Sudden abdominal pain in children is a frequently seen condition. There are several common conditions that cause acute abdominal pain, and they start rapidly and progress rapidly. Because infants and young children do not express themselves accurately in words, this makes the diagnosis of the disease difficult. Some diseases should be operated on once they develop, while others can be treated conservatively in the early stages and require surgery to remove some organs in the late stages to cure them; some abdominal pain can be improved by medication.
Therefore, children should not be given painkillers casually, as this will cover up the disease. We should learn to estimate the possible causes of abdominal pain through various abnormal manifestations of children, and do the corresponding treatment in time to reduce the pain and unnecessary losses of children.
The common causes of acute abdominal pain in children and their characteristics are as follows.
1, ascariasis. Children with this disease mostly have the habit of eating unhygienic, do not wash their hands before meals and after stools, do not rinse enough raw fruits or even do not wash, which is manifested as normal eating but still very thin. When the environment changes or the child has a fever, diarrhea, hunger and eating irritating food, suddenly abdominal pain, the child cries and rolls, bending, cold sweat, pale face, abdominal pain around the navel for heavy.
It is often accompanied by vomiting, and even roundworms may be vomited out. Sometimes the abdominal pain disappears and the child appears tired. After complete recovery, the child plays as usual. Each painful episode lasts for a few minutes and may not occur every day or may occur several times a day. Give appropriate deworming medication such as dewormer, 2.5-3 mg/kg body weight, maximum 150 mg/time, once at bedtime, or intestinal morning after, as directed. When there is constipation or no defecation, abdominal distension, abdomen feel the rope-like mass, may occur the roundworm intestinal obstruction, then should go to the hospital for infusion and enema and other deworming treatment.
2.Acute appendicitis. Children of all ages can get this disease, and it is more common. The onset of the disease is urgent, abdominal pain is heavy in the right lower abdomen, and pressing the child’s right lower abdomen with the hand will intensify the child’s crying, often accompanied by nausea and vomiting, and then fever, the temperature can rise to about 39 ℃. At this time need to go to the hospital for treatment, because the development of pediatric appendicitis faster, a little longer there is a perforation of the appendix caused by septic peritonitis may endanger the life of the child.
3, intussusception. Intussusception mostly occurs in infants and children within 2 years of age. The lesion is a part of the intestinal tube into the adjacent part of the intestinal cavity, so abdominal pain can be felt in the abdomen a fixed mass, pressure pain is obvious, vomiting soon after the onset of abdominal pain, especially 2-12 hours after the onset of dark red jam-like stool as a characteristic, sometimes dark red blood water-like stool. If the hernia is detected early and repositioned by inflation in hospital, it can avoid surgical treatment due to prolonged ischemia and necrosis of the intestinal tube.
4. Incarcerated hernia. Umbilical hernia and inguinal hernia are the most common types of pediatric hernia. Umbilical hernia is rarely imbricated, but most of them are caused by abdominal pain due to inguinal hernia imbrication. Such children have a reversible hernia before the onset of the disease, i.e., a swelling appears in the medial groin when the child stands or strains to defecate, or only one side of the scrotum is enlarged and disappears when lying down, and even if it does not disappear, it can be slowly returned by hand.
Once it cannot be returned, the swelling does not disappear and there is abdominal pain, paroxysmal crying, abdominal distention and vomiting, swelling of the skin on the surface of the swelling over time, fever and obvious pressure pain, there is no doubt that an incarcerated hernia has occurred and the child must be sent to hospital for treatment.
5. Intestinal spasm. Intestinal spasm is a paroxysmal abdominal pain caused by strong contraction of the muscles of the intestinal wall, and is the most common case of acute abdominal pain in children. The causes of its occurrence are related to a variety of factors, such as cold, overeating, large amounts of cold food, too much breastfeeding for infants and so on. The disease is a simple functional change and a non-organic lesion, so the prognosis is good and most of them can heal spontaneously.
