“My tummy hurts!” - How to Tell When a Stomachache Is Real

“Mommeeee… my tummy hurts!” my three-year old complained as he came out of his room for the second time that night.  

“Show me where it hurts,” I said to him.

He pointed to an area around his belly button (where most children will point when asked this question).  My son was normally a great sleeper, so I was a little concerned that maybe he really was coming down with something.

I looked at him and went through my checklist.  Dressed in his dinosaur fuzzy footy pajamas, he had walked over to my room to report his distress (no signs of pain with walking).  He wasn’t bent over or crying (not severe pain).  He had come up with this reason after a previous unrelated reason for leaving his bed (not repeated or consistent pain).  He had eaten dinner well earlier today and went to the bathroom normally (no loss of appetite and no vomiting, diarrhea or constipation).  I put his hand on his forehead and he did not feel feverish (yes, we will always tell you to take your child’s temperature with a thermometer – but I’ll admit to using the mommy forehead test).

 “What do you need to make it better?” I asked.  I almost always ask my kids this question when they have a complaint.  They usually have a fix in mind and the “boo-boo” disappears magically.  My favorite was when my daughter told me that “chocolate candy” would fix her stomach pain.  (I didn’t give in on that one!)

“I need boo-boo penguin,” he answered promptly.  He was referring to our penguin-shaped ice pack that seems to cure almost all ailments. 

So, I said okay.  And within five second of boo-boo penguin’s magic, he was ready to sleep.

I wouldn’t recommend giving in to demands on repeated nights, but since this was a first request, I let it slide.  Sometimes it isn’t worth the battle!  (ummm - perhaps “do as I say, don’t do as I do” applies here also)

How do you know when a stomachache is the sign of real illness or when it’s just a behavioral ploy for attention or to get out of doing something (like eating vegetables or going to school)?

It can be difficult to tell sometimes.  However, there are certain signs that are red flags for illness.  Some of these require immediate medical attention.  Others can be treated first at home and then your child should be brought to your pediatrician if there isn’t any improvement.

When you call your doctor, think about the following so that you can have these answers ready.

Timing  - How long has the pain been going on?  How often does your child have the pain?  How long does it last? When does it happen?  Most simple pains only last a few minutes and happen only once or twice.  If the pain lasts for several days or several hours, call your child’s doctor.  Some pains only occur during school mornings.  Others happen only at bedtime.  These can all be clues as to the underlying cause (or motive as the case may be!)

Severity – Is your child running around and playing? Or is she rolled up in a little ball crying about her pain?  This will help you to determine the seriousness of the pain.  Asking young children if their stomach hurts does not always help since they will usually give the answer that they think you want (not how they actually feel).

Location – Where does your child point to when you ask where it hurts?  Tell them to point with one finger to where it hurts the most – otherwise, they’ll usually rub their entire belly button area and say “It hurts all over!”  Pain located in the lower right side of the belly is possible appendicitis and is an emergency.

Triggers – Does it occur after eating certain foods or drinking certain liquids?  Lactose-intolerance is fairly common and can be helped by eliminating lactose from the diet (your child can drink soy milk or Lactaid milk to get the needed calcium).  Also, food allergies can cause stomach pain or vomiting or diarrhea.  Celiac disease (or gluten intolerance) is a common food allergy that can cause ongoing stomach pain.  Bloating and gassiness can be associated with food-related allergies or intolerance.

Vomiting or Diarrhea – Stomach bugs can cause short-term belly pain along with vomiting or diarrhea.  However, if the vomiting/diarrhea is severe, lasts more than 24-48 hrs, contains blood, or your child is unable to keep fluids down, call your doctor.

Constipation – If your child’s pain is much better after having a bowel movement, then the pain may be related to constipation.  Increase water, fiber and vegetables in your child’s diet to see if your child’s pain improves with softer stools.  See my previous blog post on constipation for more information.

Urinary problems or groin pain – these can be signs of other medical problems like a urinary tract infection or testicular torsion.  Call your doctor immediately.

Rash – stomachache and rash can be signs of other types of illnesses, such as a Strep infection, call your doctor for guidance.  If your child has hives, then it may be an allergic reaction, seek help immediately.

Fever – fever usually means infection.  If the fever is low grade (102 or less), has been less than 3 days, and the stomach pain is minimal, you can likely treat your child’s symptoms at home.  However, if the pain is severe, your child is in distress, the fever is high, or any of the warning symptoms described above are present, then you should call your child’s doctor.

Weight changes or poor growth – if your child is not growing well or is losing weight, these can be signs of more serious diseases and your child needs to be seen.

What to do if you suspect the complaint is behavioral?

