Lecture notes Acute Care (SHN2004)

SHN2004 – Care of the Child with Abdominal Pain


Vomiting/Abdominal Pain in Children and Young People

Introduction
 Abdominal pain is one of the most commonly experienced medical issues
experienced by children and young people – whether minor to life threatening

Abdominal Pain – Detection
 Toddler and has verbal ability to communicate problem
 Infant requires assessment of behaviour  vomiting (sometimes this is the only way
to discern that the infant is experiencing pain)
o Also young people with cognitive issues that prevents them
verbalising/expressing pain

Vomiting in the Infant – Causes
 Gastro-oesophageal reflux
o Acid rises and burns the oesophagus
o When the reflux starts afters eating the infant begins to associate pain with
eating (this pattern can be established surprisingly quickly)
 Feeding problems
o Breast Feeding issues
 Breast feeding is typically best for the child however sometimes this is
not possible
o Formula Feeding
 Potential for the wrong formula to be given to the child
 Infection
o Gastroenteritis
o Respiratory tract/otitis media
 Otitis media = inner ear infection
 Bronchiolitis
 Working hard to breath – can put pressure on their stomach
causing pain and vomiting.
 Children often swallow their mucus which irritates the
stomach
o Pertussis
o UTI
o Meningitis
 Dietary protein intolerances
o Breast feeding generally avoids this issue
o Some people will encourage an apparent intolerance in ordered to get free
prescription milk


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, SHN2004 – Care of the Child with Abdominal Pain


o The worried well – people who have convinced themselves that they are
intolerant to things (e.g. gluten)
 Intestinal obstruction (from mouth to anus this is a long way)
o Pyloric stenosis
 Occurs in more males than females
 Requires surgery to fix
o Atresia – duodenal, other sites
o Intussusception
o Malrotation
o Volvulus
o Duplication
o Strangulated inguinal hernia
o Hirschsprung’s disease
 Breast Milk helps to avoid this
 Inborn errors of metabolism
 Congenital adrenal hyperplasia
 Renal failure

Vomiting in Preschool Children – Causes
 Gastroenteritis
 Infection
o Gastroenteritis
o Respiratory tract/otitis media
o Pertussis
o UTI
o Meningitis
 Appendicitis
o Located at the base of the ascending colon
o Rare in the under 3s
 Intestinal obstruction
o Intussusception
o Malrotation
o Volvulus
o Adhesions
 Where the bowel adheres to other parts of the bowel and causes an
obstruction
o Foreign body – bezoar
 Raised intracranial pressure
 Coeliac disease
o Uncommon


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