It is manifested as sudden onset of paroxysmal abdominal pain in healthy children, each attack for a few minutes to ten minutes, sometimes painful, repeatedly, abdominal pain can be light or heavy, serious persistent crying, rolling, stomach slightly hard, intermittent whole abdomen soft, may be accompanied by vomiting, vomiting after the spirit is still good. If you give the right amount of tincture of belladonna orally, 0.03-0.06 ml / time, it can be quickly relieved.
6, bacterial dysentery. The disease is more frequent in summer and autumn. Often rapid onset, first fever of 39 ℃ or even higher, the number of stools increased, diarrhea before often paroxysmal abdominal pain, stomach “gurgling” sound increased, but the abdominal distension is not obvious. The child is severely dehydrated, poor skin elasticity, general weakness, should be sent to the hospital for treatment.
7, allergic purpura. It is a kind of allergic reaction disease, all accompanied by circumscribed symptoms. The first manifestation is skin purpura, the area varies in size, the surface is purplish red, the pressure does not fade, mostly distributed in the extremities and buttocks, to ankle, knee joints at the obvious. On the basis of this, paroxysmal severe abdominal cramps appear, obvious around the umbilicus or lower abdomen, with pressure pain but soft stomach.
It may be accompanied by diarrhea and blood in stool of varying severity, with black or red stools. It is caused by bleeding and edema in the lining of the intestinal canal. Some children may also have painful swollen joints and even hematuria. Such children should rest in bed, limit hard and indigestible food, and mostly treat symptomatically with Chinese herbal medicine to achieve the effect of eliminating evil and strengthening the root. In severe cases, hormone therapy is still needed. The prognosis of this disease is generally good, with mild cases cured in 1 week and severe cases in 4-8 weeks.
Five perspectives on pediatric abdominal pain
Abdominal pain is one of the most common symptoms in pediatrics. Pain that occurs under the sternum, on both sides of the umbilicus and above the pubic bone is collectively called abdominal pain.
In our daily life, we can often see such scenes, some children will suddenly say that their stomach hurts while playing, some cover their stomach with their hands when in pain, or squat on the ground and cry out that their stomach hurts, and some even look pale. This is when parents usually rush to take their children to the hospital, only to have them get better after a while. This tossing and turning of parents wastes time and delays work, so it becomes important to learn to distinguish whether the abdominal pain in children is functional or organic lesions.
The etiology of pediatric abdominal pain is very complex and troubles pediatricians in diagnosis, then it is even more difficult for parents.
To identify pediatric abdominal pain, parents can observe carefully in daily life from the following aspects.
First, from the age of abdominal pain
The prevalence of abdominal pain varies among children of different ages. For infants under 3 years old, in particular, their language function is not yet well developed, so they cannot fully express their feelings in words, and only use crying to express their discomfort, parents must pay attention to this time, pay attention to the child’s symptoms, so as to introduce to the doctor to facilitate diagnosis. Intussusception, colic, incarcerated hernia and intestinal infections are common in this stage.
Intussusception
In infants and toddlers, especially those under 2 years of age, paroxysmal crying that is not easily comforted, lasts about 10-15 minutes with intervals of 15 minutes to an hour or two, and may be accompanied by vomiting and dark red or jam-colored stools, must be beware that it may be intussusception. Infant colic
Most often seen in the early postnatal period, mostly relieved after 4 months of age, the cause is not clear.
Incarcerated hernia
It can also be seen in infants and toddlers. Usually such children have a history of hernia and must be told to the doctor, and parents should also pay attention to the color change of the hernia skin.
Infant intestinal distention
This is characterized by sudden loud crying, distended abdomen, clenched fists, and curling between the legs and abdomen. It is usually seen in infants within one year of age, and is caused by abdominal pain due to excessive consumption of milk, sugar or swallowing of large amounts of gas in the abdomen.
