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School age stomach aches

Children frequently have abdominal pain weekly during grade school ages. These are for several reasons. The signs that there is significant trouble are these symptoms: Diarrhea more than 7 days; bloody diarrhea (a whole lot of blood with clots, not red streaks here and there.); vomiting; 5 lb. weight loss; or waking up at night with them. The other causes are not bad and I will list them here.

  1. Constipation. Kids do not like using the toilet at school and hold it in all day till they get home. This causes cramps. Give them a mild laxative once a day for three days and see if the symptoms go away. See other articles on encopresis.
  2. Ulcer or acid stomach. Kids are under stress now days and understandable if they listen to the news. Just the normal stress of do your work and watch out for the bullies. This causes acid or a full blown ulcer. You can give them antacids like Maalox or Mylanta (not Tums or Rolaids). Or you can give them one tablet of over the counter Tagamet or Prilosec. These are not habit forming and can be given safely for a period of time.  Most of the time this is caused by an infection in the lining of the stomach by a germ called H. pylori.   it can be treated so see your doctor for tests &/or treatment.
  3. Food Allergy. This may be full allergy or a protein intolerance or lactose intolerance. This can come up at anytime and can be due to foods eaten all their life and now is causing symptoms. It can be from any amount of food or be caused from the volume of the food (especially with lactose intolerance.). For example: A little milk is fine but if they drink 12 oz. plus ice cream they have cramps. The skin tests do not help greatly. Eliminate the food from the diet and watch the symptoms. Do this in food groups: remove the dairy products for 1 week and put them back in the diet. Remove the fruits and juices and put them back in. Remove the vegetables (no problem) for 1 week and put them back in. Then the meats. If a whole group causes the symptoms to stop, then put them back in the diet one at a time. The decide if the removable is worth the lack of symptoms. Check with the doctor to see if supplements need to be given if that food is not eaten.
  4. Urinary infections. Almost always comes with pain on urination or frequency. Ask your doctor about running a test since they do not need to see the doctor to diagnose this. It needs a lab test.
  5. Celiac Disease.  Gluten allergy.  Most people who say they are allergic actually are not.  You can be tested for this.
  6. Stress. When people are trying hard to do good every day, that creates stress in all of us and comes out in different ways. It comes out in headaches, wheezing, hives, and stomach aches. These are real pains and not faking it. Reassurance and understanding how they are hurting is needed but do not let them manipulate you with the cramps. This diagnosis is one of excluding all the other causes.

Often you will wander if the stomach pain is appendicitis on a weekend and should you take them into the ER. Parents cannot tell by pushing on the stomach or by the location of the pain. Here are the tests to see if it could be appendicitis.

  1. Have them cough. Have you ever seen a person after an abdominal operation when they cough? It hurts and they grab their stomach and the have a grimace on their face that tells you it hurt. You do not have to ask them if it hurt, because you can tell on their face. Have the child cough and watch their face for the grimace and grabbing their abdomen.
  2. The other test is have them jump up and down once and watch their face for the grimace.
  3. The last and best test is lay them down on the table or bed and pound firmly on the bottom of one of their feet. This will also jiggle their abdomen and if they have appendicitis, they will grimace and grab their stomach. It may not be appendicitis but it is enough pain for us to evaluate them in the ER. If there is no pain then it almost is never appendicitis. With all these tests, do not ask them if it hurts or if it hurts their stomach, because you will lead them into the answer. Just watch the face.

Of course if there is any question, bring them in and let the doctor check them out.

 

Dr. Knapp