ABDOMINAL PAIN

• One of the most common symptom in children. Pain may range from mild and temporary to severe and requiring emergency care
• About 1 out of 3 children is seen by a doctor for abdominal pain by the time they are age 15, but only a small number of these children have a serious problem
• Complaints of abdominal pain are more common in children younger than 11 years and are often caused by changes in eating and bowel habits. Most cases of abdominal pain are not serious and self limiting
• Acute pain: first episode of pain or recurrent with a history of repeated episodes of acute pain
• Chronic abdominal pain: recurrent or persistent bouts of abdominal pain occur over a minimum of 3 months

Causes of Acute Pain

• Infections and inflammations
• Commonest cause: gastroenteritis, hepatitis, mesenteric lymphadenitis, appendicitis, pyelonephritis
• Less common: liver abscess, pancreatitis, cholecystitis, acute peritonitis
• Colics: intestinal colic, renal colic
• Obstruction: intussusception, intestinal obstruction, torsion of ovaries

Causes of chronic pain

• Constipation
• Dyspepsia,
• Psychogenic
• parasitic infection
• Celiac disease
• Milk allergy

Age of the patient: 

• Infant: cannot complaint of pain, but would present with episodes of crying.
• 3 month colic: crying every evening for 2 to 3 hours since the age of 2 to 3 weeks
• Functional pain – in school going children
• Girls- suffer from severe abdominal pain with each menstrual period especially around menarche. 

Onset of Pain and Progression

• Sudden onset of within minutes and hours suggest colic. It is short lasting, self limiting and often recurrent.
• If pain is recurrent: - check following 

• Frequency
• Duration
• Duration of pain free intervals

• Recurrence occurs in worm infestation, urinary infection, urinary tract infections, ulcers, renal calculi, sickle cell disease, abdominal epilepsy and psychogenic causes.
• Pain lasting longer than 3 hours–due to an organic cause like appendicitis

Location of pain and radiation

• Site of pain: localised to a quadrant or all over abdomen
• Generalised pain is more common and is due to intestinal or peritoneal pathology.
• Functional abdominal pain – is peri umbilical. (Closer the pain occurs to the Umbilicus less is the chance of organic disease.)
• Acute appendicitis and lymphadenitis –pain in right iliac fossa 
• Acute Hepatitis, liver abscess, congestive cardiac failure- pain in right hypochondrium
• Abdominal pain in kidney disease: over back, flanks and lower abdomen
• Ureteric colic: pain radiates from loin to groin
• Pain radiating to right shoulder: acute cholecystitis
• Radiation to left shoulder: splenic rupture
• Pain radiating to back: acute pancreatitis

Nature of pain

• Dull aching pain- chronic pathology
• Pain in peri umbilical region in an adolescent- functional pain
• Obstructive lesions of gut- severe colicky pain in abdomen
• Stabbing pain- peritonitis
• In some cases of peritonitis- patient lies still in bed and does not move
• In renal colic- child is restless, rolls and doubles up

Exacerbating and Relieving Factors

• Acute gastritis- consumption of food may aggravate the pain
• Duodenal ulcer- ingestion of food relieves pain
• Cough can exaggerate pain- basal pneumonia and pleurisy
• Peritonitis- movement aggravates pain
• Passage of flatus relieves pain from intestinal cause

Associated symptoms

• Vomiting: commonly associated with gastroenteritis.
• Vomiting and pain in the right iliac fossa- feature of appendicitis
• Allergy to milk proteins: colicky abdominal pain, vomiting and diarrhoea
• Red current jelly stool- intussusception
• Constipation: common cause of dull ache in abdomen
• Fever: viral hepatitis, acute gastroenteritis, acute pancreatitis, 
• Dysuria and increased frequency of micturition- urinary tract infection

Psychosocial factors

• Commonest cause of chronic abdominal pain in older children is functional
• Enquire about parent- child relationship, school environment and whether child is reluctant to go to school
• Menstrual history
• In adolescent girls enquire about dysmenorrhea

• Most children with pain in abdomen does not need an extensive lab investigation
• But children with acute abdomen and those getting recurrent abdominal pain need to be investigated.

Complete blood count

• If an infection is suspected -Leukocytosis with polymorphonuclear preponderance suggests infection or inflammation. Eg. Acute appendicitis, acute pancreatitis, peritonitis

Urine Examination

• Pus cells and bacteriuria indicate UTI
• Bile pigment- hepatitis

Stool Examination

• Pus cells and blood- dysentery

Plain X-ray abdomen

• Intestinal obstruction, calculi

USG Abdomen

• In cases of organomegaly, appendicular mass, gall stones

Blood biochemistry

• Serum bilirubin, SGPT raised in hepatitis
• Serum amylase raised in acute pancreatitis

Surgical correction if required

Ayurvedic Treatment

In case of inflammations, infections, gastrointestinal origin 

• Vatanuloma, Deepana Pachana Srodhoshodhana
• Hastasweda for newborns and infants

Internal medicines 

Kashayas

• Kaidaryadi kashaya, Kalasakadi kashaya, Indukantam kashaya
  • Up to 1 year: for mother: 2 tsp sookshma choorna is boiled in 2 glass water, strained, and given to mother. If agni bala permits give 1 tsp thrice to the child
  • 1 year to 5 years: ½ tsp powder boiled in 1 glass water and given as divided doses mixed with sugar or jaggery.
  • 5 to 10 years: 1 tsp powder boiled in 1 glass water and given as divided doses mixed with sugar or jaggery.
  • 10-15 years: 1 ½ tsp powder boiled in 1 glass of water and given twice daily mixed with sugar or jaggery.

Gutikas

• Dhanwantaram gutika, Vayu gutika, Ponkaradi gulika, Kompanchadi gutika; Vatanuloma can be given with Jeeraka water
• Vilwadi gutika- amavisha- with honey or Ardraka swarasa
  • From 2- 6 years ¼ tab twice daily
  • 7-12 years- 1 tab bd
  • 12-15 years- 1 tab tds

  Arishtas

• Abhayarishta, Poothikasava, Jeerakarishta, Kutajarishta

• Up to 2yrs- ½ tsp arishta diluted with 1 tsp water
• 2-5 years- 2.5ml-5ml diluted with 5 ml boiled water
• 5-10 years- 10ml
• 10-15 years- 15ml

 Bhasmas 

• Pravala bhasma, Shanka bhasma
  •  5-10 years: ½ pinch with honey
  • 10-15 years: 1 pinch

 Choornas

• Hinguvachadi choorna, Abhayadi choorna, Ashta choorna, Induppukanam

• Infant: 2-3 gm
• Toddler- 5gm
• School going- 7-10gm