Special reminders
In this stage of child care, try to let the baby suck on the pacifier as little as possible, do not add sugar to the formula, and go to the hospital for inexplicable baby crying. In addition, nocturnal crying in children, once the night does not sleep and cry, repeated episodes, may be related to vitamin D deficiency, immature development of internal organs nerves.
Second, from the pain characteristics of abdominal pain.
Paroxysmal pain or colic – with obstructive disease, if the abdominal pain is alleviated after localized hi press or hot compress, it is often the spasm of the stomach, intestines, bile ducts and other cavernous organs;
Persistent abdominal pain – aggravated mostly in gastrointestinal perforation; persistent dull pain, aggravated when changing position, refusing to press, often due to inflammation of abdominal organs, peritoneal stretching, tumor and stimulation of peritoneal viscera.
Occult pain – mostly seen in peptic ulcers.
Acute abdominal pain – intolerable accompanied by other symptoms such as vomiting, blood in stool, pallor, and altered consciousness may be acute abdominal conditions such as intussusception, intestinal obstruction, intestinal perforation, allergic purpura, torsion of the stomach and intestines, and pancreatitis. At this time, do not easily use analgesics, not only to cover up the condition, but also to aggravate the condition and make it worse. Do not apply hot compresses and rub the abdomen, and go to the hospital immediately to receive treatment without food and water.
Chronic recurrent abdominal pain – mostly vague pain that can be tolerated, can be accompanied by pale, rapid heart rate and other vegetative symptoms, mostly seen in recurrent abdominal pain, chronic gastritis, peptic ulcer, chronic enteritis, lead poisoning, sickle cell anemia, abdominal migraine, abdominal epilepsy, irritable bowel syndrome, functional dyspepsia, etc.; for functional pathologies such as irritable bowel syndrome and functional dyspepsia, such children should develop the habit of regular bowel movements and regular eating.
Recurrent abdominal pain – the pain is spasmodic or colicky, mostly around the umbilicus, but also in other parts of the abdomen; it can occur daily, weekly, monthly, or once every few months, and each attack does not last more than 1-3 hours and can resolve on its own; the attacks are more common in the morning and at 3-4 pm, and often increase suddenly on an empty stomach or during meals. Recurrent abdominal pain is 90% functional and is associated with calcium deficiency due to overgrowth, vegetative dysregulation, highly sensitive visceral sensations, gastrointestinal motility disorders, psychological factors such as sudden shock, anxiety, depression, school phobia, etc.
Special reminders
1, the onset of acute or paroxysmal intensification is often surgical diseases, such as acute appendicitis, strangulated intestinal obstruction, gastrointestinal perforation, intussusception and inguinal hernia impaction. Those with slow onset and persistent pain are often medical diseases, such as intestinal ascariasis, gastric and duodenal ulcers, enteritis and viral hepatitis.
However, it should be noted that sometimes the etiology of chronic abdominal pain and acute abdominal pain can be the same, because the nature of the disease changes at different stages, for example, ulcer disease is originally chronic abdominal pain, but when combined with perforation, it becomes acute abdominal disease. So for those children who originally had chronic abdominal pain, if the abdominal pain turns into continuous or sudden severe pain, attention should be paid to the possibility of acute abdominal disease.
2, the pain characteristics of abdominal organic lesions are.
① persistent colic with paroxysmal intensification;
② local pressure pain is obvious;
③ abdominal muscle tension;
④ abnormal bowel sounds;
The pain of functional abdominal lesions is characterized by
① episodic dull pain with recurrent episodes;
② localized pressure pain is not obvious;
③ abdominal tenderness;
④No change in bowel sounds.
3. If abdominal pain occurs after consuming foods such as milk, eggs, fish and shrimps, it is generally allergic abdominal pain, and the abdominal pain will improve as soon as the child stops eating such foods. Avoid overeating, or over-eating cold drinks, can also reduce abdominal pain in children.
