Recurrent abdominal pain in children: what are the possible causes?

Abdominal pain is very common in school-aged children, found in around 10% and accounts for about 40% of referrals to specialists. Whilst there are many potential causes, it’s important to distinguish between functional or organic explanations of abdominal pain to determine the correct treatment.

We sat down with expert paediatric gastroenterologist Dr Assad Butt to find out how to distinguish between both types, focusing on symptoms and the possible causes of tummy pain in your little one.
 

What are the different types of abdominal pain?

The most common is functional pain as opposed to organic pain, the latter, related to an underlying cause. Functional abdominal pain in children can be compared to tension headaches that occur in adults.

When diagnosing functional pain, we look at how feelings or stressors in your child’s environment influence the tummy pain, for example, you would recognise that if you see something terrible or exciting, you get a feeling of butterflies or you feel physically sick in your stomach.

Similarly, if something important like an exam or school performance happens, people may rush to the toilet and get abdominal cramps. These symptoms arise because we are hardwired in a complicated way by nerve connections between the brain and the ‘little brain in the gut’, the autonomic nervous system, which controls the smooth muscle in the gut.

These nerves connections fire-off and cause our guts to squeeze or stretch, which causes pain. There may be no underlying inflammation or disease i.e organic cause, but pain can occur because of this brain-gut link.

These nerve connections may be difficult for parents and kids to understand. They are there because we need them to coordinate our normal gut motility, digestion and absorption. When we eat, these signals go to the gut through the nerves in order to get the gut moving (‘peristalsis’) in the right way. It can be affected when emotions or life-stressors are in the system.
 

What are the symptoms?

Symptoms may be quite varied in nature and severity, include abdominal pain, nausea, diarrhoea, constipation and bloating. All features may be amplified and it’s important to distinguish whether they are symptoms of functional pain or an underlying organic cause.

We are looking to see how this integrates with a child’s normal activities. If the pain is significant to hinder normal activity, such as football, prevent school attendance, it’s worth looking into.

Alarm or red flag symptoms to pay attention to with abdominal pain, include concerns about weight loss, bleeding from the bowels, waking up at night with pain or anything that appears unusual for your child.

There may be another group of symptoms specific to underlying conditions, which fall under organic causes of abdominal pain. These could be related to the waterworks, for example, with a urinary tract infection (UTI) and whether passing frequently or stinging.

Or if there is diarrhoea with blood then it may be due to gut inflammation (e.g. Crohns disease, Ulcerative Colitis). If there are symptoms of celiac disease, it may be related to gluten or wheat in the diet.
 

What does it mean when a child has pain around their belly button?

Pain around the belly button is known as referred pain, which means that it’s coming from the central part of your intestine. Now, typically, short-lived central tummy pain is more often related to functional abdominal pain and of less concern.

We would ask questions to determine the characteristics of the abdominal pain, such as 'where is the pain?'. If it is on one side more than another, in one area, it points to something related to an underlying condition. For example, if pain persists in the back in the loin area, it could be related to a kidney infection. Or if it’s lower down on the right or left side, it might be related to bowel inflammation. Belly button pain that comes and goes is associated more as functional pain.
 

What can you give a child for a stomach ache?

It is always good to have paracetamol to hand as it is relatively safe as well as simple analgesia, which can be given for relief in both functional and organic abdominal pain.

It depends on the cause of the tummy ache but if someone has irritable bowel syndrome (IBS), there are anti-spasmodic medicines that may help, such as Buscopan, peppermint oil capsules, that relax the smooth muscle of the bowel.

In recurring pattern of abdominal pain, you might be able to treat the pain by addressing any underlying non-medical trigger. The way to address it is to question whether there are any possible underlying stressors.

Perhaps your child is being bullied at school, they have anxieties around a recent move of school or house, or there are other family circumstances. Look for stressors in life that may influence and can be reflected as tummy pain.

Minimise the stressors and use of simple cognitive behavioural therapy (CBT) distraction approaches may help

When should I be concerned about my child’s stomach pain?

It should be a cause for concern if the tummy pain is severe, persistent and interferes with normal activities.

If it comes and goes very spontaneously, then you should be less concerned. Look for any red flag features or symptoms pointing to an underlying cause as mentioned above.

Remember that even with a background of recurrent, long term abdominal pain, a severe acute flareup of symptoms may occur.

If in doubt, you must seek advice from NHS helpline / GP or take your child to the emergency department if concerned.

Dr Butt specialises in treating irritable bowel syndrome (IBS)/ inflammatory bowel disease (IBD), acid reflux, abdominal pain, food intolerance, coeliac disease and diarrhoea in children. Do not hesitate to book an appointment for your child to see Dr Butt here if you’re concerned about them showing any of the symptoms mentioned in this article.