Abdominal pain in children is a common symptom in pediatrics, and is also the most frequent symptom in pediatric medical and surgical consultations. Because of the young age of children, it is difficult to express in words, so abdominal pain is easy to be ignored, and they often consult internal medicine because of accompanying symptoms such as fever, vomiting, loss of appetite and increased number of stools, etc. These symptoms are common when children suffer from various diseases, and because children are uncooperative in abdominal physical examination, surgical diseases are more likely to be misdiagnosed, which brings a certain degree of difficulty in timely and correct treatment, and is also an important factor causing conflicts between doctors and patients. One of the important factors that cause doctor-patient conflicts, such as peritonitis due to acute appendicitis perforation, intestinal necrosis due to intussusception, etc. Therefore, it is necessary to understand the characteristics of surgical diseases that cause pediatric acute abdomen. I. Neonates Neonates are commonly born with congenital abnormalities of the digestive tract. The children mostly have crying, bloating, vomiting and other symptoms at birth, and the vomit mostly contains green bile or fecal-like gastric contents; while the only congenital hypertrophic pyloric stenosis mostly starts vomiting about 20 days after birth, and the vomiting is gradually aggravated, vomiting is jet-like, vomit does not contain green bile or persistent food and has a distinct sour odor, and the children mostly have wasting, dry skin, like a dried up little old man. Therefore, if a newborn baby is born with the above symptoms, it is necessary to consult a doctor immediately, so that relevant tests can be performed to identify the cause and treat it in a timely manner. In infants and young children, esophageal hiatal hernia and intussusception are common. Children with esophageal hiatal hernia are usually 3 months to 2 years old and present with irregular pain in the upper abdomen under the glabella, repeated episodes of vomiting, especially after eating, in the form of non-jetting vomiting, and vomit with stomach contents, which may be bloody or coffee-colored if complicated by esophagitis. The children are relatively thin. The children with intussusception are mostly 4 months to 2 years old, at this age, it is the time to add supplementary food, if improper diet, poor digestion or gastrointestinal inflammation, diarrhea, etc., and easy to induce intussusception. At this time, the child shows sudden paroxysmal crying, every 10-20 minutes, each attack lasts about 3-5 minutes, sometimes accompanied by pale face, cold sweat, and frequent vomiting, the time lasts more than 6 hours can also appear to solve jam-like stools. Intussusception generally occurs in obese children, and is more common in winter, spring, summer and autumn when the seasons change or when the child has upper sensation and diarrhea. The most common cause of acute appendicitis in school-age children is acute appendicitis, because the ileocecal part of the child is relatively free, the appendix is easily ectopic, and the appendix of children is in the shape of a long and thin tube, so the lumen of the appendix is blocked by fecal stones and not easily discharged, so the obstruction in the lumen of the appendix and the invasion of pathogenic bacteria are the main causes of appendicitis. At the beginning of abdominal pain in children, most of them show pain in the upper abdomen, accompanied by poor appetite and vomiting, which can be easily mistaken for gastroenteritis, but with the development of the disease, the pain will gradually shift to the right lower abdomen, sometimes accompanied by fever, also accompanied by diarrhea or frequent and urgent urination. In children, the large omentum is shorter and should not descend to wrap the appendix, and the appendix can be perforated 12 to 24 hours after the occurrence of abdominal pain in pediatric appendicitis. In addition, the abdominal wall of pediatric patients is thin and the abdominal wall muscle tension is sometimes not obvious, which makes the diagnosis difficult. Therefore, in principle, pediatric acute appendicitis should be operated early. Pediatric abdominal pain is also commonly associated with acute mesenteric lymphadenitis, acute gastroenteritis, intestinal cramps, bacillary dysentery, Meckel’s diverticulitis, acute pancreatitis, pneumonia, and iliac fossa abscess. In addition, with the increasing incidence of traffic accidents and outdoor activities of pediatric patients, closed liver, spleen, pancreas, kidney rupture and traumatic gastrointestinal perforation in pediatric abdomen cannot be ignored. Other causes of pediatric abdominal pain can include common bile duct cysts, torsion of mesenteric cysts, torsion of large omental cysts, torsion of ovarian cysts, compression of intestinal cavity tumors, compression of retroperitoneal tumors, hydronephrosis, allergic purpura, abdominal epilepsy, intestinal worms, biliary ascariasis, etc. In recent years, with the progress of the times, including the popularity and technical level of pediatric gastrointestinal endoscopy, as well as the development of new technologies such as abdominal ultrasound, nuclear examination, CT, MRI, gastrointestinal manometry and PH monitoring, the level of diagnosis and treatment of pediatric abdominal pain has improved significantly. Therefore, if you encounter sudden onset of abdominal pain and vomiting in children, you should not feel helpless and should not give your child painkillers on your own, but should go to the hospital in time to avoid delaying the condition and affecting the diagnosis and treatment of the disease.