It’s My Head, It’s my Belly!

This week’s guest columnist is Dr. Ashanti Smith, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Every parent dreads: “Mommy..Daddy…my tummy hurts…”  Sometimes they whisper this in the middle of the night, sometimes they holler it at the bus stop.  Then often when they come to the Emergency Department, we walk in the room and the kid is leaping off the stretcher, smiling and giggling.  “I swear he was in terrible pain!” mom says.

Stomachaches are a common pediatric complaint.  Sometimes it’s serious, sometimes not.  Questions many parents ask: When was the last bowel movement?  How much junk food did he eat today? How’s she drinking?

Constipation is the most common reason for belly pain in the ER.  This is because the pain can look terrible, the child crying, doubled over with cramps.  This freaks parents out. They worry about bad things like appendicitis.  Then the pain relents, and the kid looks fine upon arrival.  Signs of constipation include skipping days of pooping, or passing hard painful stools, or only passing small pebbles.  Often parents don’t know their kids’ stooling patterns- who investigates what’s happening in the bathroom?  Sometimes kids go in, sit for awhile, produce nothing, and then leave.  But mom assumes they stooled.

If it’s constipation causing pain, the fix is usually dietary.  Kids don’t get enough fiber, especially when they eat lots of prepared foods like hot pockets, pop-tarts, McDonald’s, and other junk.  Kids should eat fruit with every meal, vegetables with lunch and dinner, and eat more fiber.  Sometimes they need medicine from their doctor to help.

“Stomach bugs” are another common cause of abdominal pain.  Usually these are associated with vomiting, diarrhea, and fever, but not always!  They usually last 1-2 days, and the goal is to keep the child hydrated.  Give clear liquids like sports drinks or Pedialyte.  They’re easy on the stomach and well absorbed for hydration.  Other viruses, like the common cold, can cause stomach aches too.  If your child vomits more than 4-5 times, has worsening belly pain, or has worsening fatigue, get seen.

Headaches are another common complaint that brings children to the Emergency Department.  Like our stomachache from above, kids can cry in pain.  Then often when they get to the ER, they’re going through all the cabinets and running into other patient’s rooms..  What kids do to entertain themselves while waiting for the doctor! They’re not miserable like they were earlier, to the parents’ embarrassment.

The majority of headaches aren’t serious.  Usually they’re brief pain episodes, called “tension headaches,” or are due to illnesses like viruses or allergies.  Sometimes, the “tension” is because kids don’t want to go to school.  Infections like stomach viruses, influenza, and strep throat are notorious for causing headaches.  Kids, like adults, sometimes get migraines too.

When children cry with head pain, parents go to their worst fears.  Is it meningitis?  A brain tumor?  Meningitis is an infection of a lining of the brain called the meninges, a saran-wrap-like membrane, which can get infected.  When this happens, the inflammation from meningitis presses on and poisons the brain.  It can be life-threatening, and cause permanent brain injuries like hearing loss or cerebral palsy.  Brain tumors are lumps that grow in the brain, compressing it, causing headaches and vomiting.  Sometimes the tumor is cancer, sometimes not.

How do you tell if the headache is serious, or just school avoidance?  If a dose of Tylenol or ibuprofen fixes it, no problem.  It’s also easy to try a cold compress on the forehead.  Questions to ask: Is there vomiting or nausea?  Is there a stiff neck?  Was she awakened at night by the pain?  Does he look excessively tired?  Yes answers to these mean your child should get seen.

As we mentioned, kids can get migraines.  These are recurrent headaches, often accompanied by nausea and vomiting.  They can be worsened by bright light and loud sounds, and can be debilitating.  Sometimes kids need brain scans to tell the difference between migraines and more serious things.  Fortunately, once brain tumors or meningitis are ruled out, migraines can be treated.  Usually a healthy dose of ibuprofen and napping in a dark, quiet room are all that’s needed.  And they’re prevented by basic good health- three healthy meals a day, reduced phone and computer time, and  reasonable bed times!

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