Child & Adolescent Health

Abdominal Pain in Children: When to Worry and When to Wait

A parent-focused guide to tummy pain in children — with red flags, traffic-light triage, common causes, home care, and when to seek urgent help.

8 min read

Intro

Abdominal pain is one of the most common reasons children feel unwell — and one of the hardest symptoms for parents to interpret.

Most cases settle on their own (constipation, a viral bug, gas, or stress-related pain). A smaller number need urgent medical assessment. The key difference is usually how your child looks and behaves, how the pain is changing, and what symptoms come with it — not pain intensity alone.

If you’re unsure and your child seems “not themselves,” trust that instinct and seek advice.

Key Points

  • Most tummy pain in children is not dangerous, especially if your child is playing, drinking, and improving.
  • Urgent assessment is needed when pain is rapidly worsening, your child looks very unwell, or there are red flags (below).
  • Constipation is a top cause — even when a child is still passing some stool.
  • Appendicitis matters because it often starts vaguely, then becomes more localised and progressive.
  • If symptoms persist beyond 24–48 hours, recur frequently, or disrupt sleep/school, organise a review.

Traffic Light Triage

Red: seek urgent care now

Go to urgent care / emergency (or call local urgent services) if your child has any of the following:

  • Looks very unwell: very drowsy, floppy, confused, or hard to wake
  • Severe, worsening pain, especially pain that escalates over hours
  • Green vomiting (bilious) or repeated vomiting that won’t settle
  • Blood in vomit, black/tarry stool, or significant blood in stool
  • Rigid belly, severe tenderness, or pain with even light movement
  • Pain that worsens with walking, jumping, or bumps (classic “peritonism” concern)
  • Testicular pain (in boys) with abdominal pain
  • Dehydration signs: very dry mouth, no tears, minimal urine, sunken eyes, lethargy

Amber: same-day review

Seek a same-day GP/urgent clinic review if:

  • Pain lasts more than 24 hours without clear improvement
  • Pain wakes your child from sleep
  • Fever + abdominal pain (especially persistent or rising fever)
  • Ongoing diarrhoea or vomiting (even if not severe)
  • Urinary symptoms (pain with urination, frequent urination) or flank/back pain
  • Your child is refusing fluids, eating very little, or seems significantly reduced in activity
  • Recurrent pain that is increasing in frequency or severity

Green: watch and wait (with active monitoring)

Home care and observation is reasonable when:

  • Your child is generally well between waves of pain
  • No fever, no persistent vomiting, and your child is drinking
  • Pain is mild–moderate, intermittent, and not rapidly worsening
  • Pain improves with rest, passing gas/stool, or after a bowel movement

Decision Tree

flowchart TD A[Abdominal pain] --> B{Child looks very unwell?} B -->|Yes| R[Urgent care now] B -->|No| C{Any red flags?} C -->|Yes| R C -->|No| D{Constipation likely?} D -->|Yes| E[Constipation support + monitor] D -->|No| F{Vomiting/diarrhoea pattern?} F -->|Yes| G[Likely gastroenteritis support + hydration plan] F -->|No| H{Recurrent pattern with stress/school?} H -->|Yes| I[Functional pain support + GP review if persistent] H -->|No| J[Same-day review if ongoing or worsening]

Common Causes by Age

Toddlers and preschoolers (roughly under 5)

Common:

  • Constipation
  • Viral gastroenteritis
  • Urinary tract infection
  • Swallowed air/gas, food intolerance

Higher caution:

  • Intussusception (episodic severe pain, pallor, vomiting)
  • Incarcerated hernia (groin swelling + distress)
  • Appendicitis (can still occur, may present atypically)

School-aged children

Common:

  • Constipation
  • Gastroenteritis
  • Functional abdominal pain
  • Appendicitis

Adolescents

Common:

  • Constipation, gastroenteritis, functional pain
  • Menstrual-related pain (period cramps, ovulation pain)
  • Urinary infections

Higher caution:

  • Appendicitis
  • Ovarian/testicular torsion (time-critical)

The Big “Don’t Miss” Patterns

Appendicitis (progressive pattern)

Often starts as vague pain near the belly button, then:

  • Pain moves to the lower right abdomen (not always)
  • Becomes steadily worse
  • Appetite drops; nausea/vomiting may develop
  • Walking, hopping, or bumps worsen pain

If your child has a pattern of progressive pain + reduced appetite + movement pain, get assessed.

Gastroenteritis (viral “stomach bug”)

More likely when:

  • Vomiting and/or diarrhoea are prominent
  • Others at home/school are unwell
  • Cramps come in waves

Main risk is dehydration, especially in younger children.

Constipation (the most underestimated cause)

Consider constipation if:

  • Hard stools, pain with stooling, or infrequent stools
  • “Rabbit pellet” stools or large painful bowel movements
  • Bloating, gassiness, reduced appetite
  • Pain improves after passing stool or gas

Constipation can cause significant pain — and can coexist with other illness.

More likely when:

  • Recurrent pain with normal exam/tests
  • Child appears well between episodes
  • Pattern fits school mornings, social stress, or anxiety
  • No red flags, normal growth, no persistent fever/vomiting

This is real pain — the goal is symptom support and addressing triggers, not dismissing it.

What You Can Do at Home

If there are no red flags:

Fluids first

  • Offer small, frequent sips of water or oral rehydration solution if vomiting/diarrhoea
  • Aim for regular urination (a practical hydration marker)

Gentle food

  • Don’t force eating.
  • Bland foods are okay if hungry (toast, rice, soup, banana), but hydration matters more.

Comfort and monitoring

  • Rest, warmth, and distraction can help.
  • Re-check every few hours for worsening pain, new fever, vomiting, or reduced urination.

Constipation support (if likely)

  • Encourage fluids and fibre (as tolerated).
  • If your local guidance supports a stool softener/laxative regimen, follow it — and see the dedicated constipation guide for a structured plan.

Avoid giving new medicines (including anti-diarrhoeals) without guidance if your child is very young or unwell.

When to Seek Medical Review Even If It’s Not “Emergency”

Arrange a review if:

  • Pain persists beyond 48 hours
  • Pain recurs frequently (especially weekly or more)
  • Weight loss, poor growth, persistent fatigue, or ongoing diarrhoea
  • Blood in stool (even small amounts) or persistent vomiting
  • Pain consistently wakes your child at night

FAQ

Q: My child says it’s “10/10” pain — is that automatically an emergency?
A: Not always. Children may describe intense pain from constipation or cramps. What matters most is progression, associated symptoms, and whether your child looks very unwell or cannot move comfortably.

Q: What’s the single most important warning sign?
A: A child who looks very unwell (drowsy, pale, floppy) or pain that is rapidly worsening with vomiting/fever.

Q: Can constipation still be the cause if my child is pooping daily?
A: Yes. Some children pass small stools while still being constipated (retained stool). Hard/painful stools, straining, and bloating are clues.

Q: If it’s anxiety-related, should I still see a doctor?
A: Yes if the pattern is persistent, disrupting school/life, or if you’re unsure. Functional pain is common, but red flags always override pattern-based assumptions.

Further Reading

  • Constipation in Children (guide)
  • Appendicitis Explained Simply (guide)
  • When Anxiety Causes Abdominal Pain (guide)
  • Gastroenteritis / dehydration guidance (guide, if available)