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Quick reference medical handouts used by Pediatric offices

Abdominal Pain: When to Call the Doctor

When to worry about sudden, acute abdominal pain

important note: this discussion focuses on sudden causes of abdominal pain in children. It does not pertain to chronic, long-term abdominal pain. 

Causes of Acute Abdominal Pain by Child's Age

Birth to one year
Infantile colic
Intestinal "flu"
Urinary tract infection
Incarcerated inguinal hernia*
Hirschsprung's disease
Two to five years
Intestinal "flu"
Urinary tract infection
Sickle cell crisis
Henoch-Schönlein purpura
Mesenteric  lymphadenitis
Six to 11 years
Intestinal "flu"
Functional pain
Urinary tract infection
Sickle cell crisis
Henoch-Schönlein purpura
Mesenteric lymphadenitis
Abdominal trauma*
12 to 18 years
Intestinal "flu"
Dysmenorrhea (menstrual cramps)
Mittelschmerz (ovulation)
Pelvic inflammatory disease
Threatened abortion
Ectopic pregnancy
Ovarian/testicular* torsion
Abdominal trauma*

source: American Academy of Family Physicians


*Appendicitis this is probably the most worrisome cause of sudden abdominal pain for parents since it is so well known. The appendix is a one-inch long piece of intestines that branches off of the colon in the lower right part of the abdomen. It can become inflamed and infected for a variety of reasons. (learn more)
*Intestinal obstruction this is by far the most serious and emergent cause of sudden abdominal pain, but it is also the most rare.
  • Intussusception this unusual word refers to when a part of the intestines "telescopes" in upon itself, just like a telescope collapsing. This is usually occurs in children under age two. 
  • Volvulus this occurs when the intestines get twisted. The twisted area gets closed off. This occurs mostly in children over 2 years. 
  • Incarcerated inguinal hernia: this occurs when the intestines gets caught inside the hernia sac
*Testicular Torsion - The testicles hang loose in the scrotum and in become twisted, so that the channel with the blood vessels is tightened, cutting off the blood flow to the testicles. 
*Ovarian torsion - Twisting of one of the ovaries causing the blood supply to be cut off
*Abdominal trauma - possibility of damage to one or more internal organs. 

When to suspect your child has a serious cause of acute abdominal pain 


note: Unfortunately appendicitis doesn't always behave exactly the way the textbooks say it's supposed to. It can fool even the most discerning parent and experienced doctor. If your intuition says that your child may have appendicitis, promptly see medical attention! 

Classic signs of appendicitis: 

  • The pain starts as a mild discomfort around the belly button. Then the pain moves down to the lower right side of the abdomen and increases in severity 
  • The pain is constant pain and usually doesn't come and go
  • The pain gradually gets worse hour by hour and generally never gets better, even for a short period of time 
  • Fever may or may not be present
  • The child usually refuses to eat or drink - and it is better not to offer them anything in case surgery is necessary 
  • Vomiting sometimes is present, but not always
  • The child refuses to walk and prefers to lie down in a curled up position 
  • The child refuses to jump on one foot - have your child try to hop on one foot. With appendicitis, this will cause sever abdominal pain and the child usually refuses to try again. If a child can jump up and down repeatedly with not much discomfort, then appendicitis is unlikely. 

If your child can jump up and down repeatedly with not much discomfort, then he probably doesn't have appendicitis (this is not a perfect test, just a helpful tool to help decide how likely appendicitis is).

Appendicitis is rare in children younger than four years old but can occur.

Important note - keep in mind that many illnesses start off with vomiting, diarrhea, fever, and belly pain. Don't jump to the conclusion of appendicitis until you have observed your child for several hours. Appendicitis rarely has the frequent vomiting and diarrhea that is characteristic of the stomach flu. Most causes of abdominal pain don't focus of the lower right area of the belly. Unless the pain moves to the lower right abdomen, becomes increasingly severe, and your child is unusually ill, then appendicitis is unlikely.

Intestinal Obstruction

Intestinal obstruction is usually characterized by sudden excruciating belly pain, usually in the middle, with persistent projectile vomiting. A unique aspect of the vomitus is that it is dark green. 

Intussusception, in which part of the intestines "telescopes" in on itself, commonly occurs in children under the age of two.  The child strains and cries loudly, and characteristically wants to lie very still during the attack of pain. At first the child may act normally between the episodes of pain, but if the diagnosis is delayed, may become progressively more sick.

Classic signs of Intussusception include:

  • Sudden onset of intense abdominal pain that causes child to draw their knees up to their chest. The pain is usually intermittent, but recurs and becomes stronger. As the pain subsides, the child with may stop crying and seem fine.
  • Passing of stool mixed with blood and mucus, known as "current jelly" stool (present in 60% of children with Intussusception).
  • Vomiting up bile, a bitter-tasting fluid secreted by the liver that is often golden brown to greenish in color
  • Abdominal distention and swelling
  • Lethargy, shallow breathing and grunting late in the illness

Volvulus is the condition in which the intestine becomes abnormally twisted. The bowel may become obstructed and is unable to push food past the site of the obstruction. In addition, the blood supply may be decreased or cut off to the twisted area.  

Classic signs of Volvulus include:

  • Pulling up the legs and crying because of severe pain, then behaving normally for 15 to 30 minutes
  • Swollen abdomen that is tender to the touch
  • Vomiting up bile, a bitter-tasting fluid secreted by the liver that is often golden brown to greenish in color
  • Diarrhea, bloody stools, or no stools at all
  • Little or no urine because of fluid loss. 

Testicular Torsion

Testicular torsion is a urologic emergency because a delay in diagnosis can lead to loss of the testicle.

Classic signs of testicular torsion include:

  • Sudden onset of severe lower abdominal pain or unilateral scrotal pain associated with scrotal tenderness
  • Swelling of the scrotum
  • Nausea and vomiting
  • Fever
  • Frequent urination
  • Redness of scrotum
  • diminishing pain after several hours if blood supply to the testis is not restored

Ovarian Torsion

Ovarian torsion is a condition in which an ovary twists or turns on its supporting ligament, cutting off its blood

Classic signs of ovarian torsion include: 

  • Typically, a teenager presents with sudden onset of lower abdominal pain.The pain usually is localized and over the involved side, with radiation to the back, the pelvis, and the thigh and continually gets worse
  • Nausea and vomiting
  • Occasionally diarrhea or constipation
  • There may be a history of similar abdominal pain in the past
  • 20% of women with ovarian torsion are pregnant

posted 03-1304 on






As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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