GI 10125 TummyAche Interactive PDF

When is a
tummy ache not just a

tummy ache?
A GUIDE TO MANAGING
STOMACH PAIN AND OTHER
GASTROINTESTINAL CONDITIONS
STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP
WHAT WHEN HOW WE MORE ON WHAT WHEN HOW WE MORE ON WHAT IS IT? & HOW WE RELATED MAKE
CHECKLIST TIPS LOCATIONS
IS IT? TO CALL TREAT IT TREATMENT IS IT? TO CALL TREAT IT TREATMENT WHEN TO CALL TREAT IT CONDITIONS AN APPT
What is stomach pain?
It is 2 a.m. and your child has a tummy ache. Was it caused
by something she ate? Is she experiencing cramping, gas or
constipation? This is a common childhood scenario, and the
reality is every child will have an upset stomach at some point.
Rest assured, while stomach pain can happen for any number
of reasons, the discomfort is usually short-term, and children
continue to maintain their overall good health.
What causes stomachaches?
Our gastrointestinal tract is a complicated system of nerves
and muscles that pushes the food we eat through the digestive
process. But some children’s nerves are very sensitive. Even
normal intestinal activities upset their nerves, causing pain.
In some cases, a stomachache is caused by a very specific
problem such as ulcers, heartburn or constipation. In other
children, the cause may not be so clear.
An infection caused by a virus, bacteria, stress or fatigue
may make the intestinal nerves more sensitive and trigger pain.
In some cases, the problem may be genetic, which means it’s Did you know 10 to 15
a condition that “runs in the family,” so other family members percent of all school-aged
may have a similar history of the problem. children report recurrent
tummy aches and pains?
These pains can disrupt a child’s
everyday life and cause them
to lose interest in activities they
normally enjoy.
Tummy ache checklist
If your child is experiencing abdominal
pain and able to describe the discomfort,
ask her the following questions:
t the
d throughou
e pain locate
q Is th
ar ea o r consuming at
least half
b el ly
h?
of the stomac mfort
pain and disco
If so, thislyfoatrmtribouf ted to a stomach
is typical stipation.
s, in d ig es tio n, gas or con
vi ru
d/or
g cramping an
e pain causin
q Is th
followed by d
iarr ea?
h
bloating, and
typically
f st omachache is
Th is ty p e o
nature.
not serious in
vere or
p ai n lo calized and se
q Is ing in waves?
th e
com For infants and toddlers
e associated
Th is ty p e of pain may b who cannot verbalize their
r
’s appendix o
with your child th e re sult of discomfort, here are some signs
llb la d d er , o r may be your child has a tummy ache:
ga
s.
stomach ulcer • increased fussiness
• poor eating
• pulling her legs up toward the belly
Tummy ache tips
Helpful tummy ache tips to cure a common stomachache
Most of the time, home remedies will alleviate or eliminate a
common tummy ache. Here are some tips to help reduce your
child’s discomfort caused by a stomachache:
DOs DON’Ts
• Have your child relax quietly Do not give your child foods
to see if the abdominal pain or drinks that are irritating to
goes away. the stomach including:
• Offer sips of water or other • caffeine

