When is a belly ache “real”?

Holly asked: “My almost-3-year-old twins have recently started telling me on occasion that their tummy hurts. It almost seems like it’s a catch-all phrase for any malaise, but I also think that they have figured out that a statement like that brings on immediate attention. So far, in every instance, either food or a distraction has resolved the issue, but I did wonder if there’s way to recognize when the complaint should be taken seriously – absent the obvious symptoms like fever.”

I love this question. It speaks to something I consider my main goal as a doctor: teaching parents to become self-reliant, and teaching them how to teach their own children to become self-reliant. It’s a circle-of-life thing, without the smarmy Elton John soundtrack, sort of a recursive zen way of looking at what I consider the point of my life as a parent and a pediatrician. Teach parents how to deal with belly aches in a way that helps their own children deal with their own belly aches, that’s been a good day.

I wrote a chapter, called “Communication Remedies,” about this in Solving Health and Behavioral Problems from Birth through Preschool. It’s sort of a whole philosophy of parenting, plus a practical guide to dealing with things like common headaches and belly aches. Here’s an excerpt:

Any body complaint can be caused by social stresses or psychology. Think especially about this sort of problem when a preschooler complains about any of the following symptoms:

  • Belly ache
  • Dizziness
  • Headache
  • Tiredness
  • Sleep problems

I’ll go more into the various causes of these problems in other chapters, but it is important to not always assume any of these has a “medical” cause. More frequently, there are both biologic and psychological issues at work, and to help a child feel well parents should be prepared to look for the stresses that are contributing to the symptoms.

A good scheme for listening and responding to a child’s complaints follows these steps:

1. Listen right away. Don’t force a child to get your attention with more dramatic or painful symptoms. When a child complains of a headache, it’s best to quickly listen.

2. Listen with attention. Show with body language that you are listening and interested.

3. Try an “explore question”. Often, a quick “How was school today?” type of question will get you to the root of the problem. If you don’t ask, they won’t tell.

4. Encourage the child to discuss the symptoms. Ask a few brief clarifying questions to allow the child to discuss the pain for a few moments. This allows the child to talk with your attention, which is therapeutic. This step should not last longer than 30 seconds or so. Use open-ended questions like:

  • Tell me about the pain.
  • Where does it hurt?
  • What does it feel like?
  • Why do you think it hurts?
  • What could I do to help it feel better?

Avoid yes/no or leading questions:

  • Does it hurt right here?
  • Does your throat hurt too?

5. Touch the child. Touch is powerful and important. Try a kiss in the middle of the forehead for a child’s headache. You’ll be amazed how well it works.

6. Attack the problem. You need a firm, confident plan. It may include medicine (for example, a safe antacid for belly pain, or acetaminophen for a headache), comfort measures (hugging a heating pad), or resting in a certain way (“Lie here on your side for five minutes.”) The plan should always include specific steps and be time-limited.

7. Confirm the child is better. Use a statement, not a question. Say “I am glad you’re starting to feel better.” This is a special phrase: it does not imply that the pain is all gone, it is reassuring, and it helps children feel better by making their parents happy. It’s magic.

8. End the encounter. Gently change the subject and encourage your child to play, with a specific suggestion.

  • Good: “I’m glad you’re starting to feel better. Go play with your sister.”
  • Better: “I’m glad you’re starting to feel better. Go play dress up with your sister.”
  • Best: “I’m glad you’re starting to feel better. Let me help you get your cowboy vest on to play dress up with your sister.”

I’m sometimes asked, “What if it is really serious?” Families will not miss a serious illness by first following the scheme above. If the problem is something to worry about, children will show you with their behavior that they’re truly ill. If after a few days symptoms persist in an otherwise well appearing child, consider a trip to the doctor.

Reassuring factors: (these are clues that pain is not caused by a serious medical problem):

  • Pain in a vague location, or pain right in the belly button.
  • Symptoms that are difficult to describe or talk about.
  • Symptoms that only occur on school days, or are especially bothersome the few days after a school vacation.

Concerning factors: (clues that should raise your concern)

  • Associated symptoms like fever, vomiting, diarrhea, or weight loss.
  • Symptoms that wake a child from sleep.

Many symptoms have no definite medical cause, but are still stressful and upsetting to children. Watch how children act to help determine if immediate medical concern is justified, and listen to what they say to find ways to help alleviate the symptoms.

Explore posts in the same categories: Behavior, Medical problems

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2 Comments on “When is a belly ache “real”?”

  1. Holly Says:

    Thanks Dr. Roy – I looked in your book under tummy aches, but forgot about the communication section! Guess I didn’t think that we’d be dealing with potential school(daycare) problems yet….yikes. Will keep that in mind the next time.



  2. Mindy Says:

    Hi, Dr. Roy! I love this post. I started to figure this stuff out on my own…. It seems the headaches come on right about when I tell her to do something she doesn’t want to do. Hmmmm….. 🙂


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