When your child is sick, everything else seems secondary. Abdominal pain with fever is one of the most common reasons for bringing a child to the doctor. Several conditions can cause these symptoms, some far more serious than others. Your child’s age and other symptoms, like vomiting or diarrhea, are important consideration in identifying possible causes. Infectious illnesses account for most cases of abdominal pain with fever in children. Approximately 1 in 100 children with sudden abdominal pain will have a condition that requires surgery, according to a December 2013 article in "Pediatric Gastroenterololy, Hepatology and Nutrition."
Gastroenteritis is the most common cause of abdominal pain with fever in children. Commonly called a stomach bug or the stomach flu, gastroenteritis describes inflammation of the stomach and intestines. The illness is most commonly caused by a virus, such as rotavirus or norovirus. Bacteria, parasites and toxins can also be culprits. Children with gastroenteritis usually experience generalized abdominal pain and cramps. Fever is common and reflects the body’s effort to fight the infection. Watery diarrhea is another hallmark symptom of gastroenteritis, which may be accompanied by nausea and vomiting. Blood, mucus or both might be present in the stools, particularly with bacterial gastroenteritis.
Infections Outside the Digestive System
Infections outside the digestive system often cause abdominal pain with fever in children. Pneumonia, an infection of the lungs, usually triggers a fever and may cause abdominal pain -- especially when the pneumonia involves the lower parts of the lung, close to the abdomen. A urinary tract infection is another consideration in a child with fever and abdominal pain. This occurs most commonly with an infection of the kidney, known as pyelonephritis. Even a throat infection, or pharyngitis, can cause fever and abdominal pain in some children. A careful physical examination and some simply laboratory test typically suffice in diagnosing these infections.
Appendicitis is the most common surgical cause of abdominal pain with fever. The condition involves inflammation of the appendix, a short tubular structure that protrudes from the intestine in the lower right abdomen. Tweens and teens are most commonly affected, although the ailment can occur in other age groups. Appendicitis pain typically starts as dull discomfort in the area around the bellybutton. Over a period of up to 24 hours, the pain usually becomes more severe, shifts to the lower right abdomen, and it typically aggravated by activity. A low-grade fever is common with appendicitis, and nausea and vomiting may develop. A child with symptoms that might indicate appendicitis requires urgent medical evaluation. Prompt surgical removal of an inflamed appendix is usually recommended to avoid rupture of the appendix and peritonitis, a generalized infection of the abdomen.
Mesenteric adenitis describes inflammation of lymph nodes that surround the intestines. This condition most commonly affects children and usually arises due to an infection, usually viral but possibly bacterial. The symptoms of mesenteric adenitis include fever and abdominal pain, which may be accompanied by nausea, vomiting, diarrhea or a combination of these symptoms. The signs and symptoms of mesenteric adenitis can easily be mistaken for other conditions, especially appendicitis. Unlike appedicitis, however, mesenteric adenitis usually goes away on its own within a few days, although complete recovery may take up to a few weeks in some cases. In the meantime, children with mesenteric adenitis require adequate hydration, and possibly medication to control their pain and fever.
Warnings and Precautions
Other less common but serious conditions can also cause abdominal pain with fever in children. Because it can be challenging for even a medical provider to distinguish among the many possible causes of these symptoms, it's important to see your doctor if your child experiences persistent, progressive or worsening abdominal pain. Seek immediate medical care if your child has a high fever, vomits blood, experiences tarry or bloody stools, or exhibits signs or symptoms of dehydration, including:
-- dry mouth and tongue, or cracked lips
-- decreased urination or dark urine
-- increased irritability or drowsiness, especially in babies and young children
-- cool, dry skin
-- tearless crying
-- sunken soft spot in infants
Reviewed and revised by: Tina M. St. John, M.D.