When To Worry About Chronic Abdominal Pain

     The most common cause of recurrent abdominal pain in children is constipation. Constipated children often have large stools although they can have episodes of explosive diarrhea, too. They can complain of pain anytime, but frequently complain during or shortly after a meal. Between episodes of cramping, they feel well. The habit of stool withholding is hard to change, so constipation frequently comes back even after it has been resolved with treatment. It never helps a parent to ask a child if he has “pooped today”, because every child knows that the correct answer is “yes”.

     There are many more serious causes of recurrent abdominal pain and parents need to watch for certain signs to know when to be concerned. If a child has problems swallowing or has mouth sores, he needs evaluation. Constipation can cause occasional vomiting, loose stools and even occasional fever, but any child with abdominal pain and chronic or bloody diarrhea, recurrent fevers or recurrent vomiting needs to be seen by his caretaker. If a child with chronic abdominal pain has weight loss or poor growth, it is very concerning.  A child who wakes up at night with abdominal pain is likely to have a more serious reason for the pain. Chronic skin rash and sore or swollen joints are also worrisome signs.  Finally, the child who has a family history of inflammatory bowel disease, celiac disease, ulcers, diabetes or sickle cell disease needs extra evaluation.