What belly aches need to go to the Emergency Department?

The Pediatric Insider

© 2014 Roy Benaroch, MD

Giving advice over the phone is always tricky. I can’t see your child, I can’t see the chart, and I can’t get a detailed history or any physical exam at all. After-hours calls aren’t really to make diagnoses or give detailed medical advice—they’re really just for me to try to make sure your child is safe to wait until the next day to see us in the office. If not, it’s off to the Emergency Department. Believe me, as long as it’s safe, I’d really like to keep you away from there.

One of the most common “do I need to go to the ED?” calls are about belly pain. Kids get a lot of belly aches, from all kinds of things, and obviously most of them don’t require emergency care. Except those that do: appendicitis tops the list, but also bowel obstructions or ovarian torsion or a handful of other things that really can’t wait until the next day. So how can I know, over the phone, if you really do need to take your child to the emergency department?

Disclaimer: I haven’t talked to you, and I’m not your kid’s doctor, and I’m not giving you specific medical advice here. If you’re thinking your child has a bad belly ache, call your own doctor for specific medical advice. Stop looking things up on the internet—there are too many weirdos out there giving out poor information, and you’re wasting your time. Go pick up your phone and call your own doctor, now. And thanks for visiting my blog!

These are the questions I ask, things I’ve found can help distinguish which belly aches need immediate evaluation:

How does your child look, overall? A child who’s very pale or grey or barely moving needs to go to the ED. If he says it hurts but he’s walking around and looks pretty good, it can probably wait.

If the belly actually tender? Tender means “hurts to touch.” I’ll ask parents over the phone to gently squeeze the belly, here and there. Don’t ask your child if it hurts, just watch his face—if he grimaces in pain or pushes your hand away, the belly is tender. That means: to the ED.

What other symptoms are there? Frequent or forceful vomiting is concerning, especially if there’s yellow or green tint from bile. Really, any combination of serious symptoms along with belly pain are likely to lead to an ED referral.

How long has this been going on? Belly aches that have been going on for many days or weeks or months are much less likely to be an emergency than belly aches that just started, or are intensely worsening over a few hours.

Where does it hurt? Belly aches in the center of the abdomen, near the belly button, are less likely to be caused by something that needs urgent attention than belly pain in the corners, away from the center.

There’s more to phone medicine than these questions, but that’s a pretty good start. Again, if you’re worried, call your own doctor for specific advice about your own child. Most belly aches can be safely managed at home, but every once in a while there’s a serious emergency brewing. Give your doc a call with the answers in mind to these questions, and you’ll be able to get better advice to make sure your child is OK.