Parenting: Toddlers

Every parent knows how frustrating a stomachache can be. Whether your child is old enough to point to her "tum tum" or just cries inconsolably, you're probably worried and looking for some help on how to handle your little one's tummy troubles and when to head to the doctor. Here's a little expert guidance.

First of all, this is probably not your first – or last – episode of tummy troubles. In fact, abdominal pain in kids is one of the top reasons parents take their children into the emergency department. And that's where I see them. Maybe your child is fussy or hasn't eaten. Maybe he's vomiting or has had diarrhea. Maybe he hasn't pooped for a few days. Most likely, at this point he's just mad – at the pain, at you and most definitely at me, the doctor who wants to examine him.

By the time you get to the hospital and see a doctor, you may be nearly as upset as your child since you just can't figure out how to make his belly better. I can help, but I have to admit that abdominal pain can be just as challenging for the doctor as for the parents. Sometimes, we can cure the stomachache without ever finding out what caused it, though we will make sure it isn't something serious.

The truth is that belly pain can be caused by something trivial, like a little constipation, or by something that can turn ugly, like appendicitis. But it's not always easy to tell them apart. The good news is that most belly pain gets better quickly on its own. The hard part is knowing when you need to see a doctor. That's where I hope to point you in the right direction.

What Causes Stomach Pain?
The most common causes of abdominal pain in a child are the least likely to last or cause any real harm. Your child may develop belly pain after eating too fast, eating too much or developing gas. This pain will go away after some digestion and a little rest.

Constipation is also a frequent cause of stomachaches. Constipation does not refer to just how often your child has a bowel movement, but what its consistency is. So even if your child is stooling twice a day with hard, dry round balls, she is constipated. On the other hand, if she goes only every other day, but has soft, long stools, she is not constipated.

Keep in mind that if your child is potty trained, you may not have any idea how often she has a bowel movement (or what it looks like!). But this is important information, especially if your child is complaining of stomachaches. Don't rely on your child to keep track of when she goes – ask her often and write it down. This is excellent information to share with the pediatrician.

Infections caused by viruses and bacteria also can cause belly pain. A stomach flu (also called gastroenteritis) or food poisoning (eating spoiled food) also may cause vomiting or diarrhea. You may be surprised to learn that other infections, like ear infections or even throat infections (like strep throat), also can cause belly pain in kids. A viral infection will get better within a few days. A bacterial infection may need antibiotics to be treated.

Diet changes, like having a lot of juice, milk or fruit, also can result in a stomachache and diarrhea. This should resolve itself within a day. Food allergies can also cause problems. If stomachaches are frequent, keep track of what your child ate before developing the pain or diarrhea. In older children, milk products like ice cream, cocoa and cheese may cause belly pain and bloating. Starting a new medication also can bring on tummy troubles.

Injury to the abdomen is another pain generator. Ask your child if he fell or got hurt in the belly – often children don't tell you when they fall, but seek help when the injury starts to bother them. Heavy lifting and exercise (like on a jungle gym) may also strain the belly muscles and cause pain down the road.

Poisoning is a serious cause of belly problems and can be hard to detect if your toddler was sucking on a bar of soap out of your sight, or your youngster swallowed a tube of tasty toothpaste. Prevention is important, and childproofing cabinets with medications and cleaners is essential.

Medical and surgical issues also can come up unexpectedly, such as appendicitis (inflammation of the appendix, a small part of the bowel) or belly pain caused by diabetes or a spider bite.

Understanding Your Child's Pain
Asking the right questions will help you get to the bottom of what is going on and whether you should be worried. Plus, it will help you describe the problem accurately and completely to the doctor. Here are a few important questions you can ask yourself and your child:

• When did the pain start? How long has it lasted? (Pain that has no other symptoms and goes away within an hour or two is probably not serious.)
• How often does your child have belly pain?
• What does the pain feel like? Is it crampy, dull or sharp? Is it severe?
• Where is the pain located? All over the belly or in just one area?
• Has your child had any injuries to the belly?
• What other symptoms does your child have? Vomiting? Not eating well? Diarrhea? Constipation? Fussiness? Fever? Not sleeping well? Lack of energy?
• Has your child been drinking well or does she seem dehydrated (not peeing often, crying without tears)?
• What does your child's stool look like? Is it watery or runny? Or hard and dry? Does it have blood in it?

Things to Watch Out For
Now that you know what the pain is really like, you have a better idea of whether you should be worried - and whether to call your doctor or head straight to the emergency department.

Call a doctor immediately if:

• Your child looks really ill. You know your little one best; if he is feverish, unusually worn out, weak or just "looks bad," get help right away.
• Your child is not drinking any fluids. A child can become dehydrated very quickly, especially if he is also feverish or has vomiting or diarrhea.
• The pain is severe or comes on really suddenly (severe pain can cause your child to double over, ball up or arch his back).
• You notice that his stool or vomit is dark or has blood in it.
• Your child has a rash on her skin along with the belly pain.
• Your child is dehydrated and has fewer than three saturated diapers a day or doesn't have tears when crying.
• The pain is in the lower right part of the belly or in the testicles or is worse with urination.
• The belly pain, diarrhea or vomiting has lasted longer than 12 hours.

What You Can Do at Home
The doctor you talk with or who examines your child may order some tests to determine what is causing the pain or may give you some instructions on how to take care of your child at home. Rarely, children have to be admitted to the hospital for treatment when they need surgery or are very ill.

If you are taking care of your child at home, there are a few things you can do to help her get better. Allow your child to rest. Sleep often helps the pain resolve. Make sure your little one is drinking. She will do fine without solid food for a few days, but she needs lots of fluids. If she is vomiting, give a couple ounces of liquids at a time. Re-hydration drinks, such as Pedialyte, are especially good.

Give your child any prescribed medications as directed by the doctor. Talk with the doctor about any home remedies you have tried or want to use, because they could affect the treatment. Don't use any adult medications or old antibiotics. If she has a fever, take her temperature every four hours.

In most cases, a good nap and some TLC will do the trick, and your child will be back to her usual curious, cheerful, high-energy self. And a little tickle on the tummy won't hurt a bit.