Why toddlers say it so often

The Royal Children's Hospital Melbourne describes abdominal pain as "one of the most common reasons children see a doctor", and adds the important qualifier: "most cases of abdominal pain are not serious and children often get better by themselves."

Part of the frequency is anatomical and part is linguistic. A toddler who has just learned the word "tummy" will use it for hunger, for needing a poo, for feeling sick, for anxiety, and for actual pain, because it is the only word they have for a feeling somewhere in the middle. That is not manipulation and it is not nothing — it is a child describing a sensation with a limited vocabulary.

The most likely explanations

RCH lists the common causes: bowel problems such as constipation or irritable bowel; infections such as gastroenteritis or a urine infection; mesenteric adenitis, where lymph nodes in the abdomen enlarge because of a viral infection; problems that may need surgery such as appendicitis or a blockage; food-related causes including simply too much food, food poisoning, allergies and intolerances; and stress or anxiety. It also says honestly that "sometimes there is no identifiable cause".

Constipation, first

In a toddler complaining repeatedly, constipation is the first thing to consider. The NHS lists its signs: fewer than 3 poos in the last week; large hard poo; poo that looks like rabbit droppings or little pellets; straining or pain when pooing; some bleeding during or after a poo because the poo is large and hard; and "a poor appetite or stomach pain that improves after they poo." That last one is the giveaway.

The NHS also flags overflow soiling — runny poo leaking around a hard blockage in a child over 1, which can look like diarrhoea and is actually severe constipation. And it warns about the cycle: "if your child is constipated they may find it painful to poo, which may mean they do not want to try to poo. This can create a vicious circle; the more they hold back, the more constipated they get."

Its instruction is to take the child to a GP rather than manage it alone, and to do it early: "the longer your child is constipated, the more difficult it can be for them to get back to normal, so make sure you get help early." NICE guideline CG99 sets out how constipation in children up to 18 should be diagnosed and managed, including the early identification the NHS is pointing at. Do not start any laxative on your own — that is a decision for a clinician.

Urine infections

A urine infection in a toddler often does not look like one. It can present as tummy pain, unexplained fever, being off food, smelly or cloudy urine, new daytime wetting in a child who was dry, or simple misery. RCH lists urine infections among the common causes of abdominal pain, and it is one of the things a GP will want to test for if pain keeps recurring.

Worry

Stomach ache is a real physical sensation produced by anxiety, not an imagined one. RCH notes that "some children get abdominal pain as a result of stress or anxiety." The American Academy of Pediatrics goes further, describing functional abdominal pain disorders as the most common condition seen by paediatric gastroenterologists, affecting one in four children worldwide, and explains them as disorders of gut-brain interaction — constant communication between the brain and the nerves of the gut, which can generate genuine pain. Research links them with stressful events such as a move or a family separation.

Pain that appears reliably at nursery drop-off, at bedtime or before a particular activity, and vanishes once the moment passes, is worth taking seriously as information rather than dismissing.

What helps at home

RCH's home advice is short and practical.

Help your child drink their usual amount of fluids, to prevent dehydration.
If they are hungry, let them eat what they want, or offer bland foods such as crackers, rice, bananas or toast. Do not force a child to eat when they feel unwell — they will start again when they feel better.
Encourage sitting on the toilet or potty, because doing a poo sometimes eases the pain.
Rubbing the tummy, or a distraction such as reading a book, can help.
Pain relief can be given if your child is in pain or miserable, following the label for their age and asking a pharmacist if you are unsure.

A warm bath, a hot water bottle wrapped in a towel and kept off bare skin, and a quiet half hour are all reasonable. What is not reasonable is repeatedly changing the diet in search of a trigger without advice, since that risks narrowing what an already fussy toddler will eat.

When to see a doctor the same day

RCH says to take a child to a GP or hospital as soon as possible if they:

have severe pain despite pain medicine, or pain that has moved;
have pain that returns frequently and regularly;
do not want to move;
have a fever;
are pale, sweaty, lethargic and unwell;
are refusing to drink fluids;
are vomiting for more than 24 hours and not keeping fluids down, or their vomit is green;
have blood in their vomit or poo;
have problems passing urine;
have pain or lumps in the groin;
have a sore or painful skin rash;
have had a recent injury, such as falling onto bike handlebars.

RCH also gives a simple general rule: if pain or problems persist for more than 24 hours, or you are worried, take them to a GP. The NHS advises calling 999 or going to A&E for a stomach ache that came on very suddenly or is severe, if it hurts when you touch the stomach, if there is blood in vomit or poo, or if a child cannot poo or pass wind.

When it keeps coming back

Recurrent tummy pain deserves an appointment even when each episode passes. The AAP lists the symptoms that need further testing alongside abdominal pain: vomiting, headaches, dizziness, tiredness, difficulty or pain swallowing, bleeding, night-time diarrhoea, skin changes around the bottom, involuntary weight loss, slowing growth, unexplained or recurrent fever, and joint problems. A family history of inflammatory bowel disease, coeliac disease or peptic ulcer disease is also worth mentioning. Keeping a short diary of when the pain happens, what your child ate, and when they last did a poo will make that appointment far more productive than trying to recall it on the day.

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