Abdominal pain in a baby

There are at least 85 causes of abdominal pain in children, but rarely is there a problem of finding the exact cause to establish a rather rare and precise diagnosis. Most often, the question has to be decided: is there an organic disease or does abdominal pain occur as a result of emotional progression or some other physiological factor?

Only 5-10% of children hospitalized for abdominal pain are diagnosed with an organic origin, but even in this case stress often plays a very important role (for example, when it comes to peptic ulcer). When conducting differential diagnostics at the initial stage, Apley's aphorism can be very useful: the further from the navel the abdominal pain is localized, the more likely it is of organic origin. However, children often find it difficult to pinpoint the exact location of the abdominal pain, so some other information about the causes of the pain may be more reliable. For example, the sick child's answers to the doctor's question: "When did you feel the pain in your stomach?" are most often: "When I was supposed to go to school"; "When I realized that I was walking down the wrong street." Or the answers to the doctor's question: "Who was with you when the pain started?" "What (or who) relieved the pain"? Other anamnesis data may also be revealed, leading to a possible diagnosis. For example, very hard stools suggest that constipation may be the cause of abdominal pain.

• In black children, sickle cell anemia should be suspected and appropriate testing should be performed.
• Children from Asian families may have tuberculosis - a Mantoux test should be done.
• In children with a tendency to eat inedible things (perverted appetite), it is advisable to test the blood for lead content.
• Abdominal migraine should be suspected if the pain is clearly periodic, accompanied by vomiting, and especially if there is a family history. In these children, metherasine, 2.5-5 mg orally every 8 hours, may be tried.

Most often, abdominal pain is caused by gastroenteritis, urinary tract infection, viral diseases (for example, tonsillitis combined with nonspecific mesadenitis) and appendicitis. Less common causes include pancreatitis in epidemic parotitis, diabetes mellitus, intestinal volvulus, intestinal intussusception, Meckel's diverticulum, pellicle ulcer, Hirschsprung's disease, Henoch-Schonlein purpura and hydronephrosis. In older girls, abdominal pain may be caused by menstruation and salpingitis.

In boys, testicular torsion should always be ruled out.

Examination of patients.

Urine should always be examined and sent for culture. Other tests include abdominal X-ray, clinical blood test with differential, ESR, intravenous urography, barium enema.

Reflux esophagitis. The disease may manifest itself with regurgitation, apnea, pneumonia, weight loss, anemia. From a diagnostic point of view, determining the pH in the esophagus is more reliable than X-ray examinations with barium. Treatment: the child should be fed in a sitting position, the head of the crib should be slightly raised, it is not recommended to swaddle the child tightly and feed him fatty foods. Medications may also be needed, such as antacids and sodium magnesium alginate [Infant Gaviscon], available in single-dose sachets. The contents of one sachet are mixed with 15 ml of cooled boiled water and given to the baby with a teaspoon after each breastfeeding. If the child is bottle-fed, the dose of the drug is diluted in the feeding mixture. Children weighing over 4.5 kg should be given a double dose (i.e. the contents of two sachets).

Bloating

Causes. There are several causes of bloating in children.

Air

• Fecal obstruction
• Air swallowing
• Malabsorption

Ascites

• Nephrosis
• Hypoproteinemia
• Cirrhosis
• Congestive heart failure

Dense tumor formations

• Neuroblastoma
• Wilms tumor
• Adrenal tumors

Cysts

• Polycystic kidney disease
• Liver cysts, dermoid cysts
• Pancreatic cysts

Hepatomegaly. Its causes are also varied. Infections: many, such as infectious mononucleosis, cytomegalovirus infection.

Malignant neoplasms: leukemia, lymphoma, neuroblastoma.

Metabolic diseases: Gaucher and Hurler diseases, cystinosis, galactosemia.

Other causes: sickle cell anemia, other hemolytic anemias, porphyria.

Splenomegaly. The causes are the same as for hepatomegaly, except for neuroblastoma.

Neuroblastoma. This highly malignant tumor originates from primitive neuroblasts of the sympathetic nervous system. It occurs with a frequency of 1:6000-1:10000. It usually manifests itself as an increase in abdominal volume. Neuroblastoma can occur in a child of any age, but the prognosis is more favorable (even with spontaneous remissions) in children under one year old (25% of patients) and in those children whose disease is in stages I and II. The tumor metastasizes to the lymph nodes, scalp, bones (causing pancytopenia and osteolytic bone lesions). In 92% of patients, urinary excretion of catecholamines (vanillin-mandelic and homovanillic acids) increases. Treatment: excision (if possible) and chemotherapy (cyclophosphamide or doxorubicin).

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