What to do when little tummies hurt

 
 

Sandra Gordon

My tummy hurts, your 4-year-old complains. Next thing you know, he slaps a hand over his mouth and throws up all over the couch. Vomiting can be a traumatic experience for the child and parent alike. He's upset and scared, and you have no idea whether this is just a minor stomach bug or something that warrants a call to the doctor.

As unpleasant as it is, vomiting does serve a purpose. In some cases, throwing up will make your child feel better instantly. In others, vomiting is just one symptom among several that provide valuable clues to the nature of your child's illness. Does he have a fever? Diarrhea? Is he dehydrated?

"It's probably going to be something benign," says Dr. Ruben Rucoba, a pediatrician at Wheaton Pediatrics. "Signs that it might be much more than that would be vomiting with severe abdominal pain. Not just a little crampy-my-belly-hurts but when they have difficulty walking."

This symptom guide to common and not-so-common stomach illnesses will help you distinguish a short-lived tummy virus from something more serious.

Symptoms

What it could be

Fast-action plan

Vomiting + rash If your child vomits repeatedly after eating and also has a rash around her mouth, on her neck, behind her knees or in the crook of her elbows, she may have an allergy to the formula or the milk she's drinking, or to other common allergens such as strawberries, chocolate or peanuts. Call 911 immediately if your child experiences symptoms such as shortness of breath or swelling of the mouth or throat. An extreme allergic reaction can be fatal if you don't act fast. (It's a good idea to keep an antihistamine such as Benadryl on hand; 911 might ask you to administer it). Otherwise, see your pediatrician. A rash signals inflammation in the gut, which inhibits food absorption and proper weight gain. Overall, such reactions are rare in babies because allergies are related to consistent exposure to food.
Vomiting + blood
Your child could simply have a stomach bug and a broken blood vessel. "It usually means they've been vomiting for some time now, and they have a little tear in their esophagus," says Rucoda. In rarer instances, it might be caused by a bleeding ulcer from bacteria called Heliocobactor pylori, or from being given nonsteroidal anti-inflammatory drugs, such as aspirin or aspirin-related medication. Call your pediatrician immediately anytime your child vomits blood. Don't give aspirin to children or teenagers. Besides upping the risk of a bleeding ulcer, aspirin increases your child's potential for developing Reye's Syndrome, a serious brain-swelling disorder. Control fevers with a non-aspirin pain reliever such as acetaminophen.
Vomiting + rash The bright-green color means your child is vomiting bile, a liver secretion, which could indicate a gastrointestinal obstruction due to a birth defect, a meconium blockage or a twisting of the bowel (volvulus). A meconium blockage and volvulus are diagnosed most often in the first month of life, although school-age children can develop volvulus if their bowel is congenitally susceptible to twisting. Call 911 immediately if your child experiences symptoms such as shortness of breath or swelling of the mouth or throat. An extreme allergic reaction can be fatal if you don't act fast. (It's a good idea to keep an antihistamine such as Benadryl on hand; 911 might ask you to administer it). Otherwise, see your pediatrician. A rash signals inflammation in the gut, which inhibits food absorption and proper weight gain. Overall, such reactions are rare in babies because allergies are related to consistent exposure to food.
Vibrant greenish-yellow vomit
If your child vomits repeatedly after eating and also has a rash around her mouth, on her neck, behind her knees or in the crook of her elbows, she may have an allergy to the formula or the milk she's drinking, or to other common allergens such as strawberries, chocolate or peanuts. Call your doctor or go to the ER. "Bile-stained vomiting is an emergency," says Dr. Mike Farrell, chief of staff of the Children's Hospital Medical Center in Cincinnati. Surgery is often necessary to correct the problem.
Recurring vomit with no obvious cause
Cyclic vomiting syndrome, which affects 1 to 2 percent of school-age children. With this brain-gut disorder (often related to migraine headaches), children experience an intense period of vomiting that lasts from several hours to several days. Weeks or months then follow in which they're symptom-free before the cycle starts again. Cyclic vomiting syndrome is not as common as a viral stomach illness, but it's often mistaken for one. Some kids develop migraine headaches as adults; others simply outgrow the condition. If your child has repeated intense vomiting episodes, keep a log, noting how long they last and when they return. A variety of medications can control, though not cure, this syndrome. If an episode can't be stopped, kids are often hospitalized and sedated to ease their suffering.
Vomiting + severe abdominal pain
Your child may have appendicitis, an inflammation of the small finger-shaped organ attached to the large intestine. It is most common in children over age 10. At first, she may feel mild, constant pain around the belly button. The pain is usually not too severe at the start, but it will migrate to the lower right side of her abdomen and intensify. If it ruptures, your child may feel better because the pressure is gone. Six to eight hours after the rupture, she'll feel ill again as toxins spread throughout the abdominal cavity. A ruptured appendix is serious. Call your doctor if your child is vomiting for several hours and complains of stomach pain, especially around the belly button or on the lower-right side of her abdomen. If she is diagnosed with appendicitis, her appendix will need to be removed immediately.
Vomiting + fever + piercing scream (babies) or stiff neck (kids) Bacterial meningitis, a potentially serious brain infection. Fortunately, since the development of the Haemophilus influenzae type b (Hib) vaccine, which is one of the well-baby shots, this isn't as common as it once was. Besides vomiting, symptoms of meningitis in older children may include headache, stiff neck and disorientation. Call your pediatrician immediately if your baby is vomiting, running a fever and irritable or inactive, or if your older child is vomiting and complains of a stiff neck or seem dizzy and confused.
Vomiting + diarrhea +
mild fever
Gastroenteritis, often called the stomach flu, is one of the most common stomach ailments in children 6 to 24 months old. Gastroenteritis in young children is often caused by rotavirus, which is easy to catch from other kids. According to the Centers for Disease Control and Prevention in Atlanta, four out of five kids will become infected with rotavirus by age 5; the virus typically lasts from three to five days. In children over 5, an intense bout of gastroenteritis, particularly in the winter months, could be caused by a different group of bugs called caliciviruses. In this case, the vomiting and diarrhea are usually short-lived. Symptoms tend to last 24 to 48 hours. Gastroenteritis can also come from bacteria, parasites or mild food poisoning, in which case other family members may become ill. "The best remedy for an upset stomach of any kind is to avoid drinking and eating for a few hours after the vomiting has stopped, then slowly resuming fluids and foods," says Dr. Cheston Berlin Jr., a professor of pediatrics at Pennsylvania State University College of Medicine in Hershey, Pa. After your child has stopped throwing up, give him a teaspoonful of milk or juice every few minutes for about an hour. If the fluid stays down and your child is willing, encourage him to eat whatever food appeals to him.
If your child has repeated bouts of vomiting or diarrhea and can't keep fluids down, try an over-the-counter electrolyte-replacement solution such as Pedialyte, which can help stave off dehydration. A dehydrated child may lose too many electrolytes (salts in body fluids that help regulate the nervous system) and have a seizure. Call your doctor if fluids don't stay down, your child has diarrhea for 12 hours or he shows signs of dehydration: dry tongue or lips, scant urination or a sunken fontanel (the soft spot on the top of your baby's head).

Elizabeth Espindola contributed to this story.

 
 



 
 
 
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