If your child is running around happily and is not ill-appearing, then the complaint of a tummyache may be a way of getting attention or a ploy to get out of an activity.  If you think this is the case, the best thing you can do is to ignore it.  The more you acknowledge it, then the more he will repeat the behavior (i.e. getting boo-boo penguin in the middle of the night – oops!) 

Instead, provide a distraction and move on to the next activity.  If there are no further complaints, then you know it’s just a clever way to get some attention.  Or if he insists on a cure, then give a placebo, like a medicine syringe full of colored water or juice and see if the pain improves.  If so, you know that there is nothing serious causing the pain. 

Shower your child with love and attention when he is not complaining of tummy aches and gradually the behavior will stop.  It may take a few weeks, but if you stick to it, then the imaginary tummy aches will be cured.  (and then they’ll move on to “Mommeeee…  my leg hurts!!!”)  (more on that later!)

Happy Holidays, and thanks for reading!

Keeping Our Kids Happy and Healthy Through The Holidays

“Can I wear my gloves today?” asks my daughter holding up her new pink gloves decorated with snowflakes.  It’s the end of October and sixty degrees outside.  It’s been unseasonably warm this season, and we’re only just starting see some colder weather announcing the arrival of autumn.  

So I tell her, “Not yet, but soon.  It’s cold, but not cold enough for snow yet.”  She nods and puts them in her backpack for safekeeping.  “Maybe it will be cold enough tomorrow!”  

The she zips up her backpack, thinks for a second, and then asks, “Can I wear my boots?”

And so it goes…  in the end, we’ve compromised.  She can wear her boots this weekend, her hat now, and her gloves when she goes to the playground today if she wants.

Cold weather is here, and we are spending more time indoors sharing viruses and germs.  Kids and adults alike tend to get sicker in the winter months because of this.  Parents can take help prevent illness in their children by teaching them valuable skills that will prevent illness.

Regardless of age, one of the most important methods of prevention is good hand washing.  My kids are notorious for running their hands under the water for three seconds (maybe getting a little bit of soap if we’re feeling extra good today) and then quickly wiping their hands on a towel as they run out to get back to playing. 

To wash our hands properly, we should rinse our hands with water and soap for at least twenty seconds, or the time it takes to sing the alphabet song.  For children who are old enough, teach them how to wash correctly.  Show them how to clean the tips of the fingers especially well since children tend to put their fingers in their mouths often.

One of the most common ways that we pick up germs or viruses is by touching surfaces that someone else who has been sick coughed on, sneezed on, or touched.  Then we end up infecting ourselves or our children.

Many parents also notice how younger siblings seem to get sicker at a younger age or perhaps more often than an older sibling did.  This is because the older child brings germs or viruses home from school or daycare and infects the younger child.

Colds, flu, and vomiting/diarrhea diseases are some of the most common illnesses that children get from others.  If your child ends up with any of these illnesses, here are some tips to help you and your child get through them.

For colds and flu, it is important to give your child plenty of fluids.  Food is not as important while they are ill, and your child may lose her appetite while sick.  Hydrating your child with age-appropriate fluids is important.  Running a humidifier in the child’s bedroom and having her sleep in a more upright position will ease nighttime congestion and cough.  For children older than 1 year, giving 1 teaspoon of dark honey can quiet coughing episodes.   In general, over-the-counter cold medications are not recommended for children under the age of 6 years.  If your child has fever greater than 104, has prolonged fevers for more than 3days, has a severe cough, chest pain, wheezing, or seems lethargic, call your doctor immediately.

In the past, we were all told “cover your mouth when you cough”… and we did this with our hands.  However, when a child coughs and covers his mouth with his hand, the virus particles get all over that hand, spreading the virus to others as he touches various surfaces.    To help keep from spreading germs, teach your child to cough into the crook of his or her elbow.  And again, good hand-washing is key to prevention of spread.

Use antibacterial hand sanitizers when soap and water are not available.  These are effective for killing many of the germs that can cause illnesses.

For vomiting and diarrhea illnesses at all ages, it is very important to prevent dehydration.  This can be done by giving small frequent sips of an electrolyte solution, such as Pedialyte.  If your child refuses to drink or cannot keep large amounts down, then give 5 mL every 5 minutes using a medicine syringe.  This can hydrate a child successfully and will be less likely to trigger more vomiting.

You should avoid giving juice or sports drinks because the excessive sugar in these liquids can result in worsening diarrhea.  Giving water alone does not provide enough of the salts and sugars that the body needs to function.  Probiotics can also be very helpful with diarrhea illnesses.  These can be found in yogurt (if your child isn't vomiting) and in powder or chewable tablet forms in most drug stores and several grocery stores.