clear fluids.
• carbonated beverages
• Suggest that your child try • citrus
to pass stool.
• dairy products
• Avoid solid foods for a few • fried or greasy foods
hours. Then try small amounts
of mild foods such as rice, • high-fat foods
applesauce or crackers. • tomato products If your child’s pain
is getting worse, or
the pain lasts longer
DO NOT give aspirin, ibuprofen (Advil®), acetaminophen than 24 hours, call
(Tylenol®) or similar medicines without first asking your your pediatrician
child’s health care provider. and make an
appointment.
When should you call the doctor about
stomach pain?
For mild stomach pains, you You should seek medical help
can typically employ home care immediately if your child:
remedies and wait for your child to
• is younger than 3 months and has
get better.
diarrhea or vomiting
Contact your child’s pediatrician
• is unable to pass stool, especially
when:
if the child is also vomiting
• stomach pain lasts more than a week,
• is vomiting blood or has blood in
even if it comes and goes
the stool (especially if the blood is
• stomach pain is getting more severe maroon or dark, tarry black)
and frequent, or if your child is
• has sudden, sharp abdominal pain
nauseous and vomiting with the pain
• has a rigid, hard belly
• your child experiences a burning
sensation during urination • has had a recent injury to the
abdomen
• your child has diarrhea for more than
2 days • is having trouble breathing
• your child has been vomiting for • is currently being treated for cancer
more than 12 hours
• your child has a fever over 100.4
degrees Fahrenheit
• your child has had a poor appetite for
more than 2 days
• your child is experiencing
unexplained weight loss
How Boston
Children’s Hospital
treats stomach pain
Whether your child is experiencing
frequent or chronic stomach pain
or upset, or ongoing bouts of
diarrhea or constipation, Boston
Children’s Hospital’s Division of
Gastroenterology, Hepatology and
Nutrition is here to help.
Ranked the #1 pediatric
gastroenterology division in the nation
by U.S. News & World Report 2015–
16, our expertly trained team works
with you and your child to find the
relief she needs. Most stomachaches
can be capably managed by a
pediatrician. In the cases where a
referral is necessary, we proudly
provide individualized treatment plans
and access to more specialized care
than any other hospital.
Click here
for a list of
Boston Children’s
locations near you.
How Boston Children’s Hospital
treats stomach pain | continued
To best understand the root of your child’s stomach

pain, a member of our clinical staff will take a
careful history of how and when your child’s pain
started, the type of pain your child is experiencing,
and ask how it has progressed over time.
We may perform blood, urine and stool tests to rule
out specific medical conditions associated with
recurrent pain. We will also ask if your child has any
history of food intolerances.
We only perform more in-depth tests, such as
x-rays or endoscopy, if your child’s medical history,
exam or lab tests raise further questions.
Once we have determined a proper diagnosis, the
care team will create a treatment plan that’s right for
your child and family. With the right treatment, most
children with stomach pain continue to grow well
and gain weight.
In some cases, abdominal pain might affect a child’s

ability to attend school or perform their normal
activities. In such cases, we can provide additional
support through our multidisciplinary team, which
includes dietitians and psychologists.
To make an appointment or to speak with a
member of our clinician staff, contact the Division
of Gastroenterology, Hepatology and Nutrition at
Boston Children’s: 617-355-6058.
What is diarrhea?
Diarrhea is often an uncomfortable
part of the tummy ache equation.
Diarrhea is watery stool, an increased
frequency of bowel movement,
or both. In most cases, diarrhea in
children lasts no more than a few
days and goes away on its own.
These short-term (or acute) cases
of diarrhea are usually related to
bacterial or viral infections.
In other cases, diarrhea may last
for weeks at a time; this is called
chronic diarrhea. Chronic diarrhea
may also be caused by infections,
such as giardia, but is more likely
to be caused by a chronic medical Chronic diarrhea
condition, such as irritable bowel in children may
syndrome, or an inflammatory indicate a larger
condition such as ulcerative health problem.
If your child has
colitis, Crohn’s disease or celiac
diarrhea for more
disease.
than a few days,
consult your
pediatrician.
When should you call the
doctor about diarrhea?
For mild diarrhea, you can typically use
home care remedies and wait for your
child to get better.
If your newborn (under 3 months old) has
diarrhea, call your pediatrician immediately.
Also, contact your child’s physician if your child has:
• blood, mucus or puss in the stool
• more than 8 stools in 8 hours
• vomiting that continues for more than 12 hours
• fever and diarrhea lasting more than 2 to 3 days
• stomach pain or abdominal cramping
• diarrhea that develops within 1 week of travel
outside of the United States or after a camping trip
(the diarrhea may be due to bacteria or parasites
that require treatment)
• weight loss If diarrhea persists, contact your
• significant drop in activity level (e.g., not sitting up child’s pediatrician. If your
at all or not looking around) pediatrician recommends an
appointment with a gastroenter-
Severe and/or chronic diarrhea may indicate ology physician, please call us at
a serious disease, and it is important to 617-355-6058.
consult your child’s health care provider if the
symptoms persist or affect daily activities. Click here for a list of
Boston Children’s
locations near you.
How Boston Children’s
Hospital treats diarrhea
At Boston Children’s Hospital, our expert
team of physicians and nursing staff is
dedicated to caring for and finding the best
treatment options for your child.
The first step in the treatment of diarrhea
typically begins with replacing lost fluids.
To replace the body fluids lost due to
diarrhea, children should drink fluids liberally.
If they are dehydrated, a glucose-electrolyte
solution (for example, Pedialyte® or Infalyte®)
should be given to help the body absorb
fluid more easily. These fluids have the right
balance of water, sugar and salts, and some
are available as ice pops.
If your child’s diarrhea is

