When a Belly Ache Means Something More

Belly Ache

As parents know, children of all ages experience belly aches. The most common causes are acid reflux, constipation and food intolerance—usually not because of an allergy (and it’s rare for babies and young children to be lactose intolerant). But other conditions can also produce belly aches. How can parents and caregivers know the difference?

There are red flags that can signify a more serious reason behind belly aches. These include recurrent or prolonged fever, chronic belly pain, blood in stool, projectile vomiting and waking up at night with pain or to have a bowel movement. It’s important to understand possible causes based on age and to seek medical care when these occur.


When babies have belly aches, providers look for symptoms of acid reflux and constipation. Microscopic findings of blood in the stool can mean a milk protein intolerance, while breastfed infants can experience constipation when solid foods are introduced or when they transition to cow’s milk (which is harder to digest than breastmilk).

Rarely do babies have malrotation or twisting of the intestines requiring emergency surgery. In other cases, parents report lethargy in their infants up to two years old that comes and goes. They will turn their heads and look “spaced out,” but it’s not related to their mental state. Combined with abdominal pain, this uncommon condition is often intussusception or the sliding of the bowel inside itself like a sleeve. This is resolved with a radiologic procedure or surgery.


Celiac disease is often thought to be a gluten allergy, but it’s actually an autoimmune issue. Families of Western European and Mediterranean descent with a history of autoimmune diseases like hypothyroidism and Type 1 diabetes are more prone to celiac disease. When children have chronic abdominal pain with diarrhea, blood tests can support or rule out celiac disease. If diagnosed, removing gluten from the child’s diet eliminates symptoms.


Inflammatory bowel disease (IBD) includes Crohn’s disease and ulcerative colitis, which often present in teens in subtle ways like weight loss, leveling of growth, increased fatigue and lower energy. When combined with belly pain and urgency to have bowel movements several times daily (including waking during the night), IBD is likely. Most diagnoses happen around puberty, but some younger children can have Crohn’s or colitis (rarely occurring under age five). There are several medications to treat IBD, and when necessary, biologic medications can relieve symptoms and help regain growth when children are treated before age 14 or 15. Dartmouth-Hitchcock (D-H) treats hundreds of pediatric patients with IBD who are living normal lives.

There are several uncommon conditions that may present belly pain in teens as follows:

  • Gallbladder attacks—mostly affect girls and happen after eating greasy or oily foods.
  • Ovarian cysts.
  • Testicular torsion—testicle rotation that cuts off blood supply and is an emergency.
  • Pancreatitis.
  • Urinary tract infections.

Two other rare conditions can affect children of any age: ureteropelvic junction (UPJ) obstruction that can cause kidney damage if untreated, and H. pylori bacterial infections that spread between people and can be passed from animals.

If you’re concerned about your child’s belly pain, contact your pediatric provider or seek emergency care if appropriate.

Additional information and resources are available on the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) website.