Chronic tummy pain in children

Chronic abdominal pain in children is common. It refers to tummy pain that is constant or comes and goes for more than 2 months, and is bad enough to interrupt normal activities.

Key points about chronic tummy pain in children

  1. Most cases of chronic tummy pain are due to increased pain sensitivity to the movement of food and by-products through the digestive tract. This is referred to as functional abdominal pain.
  2. Common functional causes of chronic tummy pain in children are irritable bowel syndrome and functional dyspepsia
  3. Less commonly, an underlying condition may be the cause. Examples of these are coeliac disease and inflammatory bowel disease.
  4. If not treated, chronic tummy pain can impact on your child's wellbeing. 
  5. If there is an underlying cause, treatment will focus on this. If the pain is due to a functional cause, it can be managed by reassurance and explanation of the source of the pain.
  6. Chronic tummy pain in 30–50% of children will settle within 6 weeks.

What are the causes of chronic tummy pain in children?

The most common causes of chronic tummy pain in children are due to the body's functioning – this is referred to as functional abdominal pain. This means your child may have an increased pain sensitivity in response to the movement of food through the gastrointestinal tract. In most cases, there is no serious underlying disease. 

Functional causes include:

Organic causes can be found in some cases but these are less common. These include:

What are the symptoms of chronic tummy pain in children?

Chronic tummy pain is vague and is usually located around the belly button. Other symptoms that can accompany chronic tummy pain in children include:

If your child has the following symptoms, it usually suggests an organic cause. Tell your doctor about these symptoms:
  • poor growth 
  • weight loss
  • chronic severe diarrhoea (runny poos)
  • constipation (not pooing enough)
  • blood in stools (poos)
  • unexplained fevers or joint aches
  • persistent vomiting (being sick)
  • waking up at night due to the pain
  • family history of peptic ulcers or inflammatory bowel disease.

How is chronic tummy pain in children diagnosed?

Your doctor will take a history including asking about what the pain is like, any other symptoms and family history. Your doctor will also want to know about how your child has been at school and at home, including your child's behaviour and mental health. 

Your doctor will examine your child's stomach and measure your child's growth. In some cases, a rectal examination may be needed. Your doctor will also do some tests, such as blood tests, taking a stool sample, urine (pee) test or an abdominal ultrasound. These tests are to rule out other diseases and to confirm any diagnoses depending on what your doctor thinks is causing the pain. 

How is chronic tummy pain in children treated?

If there is a physical or organic cause, treatment will focus on the underlying condition. If it is due to a functional cause, it can be managed by reassurance and explanation of the source of the pain.

Medicines are usually not needed, unless the pain is caused by an organic or a physical cause. In some cases, cognitive behavioural therapy from a psychologist can be helpful.  

There are some tips that to help manage chronic abdominal pain in children:

  • Keep a diary and record the intensity, triggers, timing, duration and relieving factors of your child's pain.  It can be useful to bring this to your doctor’s appointment.
  • Encourage healthy behaviours such as a balanced diet and physical activity.
  • Avoid reinforcing pain or pain behaviours. Reassure your child the pain will ease and encourage them to continue their normal activities.
  • Chronic abdominal pain usually happens in the morning and lasts less than an hour, so bring your child to school when the pain starts to settle.
  • Encourage school attendance.
  • Gain support from school teachers and discuss a plan to manage abdominal pain in school. 

Your doctor will also ask for regular follow-up appointments to make sure that your child's pain is settling. If your child's pain gets worse or new symptoms arise, tell your doctor as this may suggest an underlying physical or organic cause. 

What is the outlook for a child with chronic tummy pain?

Chronic tummy pain in 30–50% of children will settle within 6 weeks. 

Learn more

Recurrent abdominal pain in children Patient Info, UK
Chronic abdominal pain Children's Hospital Colorado
How an organic disease differs from a functional disorder Very Well Health, US
Abdominal pain The Royal Melbourne Children's Hospital, Australia  

References

  1. Chronic abdominal pain in children Auckland HealthPathways, NZ
  2. Non-acute abdominal pain in childhood Starship Clinical Guidelines, NZ
  3. Reust CE, Williams A. Recurrent abdominal pain in children. American Family Physician. 2008;97(12):785-793.

Reviewed by

Dr Sara Jayne Pietersen is a GP practicing in south-east Auckland. She has a special interest in travel medicine, paediatrics and women's health, particularly the postnatal period. She is passionate about the role exercise and nutrition play in our general wellbeing. 
Credits: Health Navigator Editorial Team. Reviewed By: Dr Sara Jayne Pietersen, FRNZCGP Last reviewed: 05 Nov 2020