getting worse, or the
accompanying pain lasts
longer than 24 hours, call
your pediatrician and make
an appointment.
How Boston Children’s Hospital
treats diarrhea | continued
A common result of diarrhea is dehydration.

Seek medical help immediately if your child
shows signs of dehydration.
Signs of dehydration include:
• dry and sticky mouth
• no urine for six hours
• no tears when crying
• sunken eyes
Additional hydration considerations for

treating diarrhea include:
• Avoid juice or soda because these drinks may
make diarrhea worse.
• Too much plain water at any age can be
dangerous.
• Do not give plain water to infants.
• If you are bottle-feeding or breastfeeding your
child, continue to do so.
If a bacterial infection is identified as a cause,

antibiotics may also be prescribed.
For more information, contact Boston

Children’s Division of Gastroenterology,
Hepatology and Nutrition at 617-355-6058.
What is constipation?
Constipation in children is defined as:
• a decrease in frequency of bowel movements,
compared to a child’s usual pattern (some health
care providers define constipation as fewer than What are the types
3 bowel movements per week) of constipation in
• the passage of hard, oftentimes large-caliber, dry children?
bowel movements Constipation is typically
• bowel movements that are difficult or painful to push out described as being either
Contact your child’s health care provider if you have any organic or functional.
questions or concerns about your child’s bowel habits or
Functional constipation
patterns or if constipation persists.
means there is no
We recommend talking to your child’s health care provider if: identifiable cause.
Functional constipation is
• Episodes of constipation last longer than 2 weeks.
the most common form of
• Your child’s discomfort prevents them from participating in
constipation, and while it is
normal activities.
a concern, typically there
• Normal pushing is not enough to expel a stool. is not a serious medical
• Liquid or soft stool leaks out of the anus. condition associated with it.
• Small, painful tears appear in the skin around the anus.
Organic constipation
• Hemorrhoids develop. is caused by a diagnosed
• Abdominal pain, fever or vomiting occur. medical condition,
like colon disease
or a neurological
problem.
How Boston Children’s Hospital FACT Constipation results
treats constipation in 2.5 million health care
provider visits every year.
To best understand the cause of your child’s constipation, a clinician
from the Division of Gastroenterology, Hepatology and Nutrition will
assess how serious your child’s constipation is by asking if your child:
• has hard or small stools that are difficult or painful to pass
• consistently skips days without having normal bowel movements
• has uncharacteristically large stools
• has stomach pain, poor appetite, crankiness and/or bleeding from the anus
In most cases, there is no need for testing prior to treatment for

