PAEDIATRICS
Tummy Pain in Children: What Deserves a Proper Assessment
Common causes of abdominal pain in children, what to watch for, and when assessment matters.
Abdominal pain in children is common and usually short-lived. Constipation, viral gastroenteritis, trapped wind, anxiety and food intolerance are among the most frequent causes — and most resolve with simple measures. The challenge for parents is that the same complaint of “tummy pain” can occasionally indicate something more significant: appendicitis, urinary tract infection, intussusception in young children, or other conditions that benefit from prompt assessment.
Duration, location, associated vomiting, fever, appetite, bowel habits and hydration all help a GP distinguish between common self-limiting causes and those that need investigation or referral.
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Common causes by age
In babies and toddlers, colic, wind, reflux and constipation are the most frequent causes. Intussusception — where part of the bowel telescopes into itself — is uncommon but serious, typically presenting with sudden screaming episodes, drawing up of the legs, pallor and sometimes bloody stools. In nursery-age and school-age children, constipation remains one of the commonest causes (often underestimated by parents), alongside viral gastroenteritis, mesenteric adenitis (swollen abdominal lymph nodes during viral illness), and anxiety-related abdominal pain — which can be very real and recurrent even without a structural cause.
In older children and adolescents, the differential widens to include appendicitis, urinary tract infections, period-related pain in girls, irritable bowel symptoms, and food-related causes such as lactose intolerance or coeliac disease.
Red flags
Signs that warrant urgent assessment
Urgent or emergency assessment is appropriate when abdominal pain is severe and localised (particularly to the right lower abdomen, which may suggest appendicitis), when pain is accompanied by bile-stained (green) vomiting, when there is blood in the stool, when the child is lethargic, dehydrated or refusing fluids, when the abdomen is rigid or distended, or when the child appears significantly unwell. In babies, inconsolable screaming with pallor and leg-drawing episodes should be assessed urgently.
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When a GP appointment is the right step
A paediatric GP appointment is appropriate when tummy pain is recurrent (happening regularly over days or weeks), when it is interfering with eating, sleep or school attendance, when it is accompanied by persistent changes in bowel habit (diarrhoea, constipation, or alternating), when there is associated weight loss or poor growth, or when parents are simply unsure whether the pattern is normal. Chronic or recurrent abdominal pain in children often benefits from a proper clinical assessment rather than repeated reassurance without examination.
Clinical assessment
What assessment involves
Your GP will take a detailed history of the pain — when it occurs, where it is felt, what makes it better or worse, and what other symptoms are present. Examination of the abdomen is usually needed. Depending on the findings, the next step may be simple dietary or bowel management advice, a urine sample to check for infection, blood tests to screen for coeliac disease, inflammation or other causes, or onward referral for further investigation.
Common questions
Which tummy-pain signs point to something needing urgent assessment?
Severe pain, pain that is constant or worsening, pain with persistent vomiting, bile-stained (green) vomit, blood in vomit or stool, a swollen or very tender abdomen, pain with fever, a child who appears very unwell, or pain that is making the child draw their knees up and cry inconsolably all warrant urgent assessment. If in doubt, call 999 or go to A&E.
When is it reasonable to try home management first?
Mild, intermittent tummy pain in a child who is otherwise well, eating, drinking, active and without red flags can often be monitored initially with simple measures — hydration, rest, a bland diet. If pain persists, worsens, or is accompanied by other symptoms, a GP review is appropriate.
What does a GP typically check when examining a child with tummy pain?
The GP reviews the history, examines the abdomen, checks hydration, assesses for signs of infection, and considers whether urinary, respiratory or other causes may be relevant. Investigation may include a urine sample, blood tests, or onward referral depending on what the assessment suggests.
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