12 months)

• Fussiness/irritability can be many things; abdominal pain is harder to confirm
• Concerning signs: persistent vomiting, blood in stool, poor feeding, fever, dehydration

Toddlers (1–4 years)

• Constipation (very common)
• Viral illness
• Urinary tract infection
• Intussusception (episodic severe pain, may pull legs up, may vomit)
• Appendicitis (can be less classic)

School-age (5–12 years)

• Constipation
• Functional abdominal pain / irritable bowel syndrome
• Indigestion or reflux symptoms
• Consider celiac disease or inflammatory bowel disease if red flags

Teens

• Constipation, irritable bowel syndrome, reflux/gastritis
• Menstrual-related pain
• Inflammatory causes if systemic symptoms (weight loss, blood in stool, fevers)

What’s normal vs what’s not normal

• ✅ Often normal: mild pain with normal energy, improving with rest or stooling, no red flags
• ⚠️ Not normal: persistent vomiting, blood in stool, weight loss, fever with severe pain, waking at night from pain, severe localized right-lower pain, rigid belly, dehydration, very unwell appearance

Symptom tracker (what to write down)

• Pain timing (morning, after meals, at night)
• Location (belly button, right lower, left lower, generalized)
• Severity (0–10) and duration
• Stool pattern (frequency, hardness, pain, withholding, accidents/soiling)
• Vomiting (how often, green or not)
• Fever, appetite, hydration, urine output
• Triggers (school stress, certain foods, skipping meals)

🏠 Home care and what helps (step-by-step)

✅ Do this now: If no red flags, your goal is comfort, hydration, and identifying constipation.

What to do in the first 24–48 hours

• Offer small frequent fluids (water is fine; oral rehydration solution if vomiting/diarrhea)
• Gentle foods if hungry (toast, rice, yogurt, soup, fruit)
• Heat pack on the belly (if soothing)
• Calm routine and normal activity as tolerated
• Start a simple symptom + stool tracker

Supportive care basics

• Fluids: encourage regular drinking; dehydration worsens cramps and constipation
• Nutrition: do not force large meals; small frequent is fine
• Sleep: keep bedtime routine steady
• Comfort: warm bath, heating pad, distraction

Practical routines (constipation-focused)

• Toileting after meals (especially after breakfast and dinner)
• Feet supported (stool under feet) with knees slightly above hips
• 5–10 minutes, relaxed, not rushed
• Praise effort, not results

What usually makes it worse

• Skipping breakfast and rushing to school
• “Holding it” (stool withholding)
• Stopping constipation treatment too early
• Highly processed, low-fiber diet with low fluids
• High stress without coping tools

⛔ What NOT to do (common mistakes)

• Do not ignore red flags or severe localized pain.
• Do not repeatedly give laxatives “randomly” without a plan if constipation is ongoing—most children need a structured approach.
• Do not start a gluten-free diet before celiac testing (it can make tests inaccurate).
• Do not give leftover antibiotics or frequent pain medicines without clinician guidance.

Over-the-counter medication cautions

• Avoid frequent use of non-steroidal anti-inflammatory drugs (for example ibuprofen) for belly pain unless advised.
• Do not use anti-diarrhea medicines in young children unless a clinician specifically recommends them.
• If pain is frequent enough to need medicine often, book a clinic visit.

🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• Very severe pain with a rigid/hard belly and a child who looks extremely unwell
• Trouble breathing, collapse, or severe lethargy/hard to wake
• Severe testicular pain with swelling (possible torsion)

Example: “My child is very sleepy, pale, and the belly is hard with severe pain.”

🟠 Same-day urgent visit

• Severe or worsening pain, guarding, refusing to walk/jump
• Green (bilious) vomiting or persistent vomiting
• Fever with worsening pain and unwell appearance
• Blood in vomit, black stools, or large rectal bleeding
• Right-lower belly pain (appendicitis concern)
• Dehydration: very dry mouth, no urine for 8–12 hours, very dizzy
• Infant under 3 months with significant pain/irritability

Example: “Pain moved to the right lower belly and walking hurts.”

🟡 Book a routine appointment

• Recurrent pain affecting school, sports, sleep, or mood
• Constipation symptoms lasting weeks
• Poor growth, weight loss, fatigue, anemia concerns
• Chronic diarrhea, blood in stool, nocturnal stooling
• Strong family history of celiac disease or inflammatory bowel disease

Example: “Belly pain happens weekly and they are missing school.”

🟢 Watch at home

• Mild pain, normal energy, no red flags
• Improves with stooling, hydration, rest
• Short-lived pain during mild viral illness

Example: “Mild cramps that improved after a bowel movement and fluids.”