FACT Almost 5 percent of
constipation in children. However, depending on the severity of the all pediatrician visits are
problem, your doctor may order x-rays or other tests to properly in some way related to
diagnose the source of the constipation. constipation, and at least 25
Once the root and severity of your child’s constipation have been percent of visits to pediatric
determined, a treatment plan will be designed based on your child’s age gastroenterology specialists
and personality. For some, constipation can be corrected by changes are due to problems with
constipation.
in diet, like increasing their intake of water, fiber or fresh fruit. Other
children may need medications like laxatives or stool softeners to help
them go.
In rare cases, children may need to have an excessive build-up of
stool “flushed” from their colon. This usually is done with laxatives,
suppositories or enemas if needed.
For more information on constipation or to speak with a
member of Boston Children’s Division of Gastroenterology,
Hepatology and Nutrition, please call 617-355-6058.
Related conditions
Allergic Colitis Eosinophilic Gastrointestinal Hepatitis C Stomach and Duodenal Ulcers
A cow milk allergy. Disorders (EGIDs) A liver disease affecting 3 percent An open sore or lesion usually found
Rare conditions that can occur when of all children worldwide. on the skin or mucous membrane.
Celiac Disease there are high levels of eosinophils An ulcer in the lining of the stomach
A lifelong intolerance to gluten—a in one or more parts of the digestive Hyperbilirubinemia or duodenum is referred to as a
protein found in wheat, barley, rye system. Eosinophils are a type of and Jaundice peptic ulcer.
and also in oats that have been white blood cell that is involved in A condition in which there is too
contaminated with gluten from other allergic reactions. much bilirubin in your baby’s blood. Short Bowel Syndrome (SBS)
products. A serious condition where a child
Food Allergy Inflammatory Bowel Disease does not have enough small
Childhood Obesity An abnormal response to a certain A chronic condition where parts of intestine, which may lead to
When a child is significantly food. the intestinal tract become inflamed. dehydration and malnutrition.
overweight. Obesity can increase
a child’s risk for serious and Functional and/or Intractable Jaundice Ulcerative Colitis
chronic medical problems, such as Abdominal Pain A condition that makes a baby’s skin A form of inflammatory bowel
constipation, type 2 diabetes, high Abdominal pain often accompanied and the white part of the eyes look disease (IBD) where one or more
blood pressure (hypertension) and by diarrhea, constipation or both, yellow. parts of the intestinal tract become
others. which can be related to irritable inflamed.
bowel syndrome (IBS).
Crohn’s Disease
A form of inflammatory bowel Gastroesophageal Reflux (GER)
disease (IBD) in which one or more Causes the return of acidic stomach
parts of your child’s intestinal tract juices, or food and fluids, from
become inflamed. the stomach back up into the
esophagus.
Encopresis
Fecal soiling or accidental bowel Hepatitis B Virus (HBV)
movements. Irritation and swelling (inflammation)
of the liver due to infection with the
Eosinophilic Esophagitis (EE) hepatitis B virus (HBV).
An allergic reaction that causes
inflammation and damage to the
esophagus, the muscular tube that
connects mouth to stomach.
Locations
Pediatric care close to home As a leading pediatric hospital, Boston Children’s is committed to providing expert and
compassionate care to our patients. We have been advancing medicine and improving child
health for more than 140 years and proudly have several satellite locations throughout our
community of care, including:
Boston Children’s Hospital South of Boston Boston Children’s West of Boston
300 Longwood Avenue Physicians Norwood
Click here Boston, MA 02115
Boston Children’s
Draper Building, 1st Floor
Boston Children’s
for a list of Physicians Brockton at Waltham
800 Washington Street
Boston Children’s North of Boston Medical Office Building 9 Hope Avenue
Norwood, MA 02062
Suite 220E Waltham, MA 02453
locations near you. Boston Children’s 830 Oak Street Boston Children’s
at Lexington Boston Children’s
Brockton, MA 02301 Physicians Weymouth
482 Bedford Street Physicians Worcester
Stetson Medical Building
Lexington, MA 02420 Milford Regional 21 Eastern Avenue
Suite 218
Medical Center Worcester, MA 01605
Boston Children’s 541 Main Street
3rd Floor
at Peabody Weymouth, MA 02190
14 Prospect Street
10 Centennial Drive Milford, MA 01757
Peabody, MA 01960
Boston Children’s
Winchester Family Physicians
Medical Center North Dartmouth
500 Salem Street 500 Faunce Corner Road
Route 62 North Dartmouth,
Wilmington, MA 01887 MA 02747
When a
tummy ache
is more than
just a tummy ache,
call 617-355-6058 or visit
bostonchildrens.org/GI
Click here THIS BOOKLET
for a list of IS AVAILABLE AT
Boston Children’s BOSTONCHILDRENS.ORG/

TUMMYACHE
locations near you.

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When is a

tummy ache not just a

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

• Offer sips of water or other • caffeine

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

To best understand the root of your child’s stomach

In some cases, abdominal pain might affect a child’s

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

If your child’s diarrhea is

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

A common result of diarrhea is dehydration.

Additional hydration considerations for

If a bacterial infection is identified as a cause,

For more information, contact Boston

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

In most cases, there is no need for testing prior to treatment for

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

Boston Children’s BOSTONCHILDRENS.ORG/

STOMACH PAIN DIARRHEA CONSTIPATION GET TING HELP

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