Abdominal Pain in Children: When a Stomachache Needs Medical Attention

Why belly pain is so common

Abdominal pain is a frequent reason for children's visits to the doctor and emergency department. Younger children often cannot describe exactly where it hurts or what it feels like, which is why parents' observations are so valuable.

What you notice at home—how your child is acting, eating, drinking, and moving, and what the vomit or stool looks like—helps the doctor interpret the pain.

Common causes by age

The most likely causes of belly pain change as children grow.

Babies and toddlers

• Constipation: Hard, painful, or pebble-like stools, sometimes with stool withholding. Straining alone does not necessarily mean constipation, especially when a baby passes soft stools.
• Stomach bug (viral gastroenteritis): Vomiting and diarrhea, sometimes with fever. Vomiting may start before diarrhea.
• Colic: In otherwise healthy young infants, episodes of prolonged crying may include pulling the knees up. New or unusual crying with poor feeding, vomiting, fever, or an ill appearance should not simply be assumed to be colic.
• Less common but serious causes: A blocked or twisted intestine, such as intussusception or malrotation with volvulus, or a trapped hernia. These need urgent evaluation.

School-aged children

• Constipation: One of the most common causes.
• Stomach bugs and other viral illnesses.
• Infections outside the belly: Strep throat, pneumonia, and urinary tract infections can all cause belly pain.
• Appendicitis: A common reason for emergency abdominal surgery in children. Pain often starts near the belly button and moves to the lower right side, but this pattern is not always present.

Teenagers

• The causes above still apply. Menstrual cramps, ovarian problems, and pregnancy-related conditions may also need consideration depending on the teenager's circumstances.
• Testicular torsion—a twisted testicle—is an emergency that can sometimes show up mainly as belly pain.

Our guides to constipation, vomiting and diarrhea, urinary tract infections, and sore throat and strep explain these conditions in more detail.

Warning signs—when to seek emergency care

Go to the emergency department if your child has:

• Severe or rapidly worsening pain, especially if your child cannot walk comfortably or does not want to move.
• Green (bile-stained) vomit. Bile is typically dark green, rather than simply yellow. If you are unsure about the color and your child is unwell, seek urgent advice.
• Blood in the vomit, significant blood in the stool, black tarry stools, or blood and mucus resembling red jelly in a baby.
• A hard, rigid, or very tender belly, or marked swelling of the abdomen.
• A very ill appearance, extreme sleepiness, difficulty waking, or unusual limpness.
• Inability to keep fluids down with worsening dehydration, such as very little urine together with weakness or unusual sleepiness.
• Sudden testicular pain or swelling, a painful groin lump, or sudden severe one-sided lower belly pain.

A baby with repeated episodes of intense pain, vomiting, unusual sleepiness, or drawing the knees up needs urgent evaluation. Do not wait for bloody or jelly-like stools to appear.

Appendicitis can be tricky. Young children may not have the classic symptoms, and diarrhea does not rule it out. When in doubt, it is always reasonable to have your child checked.

When to call the pediatrician or seek same-day care

Contact your child's pediatrician promptly for:

• Pain that is becoming more persistent, getting worse, or settling in one spot—especially the lower right side.
• High or persistent fever with belly pain.
• Repeated vomiting, poor drinking, a dry mouth, no tears, or far fewer wet diapers or trips to urinate.
• Any blood in the stool, even if it is only a small amount.
• A baby with new or persistent belly-pain symptoms.

Tell the doctor whether the pain started before or after vomiting. This helps with assessment, but the order alone does not diagnose appendicitis or determine whether the problem is an emergency.

Do not wait for an office appointment if emergency warning signs develop.

Caring for milder belly pain at home

If your child is acting mostly like themselves, drinking fluids, and has none of the warning signs above, mild symptoms can often be watched at home:

• Offer small, frequent sips of fluid. Oral rehydration solution can help when vomiting or diarrhea is causing fluid losses. For babies, continue breast milk or formula; do not add extra water or dilute formula unless a clinician instructs you to.
• Let your child rest and offer their usual age-appropriate foods as tolerated when hungry. Do not force food.
• For suspected constipation, age-appropriate fluids, fiber, and a comfortable toilet routine can help. Established constipation often needs more than dietary changes. Ask your doctor about a treatment plan before starting a laxative or other medicine.
• Keep track of where the pain is, how severe it is, how long it lasts, vomiting or diarrhea, fever, and how much your child is drinking and urinating.
• Pain relief can be appropriate. Acetaminophen may help when used correctly for your child's age and weight; ask your clinician if you are unsure. Appropriate pain relief does not prevent a clinician from recognizing a serious cause. Do not delay evaluation or assume the problem is harmless just because medicine helps.

See our Fever in Children guide for medication safety and weight-based dosing guidance.

When to call your doctor, even without an emergency

Reach out to your child's doctor if:

• Mild pain lasts more than a day or keeps coming back.
• Your child has pain with urinating or urinates more often.
• Your child is losing weight, not growing well, or the pain regularly wakes them at night.
• Pain is interfering with school, eating, sleep, or usual activities.
• You are simply worried—trust your instincts.

These timeframes apply to mild symptoms. Worsening pain, fever with an unwell child, or any warning sign deserves earlier attention.

What to expect at the doctor's office

The doctor will ask about the pain and examine your child's belly. Depending on what they find, they may order tests such as a urine test or blood tests.

If imaging is needed, ultrasound is often a useful first test for suspected appendicitis or intussusception because it does not use radiation. The right test depends on the suspected cause; not every child needs ultrasound, blood tests, or other imaging.

Many children are assessed through the history and examination alone. Sometimes the cause becomes clearer over time, so a repeat examination may be needed if symptoms persist or change.

The bottom line

Most belly pain in children is mild and gets better on its own. Your job as a parent is not to make the diagnosis, but to watch for the warning signs, keep your child comfortable and hydrated, and know when to seek help.

When serious warning signs appear—or whenever you are worried—getting your child evaluated promptly is always the right call.

Our Pediatrician, Urgent Care, or ER? guide can help explain the different levels of care.