Why Does My Child's Stomach Hurt?

“Why does my child’s stomach hurt?” is a fair question and one pediatricians hear often. 

Abdominal pain is one of the most common complaints in childhood. In fact, the National Institutes of Health (NIH) says it accounts for 5% of primary care visits and 12% of ER visits. In other words, if your child is clutching his or belly, you’re far from alone. 

The challenge? The abdominal cavity is crowded real estate – organs, lymph nodes, nerves, blood vessels, muscles – plenty of options for something to feel off. 

So, when your child says his or her “stomach hurts,” what should you actually do? The answer (unsurprisingly): it depends. 

However, we can simplify matters by dividing “abdominal pain” into two categories: non-emergencies and emergencies. 

Non-Emergency Abdominal Pain 

Most childhood stomach pain falls into this category. The most common causes of non-emergent abdominal pain include: 

• Non-specific pain (40%)
• Constipation (22%)
• Viral illness, like a stomach bug (13%)

This category of pain is often vague. Your child may say it hurts “everywhere” rather than pointing to one specific spot. 

To help narrow things down further, consider the following: 

• Have there been any changes in urine or stool (frequency, amount, appearance, etc.)?
• Does eating make it better or worse?
• Is it accompanied by nausea, vomiting or diarrhea?
• Are there any other accompanying symptoms (cough, fever, headache, sore throat)?
• Has the child been around anyone who is sick (especially with similar symptoms)?

The bad news here is that what starts out as a non-emergency can transition into an emergency. So, keep an eye on things. 

If your child is acting okay otherwise, you can start with supportive care: 

• Push fluids
• Stick to simple, bland foods (nothing spicy)
• Let him or her rest

Most stomach pain in children resolves on its own. If symptoms drag on, it’s reasonable to check in with your child’s pediatrician. 

Emergency Abdominal Pain

Some causes of abdominal pain need prompt medical attention, likely involving the ER. Common causes include: 

• Appendicitis
• Intussusception (telescoping of the intestines into one another)
• Volvulus (twisting of the intestines around one another)
• Intestinal obstruction
• Trauma (can lead to internal bleeding or organ rupture)

Less obvious but still serious causes can include: 

• Ovarian or testicular torsion (twisting of the ovaries or testes in on themselves)
• Sickle cell pain crises
• Infections (including kidney, bladder and lymph nodes)

What does this kind of pain look like? Emergency-type pain is usually:

• Severe or intense, with the child in clear distress (bent over, refusing to move or walk)
• Localized to one area (often right upper, right lower or left upper abdomen)
• Accompanied by “guarding”—your child pushes your hand away if you try to touch his or her belly

Red flag symptoms include: 

• Frequent vomiting or diarrhea (more than six or seven episodes in a day)
• Decreased urine output (less than three or four episodes in 24 hours)
• High fever
• Bright red blood in stool or vomit
• Dark or tarry stools
• Coffee-ground-like vomit

If you see any of these symptoms, an ER visit is absolutely appropriate. 

A Simple Guide to Childhood Stomach Pain

This article can’t cover every possible cause of stomach pain, but here’s a practical way to approach it:

• If your child seems generally okay: Try fluids, rest and bland foods. Monitor symptoms.
• If your child seems very uncomfortable or you notice red flags: Seek urgent care or go to the ER.
• If you’re unsure: Call your pediatrician or Nurse Link (1-800-882-6274).

Trust your gut (pun intended). No one knows your child better than you do.