“In the middle of the night
Miss Clavel turned on her light
and said, “Something is not right!
Little Madeline sat in bed
cried and cried – her eyes were red.”
Now, like plucky little Madeline in the classic Ludwig Bemelmans tale, your child complains of a tummy ache. Should you call the pediatrician? It might be nothing. Kids often have vague stomach-related complaints that turn out to be nothing much. But what if it’s a true emergency?
“And soon after Dr. Cohn
came, he rushed out to the phone,
and he dialed: DANton-ten-six –
‘Nurse,” he said, “it’s an appendix!’”
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Stomach pains are among the most common health symptoms—leading to 5 to 10 percent of all emergency room visits—and among the trickiest to diagnose. About 25 percent of people seen in the ER for stomach pains are discharged with a diagnosis of “undifferentiated abdominal pain,” meaning the doctors couldn’t quite figure out what was causing the symptoms. About 80 percent of those people end up feeling fine within two weeks, find University of Colorado Denver School of Medicine researchers.
Here’s how you can know when to wait and see if symptoms improve, when to call the doctor, and when to go right to the emergency room:
Wait and see if…
Your child’s symptoms are mild and new—such as bloating after eating a meal, discomfort during bowel movements, slight fatigue. If symptoms pass quickly, they might just signal a short bout of indigestion or constipation. If they persist or recur, see your doctor. Similarly, if you know a bad stomach flu is going around the school and suddenly your child starts having stomach cramps and vomiting, keep him home from school and monitor him. If he doesn’t improve quickly, call the doctor.
Call the doctor if:
Your child’s symptoms are persistent or chronic, even if they are mild. Chronic symptoms that might signal a more serious problem include:
- mild or dull stomach pain that doesn’t go away after a couple of days
- stomach discomfort accompanied by changes in bowel movements or habits (more or less frequent, pain when defecating, looser or harder stools)
- stomach pain accompanied by unexplained weight loss
- prolonged fatigue or yellowing of your child’s skin or the whites of the eyes
Go to the emergency room if your child has:
- stomach pain caused by an injury or accident
- abdominal pain along with chest pain or pressure
- pain that begins in the navel area, worsens within hours and moves to the lower right abdomen, possibly accompanied by nausea, vomiting, mild fever, gassy feeling. (Yes, Madeline, in addition to crying, these are signs of appendicitis.)
- any stomach pain that is severe or intolerable
- abdominal pain that is accompanied by a fever (indicates infection)
- stomach pain that worsens when you press on the area that hurts – but hurts even more when you lift your hand and let go (sign of a potentially life-threatening condition called peritonitis)
- blood when vomiting or in your bowel movements or unusually dark or black stools
“These symptoms require immediate medical attention and you should go to the emergency room,” says gastroenterologist Patricia Raymond, M.D., associate professor of clinical internal medicine at Eastern Virginia Medical School in Norfolk, Virginia. “Most doctor’s offices don’t have the ability to get back blood tests or scans soon enough to diagnose a serious acute problem that may require emergency surgery.”
Tips when your child sees a doctor
Whether you go to the ER or the doctor’s office, Dr. Raymond says try to think ahead so you can be as precise as possible about the character of the pain: Is it burning? Stabbing? Cramping? Dull? Is it only in one area or does it move around your abdomen? What makes it worse? Better?
“If you have had the problem for a while, keeping a log of your symptoms and bringing it into your appointment can really help,” says Raymond. “Knowing your family history is important, too.” If your child has belly pain “and both of your sisters have Crohn’s disease, I need to know that.” Thinking ahead about your symptoms helps make every moment with the doctor count and may mean a faster, more accurate diagnosis.
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Laura Flynn McCarthy is a New Hampshire-based writer who specializes in health and parenting topics.