Stomach Pain - Female

• Pain or discomfort in the stomach or belly area
• Female
• Pain found between the bottom of the rib cage and the groin crease
• The older child complains of stomach pain
• The younger child points to or holds the stomach
• Before 12 months of age, use the Crying care guides

Causes of Acute Stomach Pain

• Eating Too Much. Eating too much can cause an upset stomach and mild stomach pain.
• Hunger Pains. Younger children may complain of stomach pain when they are hungry.
• GI Virus (such as Rotavirus). A GI virus can cause stomach cramps as well as vomiting and/or diarrhea.
• Food Poisoning. This causes sudden vomiting and/or diarrhea within hours after eating the bad food. It is caused by toxins from germs growing in foods left out too long. Most often, symptoms go away in less than 24 hours. It often can be treated at home without the need for medical care.
• Constipation. The need to pass a stool may cause cramps in the lower abdomen.
• Strep Throat. A strep throat infection causes 10% of new onset stomach pain with fever.
• Bladder Infection. Bladder infections usually present with painful urination, urgency and bad smelling urine. Sometimes the only symptom is pain in the lower abdomen.
• Appendicitis (Serious). Suspect appendicitis if pain is low on the right side and walks bent over. Other signs are the child won't hop and wants to lie still.
• Intussusception (Serious). Sudden attacks of severe pain that switch back and forth with periods of calm. Caused by one segment of bowel telescoping into a lower piece of bowel. Peak age is 6 months to 2 years.

Causes of Recurrent Stomach Pains

• Stress or Worries. The most common cause of frequent stomach pains is stress. Over 10% of children have a "worried stomach." These children tend to be sensitive and too serious. They often are model children. This can make them more at risk to the normal stresses of life. Examples of these events are changing schools, moving or family fights. The pain is in the pit of the stomach or near the belly button. The pain is real.
• Abdominal Migraine. Attacks of stomach pain and vomiting with sudden onset and offset. Often occur in children who later develop migraine headaches. Strongly genetic.
• Functional Abdominal Pains. Functional means the stomach pains are due to a sensitive GI tract. The GI tract is free of any disease.
• School Avoidance. Stomach pains that mainly occur in the morning on school days. They keep the child from going to school.

Pain Scale

• Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: The pain is very bad. It keeps your child from doing all normal activities.

Call 911 Now

• Not moving or too weak to stand
• You think your child has a life-threatening emergency

Go to ER Now

• Appendicitis suspected (pain low on right side, won't jump, wants to lie still)
• Severe constant pain (child not able to move or do anything)
• Can't walk or walks bent over holding the stomach
• Blood in the stool or vomiting blood
• Vomiting bile (green color). Exception: stomach juice which is yellow.
• Swallowed object (such as coin) suspected

Call Doctor or Seek Care Now

• Pain low on the right side
• Could be pregnant
• Constant pain (or crying) for more than 2 hours
• Recent injury to the stomach
• High-risk child (such as diabetes, sickle cell disease, recent stomach or abdomen surgery)
• Age less than 2 years old
• Fever over 104° F (40° C)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Moderate pain that keeps from some normal activities
• Mild pain that comes and goes (cramps), but lasts more than 24 hours
• Fever is present
• Bladder infection (UTI) suspected (passing urine hurts, new onset wetting)
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Stomach pains are a frequent problem
• You have other questions or concerns

Self Care at Home

• Mild stomach pain

Care Advice for Stomach Pain

1. What You Should Know About Stomach Pain:
   • Mild stomach pain can be caused by something simple. It could be from gas pains or eating too much.
   • Sometimes, stomach pain signals the start of a viral infection. This will lead to vomiting or loose stools.
   • Watching your child for 2 hours will help tell you the cause.
   • Here is some care advice that should help.
2. Lie Down:
   • Have your child lie down and rest until feeling better.
3. Clear Fluids:
   • Offer clear fluids only (such as water, flat soft drinks or half-strength Gatorade).
   • For mild pain, offer a regular diet.
4. Prepare for Vomiting:
   • Keep a vomiting pan handy.
   • Younger children often talk about stomach pain when they have nausea. Nausea is the sick stomach feeling that comes before they throw up.
5. Pass a Stool:
   • Have your child sit on the toilet and try to pass a stool.
   • This may help if the pain is from constipation or diarrhea.
   • Note: for constipation, moving a warm wet cotton ball on the anus may help.
6. Do Not Give Medicines:
   • Any drug (like ibuprofen) could upset the stomach and make the pain worse.
   • Do not give any pain medicines or laxatives for stomach cramps.
   • For fever over 102° F (39° C), acetaminophen (such as Tylenol) can be given.
7. What to Expect:
   • With harmless causes, the pain is most often better or gone in 2 hours.
   • With stomach flu, belly cramps may happen before each bout of vomiting or diarrhea. These cramps may come and go for a few days.
   • With serious causes (such as appendicitis), the pain worsens and becomes constant.
8. Call Your Doctor If:
   • Pain becomes severe
   • Constant pain lasts more than 2 hours
   • Mild pain that comes and goes lasts more than 24 hours
   • You think your child needs to be seen
   • Your child becomes worse
9. Extra Help - Worried Stomach:
   • Help your child talk about events that trigger the stomach pain. Talk to your child about how to cope with these the next time around.
   • Help your child worry less about things she can't control.
   • To treat the pain, help your child get very relaxed. Lying down in a quiet place and taking slow deep breaths may help. Make the belly go up and down with each breath. Then try to relax all the muscles in the body. Think about something pleasant. Listening to audios that teach how to relax might also help.
   • Make sure your child gets enough sleep.
   • Make sure that your child doesn't miss any school because of stomach pains. Stressed children tend to want to stay home when the going gets rough.
   • Caution: your child should see her doctor for an exam. Do this before concluding frequent stomach pains are from worrying too much.

Care Advice for Stomach Pain