If your child shows signs of dehydration, call your doctor immediately.  Signs of dehydration include increased thirst, dry mouth, sunken fontanelle (for infants), doughy-feeling skin, decreased urine production, and lethargy or tiredness. 

Regardless of the type of illness, do not send your child to school if he or she has a fever.  Viral illnesses are the most contagious when the person has a fever.  Most viruses are spread by respiratory droplets or contact with fluids that contain virus, so even though the fever is gone, your child may still be contagious to others.  Use your best judgment when deciding when your child should go back to school.  

Teach your child not to share food or drinks with other kids since someone else might be ill or be contagious and not realize it.

Help your child stay healthy and ready to learn by taking precautions and use prevention methods.  Teach your child to wash his or her hands often and avoid direct contact with other sick children when possible.  By doing this, everyone can stay healthy and have a happy holiday season!

Happy Fall and thanks for reading!

Vomiting and Diarrhea - the Dreaded Stomach Bug

“I need to spit up!”  declares my three-year old.  

Hearing these words (which are code for I’m about to vomit right now), I launch myself off the couch, leap across dangerous obstacles composed of toys and books  to get across the living room to scoop him up off our off-white carpet.  Then running like mad cupping my hand strategically below his mouth, I repeat over and over, “Wait wait wait!  Throw up in the potty, not on the floor!  You’re okay, you’re okay!”  

And then, a few inches from our target destination of the bathroom toilet, he throws up.  Oh well… at least it’s easier to clean here.

The holiday season this year brought my family many presents… including a stomach virus.  I got it and my kids got it (my husband kept thinking he was getting it –but managed to avoid it).  Many people have unfortunately fallen prey to stomach viruses this year.  You or your family members may have been through it, too.   If so, I’m so sorry – I know how horrible it can be.   Luckily, it tends to go away in a few days leaving most of us wiped out, but okay.

Children are smaller and have less ability to tolerate vomiting and diarrhea compared to adults.  Therefore, they get dehydrated much quicker than grownups do. 

If your child is vomiting or having diarrhea, it is of utmost importance that your child stays hydrated.  Food or solids are not important while your child is vomiting.

Sometimes vomiting or diarrhea can be a symptom of a more serious illness. 

If you see any of the following, you should call your doctor:

1. Projectile or forceful vomiting
2. Blood in the vomit or diarrhea
3. Severe stomach pain
4. Fevers>104 F
5. No improvement in vomiting in 24 hrs
6. Persistent diarrhea more than 10 days
7. Prolonged diarrhea after finishing antibiotic use.
8. Your baby is less than four months old and is having vomiting or diarrhea
9. Pain with urination or more frequent urination
10. Severe headaches
11. Drinking frequently
12. Symptoms other than just vomiting or diarrhea

To help your child get through it, try the following:

For vomiting, give your child small sips of clear fluids that have electrolytes (such as Pedialyte).  If your child refuses to drink or is unable to keep fluids down, use a medicine syringe and squirt small amounts into his/her mouth every five minutes.  Your child needs to urinate at least three times a day.  If your child has not urinated for more than eight hours or is lethargic or can’t keep anything down, call your doctor immediately. 

Do not give milk or heavy foods, such as dairy or fried foods.  These are likely to come back up.  If your child wants to eat, give small amounts of bland foods such as crackers, toast or plain cereal.  Foods with lots of liquid are also good – such as popsicles, soup, and jello.

If your child has not thrown up for at least 12 hours, it is reasonable to try slowly advancing his/her diet.  Again, avoid heavy foods for the best chance of success.

For diarrhea (and no vomiting), give your child the BRAT diet (bananas, rice, applesauce and toast) to help firm up stools.  Lactose can be difficult to digest with diarrhea, so using a lactose-free milk or soy milk/formula temporarily may help with symptoms.

Probiotics are also useful for combating diarrhea.   Probiotics are the healthy bacteria that help to keep our digestive system healthy.  If your child is not vomiting, then eating yogurt is one way to get probiotics.  Many pharmacies and grocery stores carry probiotics in various forms that kids can eat  – granules for infants and toddlers, chewable tablets for young children, and capsules for older children and adults.

To prevent spreading the virus to others, wash your hands frequently!  The viral particles are in the vomit and the stool.  Wash your hands frequently and use antibacterial soaps and surface cleaners.  Make sure that other children do not share utensils, cups and food with the sick child.

Oh wait,  I think I hear something. 

“Mommy!  I need to spit up!”  Uh oh, gotta run… here we go again! 

Stay healthy, and thanks for reading!