Abdominal pain is one of the most common reasons children visit a doctor. The good news: most abdominal pain in kids is not dangerous. The challenging part is knowing when it is serious and what to do in the moment.
This guide helps parents understand:
- The most common causes by age
- Red flags that need urgent assessment
- A simple step-by-step approach at home
- When to book a clinic visit vs. go to the emergency department
Important: This article is for general education and cannot replace medical assessment for your child.
Step 1: First check for “red flags” (seek urgent care)
Go to the Emergency Department / urgent assessment now if your child has abdominal pain PLUS any of the following:
High-risk symptoms
- Severe pain that is worsening or not settling
- Persistent vomiting, especially green/bilious vomiting
- Blood in vomit, or vomiting with severe lethargy
- Blood in stool (especially large amounts or black/tarry stool)
- Signs of dehydration: very dry mouth, no tears, very sleepy, minimal urine
- Hard belly, belly swelling, or significant tenderness to touch
- Pain with fever and your child looks unwell
- Pain in the right lower abdomen with worsening over hours (possible appendicitis)
- Testicular pain or swollen scrotum (can refer pain to the abdomen — urgent)
- New limp, hip pain, or refusal to walk (sometimes presents as abdominal pain)
- Age under 3 months with significant pain/irritability
- Unexplained weight loss, persistent diarrhea, or symptoms waking the child from sleep regularly
If none of these are present, most children can be assessed safely in clinic, and many can be managed initially at home.
Step 2: The most common causes (by age)
Toddlers (1–4 years)
Most common causes:
- Constipation (very common)
- Viral gastroenteritis or viral illness (sometimes pain without much diarrhea)
- Gas and bloating
- Food intolerance (less common than parents think, but possible)
- Urinary tract infection (especially if fever, urinary symptoms, or foul urine)
Less common but important causes:
- Intussusception (episodic severe pain, child draws knees up, may look pale; may have blood/mucus stool)
- Appendicitis (can happen in toddlers, but presentation is often less classic)
- Incarcerated hernia (painful groin lump)
School-age children (5–12 years)
Most common causes:
- Constipation
- Functional abdominal pain (pain without dangerous disease; often stress-related gut sensitivity)
- Reflux/indigestion
- Gastroenteritis
- Lactose intolerance (can appear around this age)
Consider if recurrent/chronic:
- Celiac disease
- Inflammatory bowel disease (IBD) if weight loss, blood, persistent diarrhea
- Abdominal migraine (recurrent episodes with nausea/pallor, family migraine history)
Teens (13+ years)
Most common causes:
- Constipation
- Gastritis/GERD
- Functional pain / irritable bowel syndrome
- Menstrual-related pain (period cramps, ovulation pain)
- Anxiety-related gut symptoms
Important to consider:
- IBD, peptic ulcer disease, gallbladder disease (especially with RUQ pain after fatty foods)
- Pregnancy-related causes in post-pubertal adolescents where relevant
- Ovarian torsion (sudden severe lower abdominal pain, vomiting)
Step 3: The #1 missed cause: constipation
Constipation can look like:
- Pain around the belly button or lower abdomen
- Pain before stooling that improves after passing stool
- Large or hard stools, painful stooling
- Skid marks/soiling (overflow)
- “I go daily” but stools are still hard or incomplete (daily does not rule it out)
Practical tip: A child can be constipated even if they stool regularly.
If constipation is likely and there are no red flags:
- Increase water
- Aim for regular toileting routine (5–10 minutes after meals, feet supported)
- Increase fiber gradually (fruits/vegetables/whole grains)
- If pain is recurrent, talk to your clinician about stool softening therapy (often needed for weeks to months)
Step 4: A simple home approach (when your child seems otherwise okay)
If your child is alert, drinking, and doesn’t have red flags:
What you can do today
- Offer small, frequent fluids
- Keep meals simple (avoid greasy/spicy foods for 24 hours)
- Use warm compress on the abdomen
- Encourage a calm bathroom routine (especially if constipation suspected)
Pain relief
- Acetaminophen can be used if needed
- Avoid using ibuprofen on an empty stomach or if vomiting/dehydrated (it can worsen gastritis and kidney stress)
- Avoid “leftover antibiotics” or strong laxatives without guidance
Step 5: Clues from the pain location and pattern
Around the belly button (periumbilical)
- Constipation
- Viral illness
- Functional abdominal pain
Right lower abdomen
- Appendicitis (especially if worsening, reduced appetite, fever, pain with walking/jumping)
Upper abdomen / burning pain
- Reflux/GERD
- Gastritis
- Peptic irritation (especially if NSAID use)
Pain that comes in waves (severe episodes)
- Intussusception (toddlers)
- Kidney stones (older kids/teens) or urinary causes
- Functional cramps/gas (milder and child looks well between episodes)
Step 6: When to book a clinic visit (not emergency)
Book an appointment (soon) if:
- Pain lasts more than 1–2 weeks, even if mild
- Recurrent pain affects school, sleep, or activities
- Constipation is frequent or stools are painful/hard
- There is poor appetite, nausea, or early fullness
- There are symptoms of reflux, frequent burping, or heartburn
- There is a family history of celiac disease, IBD, or ulcers
Your clinician may consider:
- Growth/weight review
- Basic labs if indicated (for anemia, inflammation, celiac screening)
- Urine test (UTI)
- Stool tests if diarrhea/blood is present
Step 7: When abdominal pain is “functional” (and still real)
Functional abdominal pain means:
- The pain is real, but not caused by a dangerous disease.
- The gut is more sensitive (brain–gut axis), often after infections or during stress.
- The goal is improving function: school attendance, sleep, normal meals, regular stooling.
Helpful strategies often include:
- Constipation management (even mild constipation can drive pain)
- Regular meals and sleep
- Stress support, school support, and reassurance
- In some children, targeted therapies guided by a clinician
Quick summary (what parents should remember)
- Most childhood abdominal pain is not dangerous.
- Always check for red flags: severe/worsening pain, bilious vomiting, blood, dehydration, very unwell appearance.
- Constipation is the most common cause and is frequently missed.
- If pain is recurrent or affects daily life, a structured clinic assessment is helpful.
If you’d like, I can write the next post in the series: “Vomiting in the newborn (0–28 days): normal spit-up vs urgent vomiting” with clear red flags (especially bilious vomiting), dehydration signs, and common diagnoses.
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