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Some of the most common concerns I see in my everyday practice have to do with abdominal pain. This is a very complex problem since there are so many different things that can cause it. The list sometimes feels endless, however, there are many factors and predictors that can narrow down the likely cause of it. Even so, as providers, we first have to ask several different questions, do a very detailed physical exam, we sometimes have to run several tests and/or imaging before we can figure out what is wrong.
The first thing to keep in mind is if the abdominal pain is something acute or chronic. A new severe pain may be an indication of a life-threatening problem. The most common surgical cause in pediatrics is appendicitis. The most common medical cause of acute pain is the one that accompanies vomiting and diarrhea (which we call gastroenteritis). A dull pain on and off that has been there for several days is also not to be taking lightly. A chronic pain, on and off, and present for several weeks or months can be caused by many different things as well–although one of the most common ones that I see in my practice is constipation.
It is very important to capture as much information as you can to tell your doctor about the pain: how long has it been there, where is it exactly located (ask your child/teen to point with ONE finger at the exact location where it hurts the most), the timing (before eating? After eating? Not related to food? After a sore throat started?) The severity: on a scale of 1-10 how much does it hurt? Is it there constantly or does it go on and off, does it feel like a burning sensation? Or like someone squeezing? How long does it last? Minutes, hours? Does it move somewhere else? How does it get better if it does? Every piece of information you can give us will be useful!
Acute Abdominal Pain
Acute gastroenteritis – which means vomiting and diarrhea – is a very common cause of acute (sudden, new) pain. The most common cause of this is viruses. Some few times it can be the presentation of a bacterial infection though. Antibiotics kill bacteria, so they will only be helpful in that last scenario. For vomiting, diarrhea and abdominal pain from cramping, if it is a viral process causing the issue, then the treatment is supportive: meaning we make sure we keep our young ones hydrated, pushing fluids (mostly water and an oral rehydrating solution). Important other measures to take into account are avoiding juices – juices will make the stool more profuse! If the patient is a very little one still in diapers, it is very important to be aggressive with applying some kind of protective cream or gel in the diaper area to prevent diaper rash. Making sure that they have at least 3 urinations in 24 hours is also very important–that ensures that they are not getting dehydrated.
Starting a probiotic is also helpful in many cases. Certain foods will also help: bananas, rice, apples, toast are known to cause constipation that can be encouraged more during this illness. Avoiding fried food that can make vomiting worse is also important. So push fluids, avoid juices though, watch for signs of dehydration, and start things in their diet that can make the stool more solid. It may sound incredibly long but all medical literature supports that we should be concerned with diarrhea only if it goes past 15 days. The exception to this will be diarrhea with blood, fever, severe abdominal pain or vomiting so bad that it is impossible to keep anything you drink in your stomach – for which you should look for medical attention immediately.
Dr. Gomez practices medicine at Pediatrics of Queen Creek, PLLC, 22709 S. Ellsworth Rd, Ste F104, Queen Creek, 480-792-9200; Dr.Gomez@bethesdapeds.com; www.BethesdaPeds.com.
Dr. Gomez is a board certified Pediatrician, who knew from an early age that she wanted to be a “doctor for children and teenagers”. She and her husband moved to Arizona in 2006, shortly after marrying, and then began her pediatric residency program in 2007 at St. Joseph’s Hospital and Medical Center in Phoenix. She took over Pediatrics of Queen Creek upon finishing her residency in 2010. At her graduation she was given the 2010 The Walt Vikram Award, granted to the graduate that had demonstrated the most exemplary compassion in the care of newborns. She has worked with community programs to teach and educate the public on several health topics. She has a special interest in educating parents about healthy eating, breastfeeding and helping those families dealing with asthma. Dr. Gomez is a mother of 2: a very funny and active boy and a loud and happy daughter. They enjoy traveling and their special Friday movie nights at home.
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