Lower abdominal pain in a child

Pain in the lower abdomen in children is a common occurrence that can be caused by simple overeating or an unhealthy diet, as well as by more serious diseases. Identifying the correct cause requires taking into account accompanying symptoms, and laboratory or instrumental diagnostics may be needed.

Causes and Symptoms

Pain in the lower abdomen may result from functional disturbances related to growth and body restructuring, improper diet, or intentional delay in urination or defecation (a child may hold it in during class or while traveling). This is more common during school age.

First Year of Life

In infants, abdominal pain can be due to the underdeveloped digestive system, which is still forming and adjusting. Since the baby cannot articulate what bothers them, be alert for these signs:

  • Unexplained crying or screaming
  • Curling up in a fetal position, kicking legs
  • Refusal to drink milk or formula
  • Slow weight gain
  • Frequent or excessive regurgitation, vomiting
  • Blood streaks in stool

Enzyme deficiency (commonly lactase deficiency) is often observed, where the body cannot break down certain substances. Another possible issue is food allergies (e.g., gluten, cow’s milk protein).

Helminth Infection

Infections with pinworms (enterobiasis), roundworms (ascariasis), or giardia (giardiasis) are common causes. Younger children, especially those under 4 years old, are more likely to neglect personal hygiene. Pain typically occurs in the lower abdomen or near the navel, accompanied by:

  • Weakness
  • Pale skin, dark circles under the eyes
  • Headaches
  • High fever
  • Vomiting
  • Diarrhea
  • Teeth grinding during sleep

With enterobiasis, the child complains of itching around the anus, especially at night when the muscles relax, and pinworm females crawl out to lay eggs. Giardia infection is characterized by foul-smelling, watery stool and skin issues (hives, eczema, dermatitis). Ascariasis may cause malaise, reduced activity, drooling, and coughing.

Digestive System Pathologies

In children, lower abdominal pain often results from gastrointestinal issues. In adolescents, poor diet and irregular eating habits can contribute to this problem.

One of the most common causes of abdominal pain is acute intestinal infections, which include a range of bacterial and viral diseases that disrupt gastrointestinal motility, leading to diarrhea and intoxication. In addition to abdominal pain, symptoms include fever, nausea, vomiting, and bloating. Specific signs of infections include:

  • Typhoid fever: pale, dry skin, and red rashes appear on days 8-9 (up to 3mm)
  • Dysentery: dull, diffuse pain at first, then sharp, crampy pain usually in the lower left abdomen, which intensifies before defecation
  • Rotavirus infection: abundant, yellow, foamy stool with a strong odor, accompanied by coughing, sore throat, and nasal congestion
  • Salmonellosis: sudden onset with chills, body aches, headache, joint pain, foul-smelling stool, possible blood or mucus, and low blood pressure.

Other digestive system disorders accompanied by lower abdominal pain include:

  • Food poisoning: Spasms and severe pain accompanied by nausea, vomiting, diarrhea, and weakness. Dehydration causes pale skin and dry mouth. Fever may also develop.
  • Irritable bowel syndrome: Dull, aching, burning, cramping, or stabbing pain usually localized on the left, intensifying after meals, defecation, or passing gas. It subsides at night but worsens in the morning with bloating.
  • Intestinal obstruction: Sudden onset of cramp-like pain every 10-15 minutes, which becomes dull and constant. Gas and stool passage are impaired, and vomiting may occur.
  • Appendicitis: Pain starts at the navel and moves down to the lower right abdomen, intensifying with movement, coughing, sneezing, and pressure on the abdomen. Accompanied by muscle tension, nausea, vomiting, and fever.
  • Mesenteric lymphadenitis: Inflammation of abdominal lymph nodes causing prolonged pain. Temperature rises, and heartbeat and breathing become rapid. Pain is crampy at first and becomes moderate, worsening with body position changes. If there is suppuration, symptoms worsen with signs of intoxication.
  • Ulcerative colitis: Pain may affect the whole abdomen or just the left side. Blood and mucus in the stool, painful urges to defecate, often at night. The sensation of incomplete bowel emptying, loss of appetite, increased heart rate, and fever are also common.

Genitourinary System Pathologies

Abdominal pain may also result from cystitis (more common in girls), where discomfort radiates to the inner thighs and lower back, intensifying during urination. Other symptoms include:

  • Burning sensation while urinating
  • Frequent urination or incontinence
  • Sensation of incomplete bladder emptying
  • Fever
  • Weakness and dizziness

If a girl complains of pain on the left or right side of the lower abdomen, it could indicate inflammation of the ovaries (adnexitis). The discomfort may radiate to the lower back or sacrum, accompanied by itching and burning in the genital area, along with serous or purulent discharge and menstrual cycle irregularities.

In girls, crampy pain in the lower abdomen may occur with primary dysmenorrhea (painful menstruation), typically at the end or beginning of the cycle, sometimes accompanied by dizziness, nausea, or diarrhea.

In boys aged 10-14, there is a risk of spermatocele (testicular appendage cyst), causing mild abdominal pain with a feeling of bloating and fullness. The affected organ enlarges, and a round lump forms. There is increased facial and body hair growth, including in the genital area.

Diagnosis and Treatment

Consult a doctor if the pain is severe, intolerable, persistent, or accompanied by other alarming symptoms. In cases of poor health, it’s best to call for emergency medical assistance. Otherwise, visit a doctor for a general examination, and they may refer you to a specialist for further tests, including:

  • Laboratory tests (blood, urine, stool, swab)
  • Instrumental exams (ultrasound, X-ray, CT, MRI, gastroduodenoscopy, colonoscopy)

Before seeing a doctor, it’s better to avoid painkillers and antispasmodics to prevent masking the symptoms. These medications alleviate discomfort but don’t address the underlying cause. If intoxication is suspected, sorbents like Smecta or Polysorb may be given. Based on the diagnosis, the doctor may prescribe antibiotics, antiparasitic drugs, NSAIDs, or antiemetics. For severe dehydration, rehydration solutions like Regidron or Trigidron are needed. Some traditional remedies may help alleviate certain symptoms, but always consult a doctor first to avoid potential interactions with prescribed medications.

Without a doctor’s recommendation, do not use enemas or laxatives. If your child is experiencing digestive or stool issues, it’s better to refrain from eating for the time being, but ensure they drink plenty of plain water.

In some cases, surgery may be the only solution. Sometimes, surgery is required urgently, so delaying a doctor’s visit is not advisable.

Lower abdominal pain in a child can indicate anything from overeating to serious conditions that require urgent intervention. Pay attention to accompanying symptoms and avoid self-treatment. Many problems can be avoided with regular health check-ups, proper diet, physical activity, and good hygiene.

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