DRHC Dubai Pediatrics Clinic

Pediatric Abdominal Pain - Dubai Pediatric Clinic

  • Pediatric Abdominal pain is the most frequent gastrointestinal complaint that brings child to a physician. The majority of pediatric abdominal complaints are relatively benign (e.g. constipation) but it is important to pick up on the cardinal signs that might suggest a more serious underlying disease.
  • Diagnosing abdominal pain in children is a challenging task.

ACUTE ABDOMINAL PAIN (Last hours to days)

Acute abdominal pain in children may be the result of:

  • Extra abdominal disease (e.g. lower lobe pneumonia; pharyngitis)
  • Intra-abdominal disease (acute gastroenteritis; hepatitis; gastritis; pancreatitis; UTI; intestinal obstruction; hernias and masses)
  • Metabolic ( ketotic acidosis)
  • Hematologic cause (sickle cell crises)
  • Genitourinary problems (testicular torsion ovarian cyst; and ovarian torsion; ectopic pregnancy for adolescent girls.
  • Surgical cases (intussusception; appendicitis; intestinal obstruction; and hernias)

Good history and physical examination is very important to detect the cause and can guide the physician to perform the appropriate investigations for final diagnosis and treatment.


  • Location of the pain and quality (localized; generalized; dull; sharp; colic pain)
  • Radiation; severity; and timing of pain.
  • Alleviating factors and aggravating factors.
  • Associated symptoms (vomiting; constipation; diarrhea; melena; weight loss; jaundice and testicular pain)
  • Dietary history
  • Family history
  • Female (menstruation cycle)


  • Vital signs
  • Growth parameters
  • General examination
  • Abdominal examination: palpation; auscultation; and percussion
  • Digital rectal examination

After history and physical examination, it is very important to discover the surgical cases for abdominal pain that needs immediate surgical intervention. Red flag signs include:

  • Bilious vomiting
  • Abdominal distention
  • Rigidity and rebound in abdominal examination.
  • Bloody stool or emesis
  • hemodynamic instability


  • CONSTIPATION – infrequent bowel evacuation or painful defecation. Blood can be seen in stool from anal fissure.
  • GASTROENTERITIS- abdominal pain, diarrhea, vomiting, fever. (can be bacterial or viral etiology)
  • ACUTE APPENDICITIS – right lower abdominal pain, fever, anorexia, vomiting, can rupture and lead to sepsis.
  • TRAUMA – history of trauma or signs of bruising.
  • URINARY TRACT INFECTION – dysuria, frequency, and hematuria.
  • PNEUMONIA (LOWER LOBE) – tachycardia, tachypnea, fever, chest and abdominal pain.


  • Intussusception – colicky pain; fever; lethargy; vomiting; peak incidence in age 6m
  • Meckel's diverticulum – similar presentation of appendicitis
  • Mesenteric adenitis
  • Small bowel obstruction
  • Volvulus
  • Hernias
  • Viral hepatitis
  • Acute pancreatitis
  • Splenic infarction
  • Nephrolithiasis
  • Testicular torsion
  • Ovarian torsion
  • Ruptured ovarian cyst
  • Ectopic pregnancy
  • Pelvic inflammatory disease
  • Cholecystitis


  • Complete Blood Count
  • Erythrocyte Sedimentation Rate
  • Urinalysis
  • Stool analysis
  • Cultures
  • Amilase or lipase
  • Abdominal ultrasound
  • CT scan
  • Abdominal Xray
  • According to the history and physical examination can help to establish the diagnosis. 

TREATMENT: It depends on the cause of abdominal pain.


Chronic abdominal pain in children is defined as pain for more than 2 weeks in duration and or recurrent pain for more than 3 episodes of pain, which is severe enough to affect activity within 3 months.


  • Irritable Bowel Syndrome:
    • Isolated recurrent abdominal pain or associated with dyspepsia or altered bowel pattern; nausea; vomiting; satiety; constipation; or diarrhea and or alternating period of both.
    • The symptoms have functional basis. Disorders such as fears, nocturnal enuresis, and sleep disturbance are seen in 30% of affected child.
    • Social factors such as: new teacher; new school; stress; parental pressure for achievement are associated with attacks of pain.
    • Antispasmodic medication is used for relief of pain. 
  • Constipation:
    • It is a major cause of chronic abdominal pain.
    • It is treated with laxative and fiber diet to resolve the recurrent pain.
  • Peptic disorder:
    • Esophagitis; gastritis; gastric and duodenal ulcer; H pylori infection.
    • Child present with chronic epigastric pain; early satiety and nausea.
    • Endoscopic investigation is generally indicated treatment with H2 receptor blockers, proton pump inhibitor and erythromycin, Flagyl for H pylori infections.
  • Abdominal migraine:
    • Periodic nausea, vomiting, abdominal pain, that last 6-8 hours with intervals of weeks or months with no symptoms or signs. Treatment is usually with antiemetic or migraine medications.
  • Lactose Intolerance:
    • Abdominal pain; bloating; after mild consumption.
    • Diagnosis: Hydrogen breath test after lactose ingestion and the treatment is free lactose diet. 
  • Inflammatory Bowel disease:
    • Ulcerative colitis; Chrohns disease; lower abdominal pain, fever, weight loss, fatigue, joint pain, rashes, hematochezia , diarrhea, and recurrent mouth ulceration.
    • Barium enema and colonoscopy is indicated for diagnosis.
    • Treatment with prednisolone, special diet and sometimes surgical intervention. 
  • Familial Mediterranean fever:
    • Recurrent fever, abdominal pain, joint pain, chest pain, and family history.
    • Treatment with (NSAID) and observance of kidney function.
  • Porphyria
    • Abdominal pain; tachycardia, increase BP and NEUROLOGIC_ symptoms such as paralysis, seizure or coma.


Dubai Pediatric Clinic at Dr Rami Hamed Center provides one of the leading pediatricians in Dubai.