4, there is a kind of abdominal epilepsy caused by abdominal pain, will suddenly seizure, suddenly self-healing. After the abdominal pain disappears, there is no abnormality in the child’s mental and physical strength. This type of abdominal pain requires an electroencephalogram at the hospital to confirm the diagnosis.
Third, the abdominal pain can be seen from the nature of the stool
In the case of abdominal pain in children, it is necessary to observe the child’s stool, the presence or absence of stool, the absence of stool for a few days and the child’s eating condition.
1, no stool for several days with abdominal distension, may be intestinal obstruction.
2, stool pus and blood especially in the summer and autumn when the attention is dysentery, hemorrhagic E. coli enteritis, Michael diverticulitis, etc..
3, the stool is egg-flower soup-like or watery stool, with vomiting, especially in autumn and winter, is mostly rotavirus enteritis. This disease is seen in young children may occur dehydration, electrolyte disorders and metabolic acidosis, parents should pay attention to the child to drink more water.
4, if there is constipation and diarrhea alternately, should pay attention to incomplete megacolon and intestinal irritation syndrome, this constipation can be used to laxative open cork. In addition, eat more fiber-rich foods and drink less carbonated beverages.
Special reminder
For new types of dairy products or those that you have just started to drink, there is a risk of allergy, which often manifests as abdominal pain followed by diarrhea. In this case, parents should switch back to the original brand of dairy products or use less allergic dairy products, and not pure milk for small babies. Generally speaking, children should not change the brand of dairy products from time to time, for one thing, they may not drink milk because they do not adapt to the taste, and for another, there is a risk of allergy.
Four, from the abdominal signs to see abdominal pain
Parents can properly grasp how to check the abdominal signs of their children. The general method is: parents let the child lie on his back, lower limbs bent up, parents talk to the child, while using warm fingers flat against the child’s abdominal wall, fingers lightly bent to feel the child’s abdominal wall muscle tension. If the abdominal wall is soft and does not feel like touching, the lesion is generally mild or functional; if the abdominal wall is hard or the child does not allow the abdomen to be stroked or if the whole abdomen is painful, the lesion is mostly organic.
Special reminder
Do not take random measures, if the child’s abdominal pain is organic lesions, at this time, if you rub the child’s stomach, or do local hot compresses, it may promote the inflammation of the septic place broken perforation, the formation of diffuse peritonitis. Pressing the abdomen will only stimulate the worm body, and even cause biliary ascariasis; roundworms may also penetrate the delicate intestinal wall of young children, causing diffuse peritonitis; and blindly pressing, may cause deepening of the set-in site, aggravating the condition.
V. From the accompanying
symptoms of abdominal pain
1, should pay attention to the relationship between abdominal pain and fever. First fever and then abdominal pain are mostly internal diseases such as upper respiratory tract infection, tonsillitis often complicated by acute mesenteric lymphadenitis; conversely, first abdominal pain and then fever are mostly surgical diseases, such as acute appendicitis, secondary peritonitis, etc.
2, accompanied by nausea and vomiting are mostly lesions of the digestive tract; with cough and fever should pay attention to the abdominal pain caused by lesions of extra-abdominal organs, such as the involvement pain caused by the lower lobe pneumonia.
3. Pay attention to skin bleeding spots, petechiae and jaundice, which can help the diagnosis of abdominal pain caused by epidemic encephalomyelitis, sepsis, purpura and hepatobiliary diseases.
4, paroxysmal abdominal pain with frequent vomiting, obvious abdominal distension, no exhaustion and no fecal discharge often suggest intestinal obstruction.
5, acute abdominal pain with toxic shock is mostly seen in gastrointestinal perforation, acute necrotizing enterocolitis, acute pancreatitis, ovarian cyst torsion, etc.
6, abdominal pain is too severe to turn the position and refuse to press, often with limited or diffuse peritoneal irritation, such as appendicitis, peritonitis, etc..
7, also pay attention to the child’s psychological problems, psychological disorders such as depression, kindergarten phobia, etc. can also produce abdominal pain.