🩺 How doctors diagnose it (what to expect)

What the clinician will ask

• Exact pattern of pain (timing, triggers, location, severity)
• Stool history (constipation, soiling, painful stooling)
• Vomiting (how often; green or not)
• Fever, blood in stool, weight changes
• Diet, hydration, sleep, stress, school attendance
• Family history (celiac disease, inflammatory bowel disease)

Physical exam basics

• Growth measurements and vital signs
• Abdominal exam (tenderness, guarding, masses)
• Hydration check
• Genital exam when needed (for testicular pain in boys)

Possible tests (and why)

• Urine test (urinary tract infection)
• Blood tests if red flags: anemia, inflammation markers, liver/pancreas tests depending on symptoms
• Celiac screening blood tests when indicated
• Stool tests when chronic diarrhea or blood is present
• Ultrasound if appendicitis is suspected

What tests are usually not needed

• Extensive imaging for mild, brief pain with normal growth and no red flags
• Broad “everything” bloodwork when symptoms strongly fit constipation or functional pain

What results might mean (simple interpretation)

• Normal growth + no red flags often supports constipation or functional pain
• Anemia, inflammation, persistent diarrhea, or blood in stool may prompt evaluation for inflammatory bowel disease or other conditions

🧰 Treatment options

First-line treatment

• Treat constipation if suspected (see constipation plan below)
• Hydration and routine meals
• Sleep and stress supports
• Return to normal activities as tolerated (avoid prolonged bed rest)

If not improving (next steps)

• Review constipation plan (most failures are due to stopping too early or under-dosing)
• Consider targeted testing (urine, celiac screening, inflammation markers) based on red flags
• Consider referral if persistent, severe, or affecting quality of life

Severe cases (hospital care)

• Appendicitis concern
• Severe dehydration
• Persistent vomiting
• Severe pain with red flags
• Significant bleeding

💩 Constipation plan (parent-friendly)

✅ Do this now: Constipation is one of the most common—and most treatable—causes of belly pain.

Consider constipation if any of these are present

• Hard stools, painful stooling, withholding
• Soiling/overflow (stool accidents)
• Belly pain improves after stooling
• Very large stools or infrequent stools
• “I don’t want to go” fear or avoiding the toilet

Practical steps at home

• Increase fluids gradually
• Add fiber slowly (fruits, vegetables, whole grains)
• Toileting after meals with feet supported
• Keep a stool diary (frequency and stool type)

Stool-softening therapy (often needed longer than expected)

Many children need a stool softener plan guided by a clinician, often for weeks to months, not just a few days.

Why constipation treatment “fails” most commonly

• Stopping too early
• Under-dosing
• Not addressing withholding behavior and routine
• Not following up to adjust the plan

🥖 When to test for celiac disease

🟡 Consider screening when belly pain is recurrent plus one or more of the following:

• Poor growth or weight loss
• Anemia (especially iron deficiency)
• Chronic diarrhea, bloating
• Strong family history of celiac disease
• Autoimmune conditions (for example type 1 diabetes, thyroid disease)

⚠️ Important: Do not stop gluten before testing. A gluten-free diet can make results falsely normal.

🩸 When to evaluate for inflammatory bowel disease (IBD)

🟠 Higher suspicion when any of these are present:

• Blood in stool, chronic diarrhea, nocturnal stooling
• Weight loss, fatigue, anemia
• Persistent fevers
• Significant abdominal pain plus systemic symptoms
• Perianal disease (pain, drainage, fistula/abscess concerns)

If these are present, targeted testing and specialist evaluation may be needed.

⏳ Expected course & prognosis

Typical timeline

• Mild viral illness pain often improves within days
• Constipation-related pain may improve within days once stooling improves, but prevention requires longer follow-through
• Functional abdominal pain often improves gradually over weeks with routine, constipation management, and coping tools

What “getting better” looks like

• More comfortable stooling
• Fewer pain episodes
• Better appetite and sleep
• Less school avoidance

What “getting worse” looks like

• Increasing frequency/severity
• Pain waking from sleep
• Persistent vomiting, blood in stool, weight loss, fever
• Localized right-lower pain

Return to school/daycare/sports guidance

• Encourage normal attendance when safe
• Make a plan for bathroom access and regular meals/snacks
• Avoid long absences unless medically needed

⚠️ Complications (brief but clear)

Common complications

• Missed school, anxiety around pain
• Stool withholding and worsening constipation cycle

Rare serious complications (red-flag reminder)

• Appendicitis or bowel obstruction
• Severe dehydration from vomiting/diarrhea
• Significant intestinal inflammation (inflammatory bowel disease)

🛡️ Prevention and reducing future episodes

• Regular hydration and breakfast routine
• Prevent constipation: fiber + fluids + toileting routine
• Sleep routine
• Stress supports (breathing, relaxation, coping skills)
• If food triggers are suspected, avoid unnecessary restriction and discuss with a clinician/dietitian

🌟 Special situations

Infants

• Abdominal pain is harder to interpret; lower threshold for medical assessment
• Any poor feeding, persistent vomiting, fever, or dehydration needs urgent review

