What are the clinical manifestations of abdominal pain in children?

There are many reasons for abdominal pain in children, such as many gastrointestinal diseases, gastroenteritis, acute gastritis, gastric spasm, ascariasis, etc. can directly cause abdominal pain. In addition, there may be some respiratory diseases, such as acute pleurisy, lobar pneumonia, etc., and it may also be cardiovascular disease or some metabolic diseases, so it is important to find out the cause.

1. Age

The common diseases causing abdominal pain in children of different ages are also different. For example, intestinal spasms are more common in infants under 3 months old, often due to improper feeding or swallowing too much air. Intussusception, incarcerated hernia and intestinal infection are more common in children under two years old, while acute appendicitis and intestinal parasitic diseases are relatively rare. Gastrointestinal infections, intestinal parasitic diseases, mesenteric lymphadenitis, biliary ascariasis, lobar pneumonia, abdominal epilepsy, and allergic purpura are more common in older children.

2. Acute or slow onset of abdominal pain

The acuteness of onset is often important for differential diagnosis. Acute onset or paroxysmal exacerbation are often surgical diseases, such as acute appendicitis, strangulated intestinal obstruction, gastrointestinal perforation, intussusception and incarcerated inguinal hernia. Patients with slow onset and persistent pain are often medical diseases, such as intestinal ascariasis, gastric and duodenal ulcers, enteritis and viral hepatitis. However, it should be noted that sometimes the causes of chronic abdominal pain and acute abdominal pain can be the same. This is because the nature of the disease changes at different stages. For example, ulcer pathogens are chronic abdominal pain, and when combined with perforation, it is an acute abdomen. Therefore, for patients with chronic abdominal pain, if the abdominal pain turns into persistent or sudden severe pain, they should pay attention to the possibility of acute abdomen.

3. Nature of abdominal pain

Abdominal pain may be paroxysmal, continuous, or mild. Paroxysmal pain or colic is caused by obstructive diseases. If the abdominal pain is relieved after local pressure or hot compress, it is often due to spasm of hollow organs such as the stomach, intestines, and bile duct. Persistent and aggravated abdominal pain is often caused by gastrointestinal perforation. Persistent dull pain that worsens when changing body position and is resistant to pressure is often caused by inflammation of abdominal organs, capsule stretching, tumors, and irritation of the visceral peritoneum. Dull pain is common in peptic ulcers. Radiating pain is pain from a local lesion that spreads to other parts of the body through nerves or adjacent organs, such as lobar pneumonia causing pain in the ipsilateral upper abdomen. Abdominal pain accompanied by difficulty in defecation or urination may be caused by fecal blockage, urinary tract infection, or stones. In summary, the pain characteristics of organic abdominal lesions are: ① persistent dull pain, with paroxysmal aggravation; ② obvious local tenderness; ③ abdominal muscle tension; ④ abnormal bowel sounds.

4. Location of abdominal pain

Generally, the location of abdominal pain is consistent with the location of the lesion.

5. Associated symptoms

Attention should be paid to the relationship between abdominal pain and fever.

6. Past History

The child should be asked in detail whether he has had similar abdominal pain attacks in the past, his history of fecal worms and skin purpura. It is also necessary to understand whether there was any trauma before the onset of the disease, his dietary hygiene and what kind of food he ate, etc., all of which are helpful in diagnosing the cause of the abdominal pain.