Patient's question:
Hello doctorA 10-year-old child often has stomach pain and poor immunity. What are the possible causes, and how should it be treated? What usually causes this condition, and which medications are effective?
Doctor's answer:
Various possible causes of children's abdominal pain can help take timely measures for diagnosis and treatment.1. Intestinal spasm. This is the most common cause of abdominal pain in children. In pediatric surgery clinics of children's hospitals, the majority of abdominal pain cases in children are caused by intestinal spasm (intestine cramping), affecting children aged 1-2 to 11-12. The most common age group is between 4-5 and 5-6 years old. The main cause of intestinal spasm is improper eating habits (e.g., overeating; consuming large amounts of cold food). At this time, there is no definite pressure point (the abdomen feels soft all over), and the child can eat, drink, and is in good spirits. Treatment involves taking anticholinergic drugs (like hyoscine) and antihistamines (like diphenhydramine) together. When this occurs, parents may feel anxious, but it is generally not a serious problem.
2. Acute pancreatitis. This condition is less common in 2-3-year-old children but more prevalent in those aged 4-5 and older. The causes are mostly overeating, especially of greasy, indigestible foods; pancreatitis caused by biliary duct obstruction by roundworms (this is rare); or the use of L-asparaginase in leukemia patients. The symptoms include pain in the upper left quadrant of the navel. Parents may notice that the child has eaten a lot, is in pain (with knees drawn up), and avoids touching the upper left side of the navel. Acute pancreatitis can generally be cured, but acute hemorrhagic necrotizing pancreatitis can lead to shock rapidly. Symptoms include severe abdominal pain (the child refuses to let parents touch the abdomen), vomiting, poor mental state, and a gray complexion. If rescue is not timely, it can lead to death. The first step in treating pancreatitis is to fast, followed by a liquid diet for regulation.
3. Enteritis. This primarily causes pain in the lower abdomen centered around the navel, accompanied by vomiting and diarrhea. The abdomen feels soft and has no fixed pressure point. Enteritis is usually caused by consuming unclean food. Paying attention to dietary hygiene in daily life can prevent this.
4. Appendicitis. This mainly causes pain in the lower right abdomen. In 2-3-year-old children, abdominal pain may be accompanied by obvious abdominal distension, vomiting, and diffuse abdominal tenderness, with the child refusing to be touched. Fever of over 38°C may also occur. This age group should be taken more seriously, as it is prone to perforation, leading to peritonitis. In children over 10 years old, appendicitis initially causes upper abdominal pain (or what feels like stomach pain), which then shifts to the lower right abdomen several hours later. Some children may also experience nausea and vomiting, with a very obvious pressure point in the lower right abdomen, which the child avoids being touched. After the pain, low-grade fever (37-38°C) or even fever as high as 39°C may occur.
5. Intussusception. In children aged 6-12 months, crying and fussiness should make parents consider whether it is abdominal pain. If the child cries intermittently, every 10-20 minutes for 5-6 minutes each time, then returns to normal, this is most likely intussusception, where one part of the intestine slides into another, causing spasms and intermittent pain (with the child curling up). This is primary intussusception. Followed by vomiting, and several hours later, bloody stools (resembling red jam or bean curd soup). Changes in dietary habits are one of the important reasons for the onset of intussusception. In 5-6-year-old children, a small mass often grows on the cecum, wrapping around the intestine and causing intussusception, which is secondary intussusception. Careful parents may feel a sausage-like mass on the child's abdomen, about 4-6 cm long, which changes over time. Initially, it may be in the upper right abdomen, then the upper abdomen, then the lower left abdomen. In some cases, the intussusception may be so loose that it protrudes from the anus.
6. Intestinal obstruction. Different ages have different types of intestinal obstruction. Children who have had congenital abdominal surgery may also develop intestinal obstruction. Symptoms include intermittent pain around the navel, accompanied by vomiting, with undigested food (in infants, curd-like vomit may be seen, followed by bile-like substances). Sometimes, the child's intestines can be seen moving in a row, and the abdomen may have pressure points (pain in variable positions, with the child avoiding being touched).
7. Tumors. Abdominal pain may also be caused by tumors. The child may experience pain in the lower navel area, and a mass can be felt upon careful examination.