Scott Webb (Host): Tummy aches are common in our kids and oftentimes the stomach issues will pass literally and figuratively. I'm joined again today by Pediatrician Dr. Joelle McConlogue. She's going to tell us about the causes of tummy troubles and how we can best help our kids.

 This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Doctor, it's great to have you on again. And today we're going to talk about tummy troubles. And I was sort of recounting a story about my daughter when she was younger. She was complaining of stomach aches, but it turned out to be a little bit of anxiety through sports. So sometimes the cause of tummy troubles isn't always obvious or isn't the most obvious thing.

So it's great to have you on today. Great to have your expertise. Let's start there. What are the most common stomach complaints for kids and what's usually the cause?

Joelle McConlogue, MD: Sure. Well, thank you for having me on again to talk about this. I think those dreaded words, my tummy hurts, almost all parents have heard at one time or another. And there are so many varied causes that can cause stomach pain. And so I think that's one of the reasons why it's worrisome to parents because it's hard to sometimes tease out what's causing the symptoms of hurting tummies.

But there are a lot of different things; a good number of them are non worrisome and non urgent that parents can treat at home, and there's just kind of a few things to watch for and have red flags. So when I see a child with abdominal pain, what I like to do is just think about where is that pain coming from and why is that child experiencing pain?

And one of the most common places that it comes from is the intestine itself. So, for example, constipation is one of the most common causes of a little bit of tummy discomfort in children. But if there is some gas, it can also cause some pain. Indigestion, if kids eat too much of a certain thing or eat a lot, sometimes their tummies can hurt or they can have some reflux.

But then there are other causes. There are infections that can cause tummy pains, stomach viruses or bacterial infections or food poisonings. There can be some food intolerances. If they eat something that doesn't agree with them or they have an allergy to, it can cause abdominal pain. And then there are some more serious causes as well, such as an appendicitis or a bowel obstruction.

But, there are things outside the gut that also can cause pain, and you alluded to this earlier with your own daughter, that things such as stress or anxiety are often a big cause of abdominal pain. So, we want to make sure that we look at that and look at what's going on in the child's life as well.

Host: Yeah. So it could be medical or psychological or perhaps sometimes a combination of things. Wondering when we're dealing with the very young children or nonverbal children, how do we spot the signs of some stomach issues?

Joelle McConlogue, MD: Right, if they're young, sometimes it's hard to tell that, and it can just be some general fussiness, especially in babies. They're just fussy. They're uncomfortable. A lot of babies suffer from reflux and they also suffer from gas. And some, sometimes in babies that manifests itself as stiffening of the body or arching or just pulling the legs up and crying.

We look more at their general demeanor. And, some of those symptoms. And if we do see that a child is having those symptoms, we also want to look for what else are they having? Are they spitting up? Are they having vomiting? Are they passing stools regularly or having hard stools? What other associated signs? then we can tease out a little bit what's the cause.

Host: So let's talk about how parents and you and everybody working together as a team, how we can help our kiddos with their tummy troubles.

Joelle McConlogue, MD: Well, I think in general, if your child is otherwise functioning well and just having occasional abdominal pain; that's something you can watch at home, talk to them about, do a few things. If the child's still going to school normally, functioning normally, eating a normal diet, sleeping well, and this pain comes and goes, that's less worrisome to me and they can try things.

However, if parents start to see more worrisome signs, then we should be partnering together to look at some of the causes. And those worrisome signs would include other symptoms such as vomiting or diarrhea, if they were to have a fever or a rash. Or if that pain is just keeping them from activities, you know, they're not going to school because their tummy hurts too much or they're not sleeping well and the pain is waking them up in the middle of the night.

If, if it's starting to impact other things or some of those other symptoms are there, then I want them to come into the office and we can both do an exam, we can look at the exam, we can talk about other things and then if needed, we can do further testing.

Host: Yeah. When my son was little, he was obsessed with apple juice. He just, the kid could just not get enough apple juice. And then later, of course, he would complain that his stomach would hurt. So for us, it was a fairly easy diagnosis, even though my wife and I didn't go to medical school. Uh, we thought, well, what is he eating? What is he drinking? Well, he drinks endless amounts of apple juice. Maybe if we just cut back on the apple juice a little bit. You know, uh, so that really seemed to help him, but it is always great to have the advice and assistance of experts. And, you know, Doctor, when you walk the stores, you go to pharmacies and things like that.

There's just endless medications and things. And I'm wondering what your thoughts are about over the counter meds for stomach issues. Like, are they okay? Does it depend on the stomach issue? That sort of thing.

Joelle McConlogue, MD: Most of the time, I don't recommend a lot of over the counter medications for children, mainly because they target different things, and it's hard to tell what you're targeting, and a lot of them are made for adults. So I think most medications should be used in consultation with your doctor. There are some things that we would recommend, but we would target that toward the cause.

I do sometimes for indigestion or for upset stomachs, will use something like Tums, or children's Tums. I think that's fairly easy to take and sometimes just taking a little chewable tablet will help the child, but other than that, I really like my patients to be checking in before they're giving a lot of over the counter medications.

Host: Yeah, so Doctor, you talked there about over the counter meds and how you're maybe not a big fan and maybe some Tums, something like that. But then at home, for us parents, and we're trying to help them, what can we do to help them at home? The sort of non medical solutions, if you will.

Joelle McConlogue, MD: Well, first I would recommend just have the child rest. Have them lay down on the couch or a bed and just, just rest for a few minutes. If they feel the urge, they can try to go in and use the bathroom. Sometimes if they're feeling a little bit of constipation or gas, trying to use the bathroom will help relieve some of that. Also, parents can put a warm water bottle or use a heating pad and just put it on the stomach. That sometimes can give relief as well.

Host: Yeah, that's great advice from an expert, you know. Go in, bring the kiddo in, let's talk through. If they can talk for themselves, great. If not, mom and dad can kind of go through things, you know, share that patient history, if you will. Good stuff, as always, with you, Doctor. Just want to finish up today and gets your sense of when we should reach out to you or our own pediatricians. Like, when has it reached a point where we're probably not going to be able to fix this at home and we're going to need an expert.

Joelle McConlogue, MD: Certainly, if the parent sees any othe r worrisome signs. If, if the child is vomiting and not able to keep down fluids, and is not staying hydrated, we need to see them. If the child has worsening pain, where the pain is starting small, but over a period of a few hours or a day, that pain is getting worse and worse. They're having difficulty walking. They're having difficulty doing normal activities or moving around. We want to see them. Any pain that's localized to that right lower quadrant of the abdomen, if the child is pointing and says it hurts right there in my right lower quadrant, that's concern for appendicitis. And so I would want to have that child be seen as well. Those are things that I would tell parents.

Host: Yeah, I appreciate that. And as always, it's great to have you on, your compassion, your expertise, and, you know, tummy troubles is kind of fun to say, you know, Hey doc, let's talk about tummy troubles. But the truth is, it's very serious things. And sometimes maybe need to go to the emergency department at the very least, you know, go in and see you.

And, we, as parents, especially with our first child, we thought, well, the kid really likes apple juice. I'm sure it's fine. Apple juice is probably good for him until he complained that his stomach was hurting. So, things we learn as parents, things we learn when we get to work with pediatricians like yourself on how to help our kiddos. So, thank you so much.

Joelle McConlogue, MD: Well, thank you for having me. It's a common problem. I think most parents will deal with it at some point, and we're always here to help answer questions or put minds at ease.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.