Abdominal Pain in Kids: What Should We Know?

baby crying

As a post Passover Post, I really wanted to focus on something spring-like, festive and light. Unfortunately, medical advocacy doesn’t lend itself to those themes, but I will try to bring rays of promise into a trying situation.
I received a call from a client who told me that she had rushed her teenage daughter to the ER with acute abdominal (stomach) pain. After many tests, blood, x-ray, ultrasound, they were no closer to a diagnosis, so they sent her home. Two days later she was back again, same extreme pain yet no closer to a diagnosis. She was at her wit’s end, both the daughter and the mother.

I often encounter concerned parents at this juncture. It is very stressful to have extreme anything, fever, pain, rash, and not know the cause or the cure. Unbelievably stressful. And for those of us who encounter it, we cannot believe that doctors are not pulling out all the stops immediately and resolving our acute issue NOW. However, and this is where things get difficult, all health care providers know the two most difficult things there may be to know a) the majority of the health events are not life threatening and b) rare events, are, indeed, rare.
For example, it is important to understand the signs of appendicitis in children, including but not limited to, acute abdominal pain. Yet, actual appendicitis only occurs in 1% of children admitted to the ER for acute abdominal pain.

It is the responsibility of the physician to examine the child, and rule out the possible lists of serious (and not so serious) causes, using blood tests, x-rays, ultrasounds, CTs and perhaps even MRIs. However, as I saw summarized in one medical article, “Any classic presentation of diagnosis for abdominal pain should be considered a gift to the physicians on the front lines.”

This means that, most of the time with abdominal pain, we’re flying blind and have to rule out appendicitis, Crohn’s disease, twisted ovary (even in girl infants), celiac disease, ovarian cyst, gallstones, and a laundry list of other possibilities. Unfortunately, this elimination process demands time, patience, and the ability to consult with other doctors, three elements that ER doctors often do not possess.

All this leads me to say that acute abdominal pain in children can mean something serious that requires surgery, but most of the time it is self limiting and will disappear with time. It is on the parent to act as a ‘patient’ medical advocate, and keep the system moving while understanding the possible pitfalls.

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