Teens

• Consider menstrual-related pain, stress, sleep patterns
• Ask privately about stool pattern and blood in stool

Kids with chronic conditions (asthma, diabetes, immunosuppression)

• Lower threshold for assessment if fever, persistent diarrhea, or weight loss

Neurodevelopmental differences/autism

• Pain may show as behavior change
• Use simple trackers, visual schedules, consistent toileting routine
• Consider sensory preferences for food textures during illness

Travel considerations

• Carry oral rehydration solution packets
• Keep constipation supports (routine, hydration)
• Know local urgent care access

School/daycare notes

• Bathroom access without delay
• Water bottle access
• Permission for scheduled toilet sits (after lunch) if constipation plan is in place
• Supportive response to pain without sending home automatically if mild and no red flags

📅 Follow-up plan

• Follow up with your family doctor/pediatrician if:
  • Pain persists > 1–2 weeks, is recurrent, or affects quality of life
  • Constipation plan is not improving symptoms
  • Any red flags develop
• Bring to the appointment:
  • Symptom diary + stool diary
  • Photos of stool if helpful
  • Medication list and prior test results

❓ Parent FAQs

“Is it contagious?”

Sometimes. Viral gastroenteritis can be contagious; constipation and functional pain are not.

“Can my child eat ___?”

Usually yes. During pain flares: small frequent meals and gentle foods. Avoid unnecessary restriction unless advised.

“Can they bathe/swim/exercise?”

Yes if they feel well and have no red flags. Gentle movement can help constipation.

“Will they outgrow it?”

Many children improve as constipation is controlled and coping tools build. Persistent red flags need evaluation.

“When can we stop treatment?”

Once symptoms are stable and routines are established. Constipation treatment often needs a longer plan than expected—ask your clinician before stopping.

🧾 Printable tools

🧾 Printable: One-Page Action Plan (Belly Pain)

Step 1: Check for emergency red flags

• Hard/rigid belly, severe worsening pain, guarding
• Green vomiting or repeated vomiting
• Blood in vomit, black stools, large rectal bleeding
• Fever + very unwell appearance
• Right-lower belly pain (appendicitis concern)
• Testicular pain/swelling
• Dehydration / lethargy / altered behavior
• Under 3 months with significant pain/irritability

If any are present: seek urgent care.

Step 2: If no red flags

• Hydration (small frequent sips)
• Gentle foods if hungry
• Heat pack if soothing
• Start symptom + stool tracker
• Check constipation clues and start constipation routine

🧾 Printable: Medication Schedule Box

Use only if your child has clinician-prescribed medications.

• Morning: ____________________ Time: ______
• Afternoon: __________________ Time: ______
• Evening: ____________________ Time: ______
• Notes / side effects to watch: ______________________________________

🧾 Printable: Symptom Diary / Tracker

Date: _______ Time: _______

• Pain location: ________________________________________________
• Severity (0–10): _____ Duration: _____________________________
• Trigger (food/stress/sleep/illness): ____________________________
• Stool today (hard/normal/loose) + frequency: ____________________
• Vomiting / fever / blood in stool: ______________________________
• What helped: _________________________________________________
• Urine output today (normal/less): ______________________________

🧾 Printable: “Red flags” fridge sheet

⚠️ Urgent / ER if: rigid belly, severe worsening pain, green vomiting, persistent vomiting, blood in vomit, black stools, large rectal bleeding, fever + very unwell child, right-lower belly pain, testicular pain/swelling, dehydration, lethargy/altered behavior, infant under 3 months with significant symptoms.

🧾 Printable: School/Daycare Instructions Page

This child has recurrent abdominal pain and may need supportive steps at school:

• Allow water bottle access
• Allow bathroom access without delay
• Allow brief rest break if mild pain
• Encourage return to class when settled
• Contact parent if severe pain, vomiting, fever, blood in stool, or concerning change

🧡 Safety disclaimer

This guide supports—not replaces—medical care. If you are worried about your child, trust your instincts and seek urgent medical assessment.

This guide was fully developed & reviewed by Dr. Mohammad Hussein, MD, FRCPC ROYAL COLLEGE–CERTIFIED PEDIATRICIAN & PEDIATRIC GASTROENTEROLOGIST Board-certified pediatrician and pediatric gastroenterologist (Royal College of Physicians and Surgeons of Canada) with expertise in inflammatory bowel disease, eosinophilic gastrointestinal disorders, motility and functional testing, and complex nutrition across diverse international practice settings.

To book an online assessment Email Dr. Hussein’s Assistant Elizabeth Gray at: Elizabeth.Gray@pedsgimind.ca
In the email subject, please write: New Assessment Appointment with Dr. Hussein

Important: This appointment is completely online as Dr. Hussein is currently working overseas. This service is not covered by OHIP

Free Printable for Parents

Get our pediatrician-approved Constipation Action Plan (PDF) by email.