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What treatment should be given to a two year old with severe abdominal cramps ?

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General & Family Physician
Practicing since : 2005
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My daughter became ill 11 days ago with what we thought was a stomach bug. She threw up 5x in a 24 hr. period. But then it became apparent she was in pain. She became lethargic and ran a low grade. She would cry sporadically like she was in pain. I took her to the dr. & they tested her for an uti and said she was mildly dehydrated. They gave her a shot of roseffin and2 days later put her on bactrum to wait for the culture results. The culture came back negative so we stopped the bactrum (after 2 days). Monday was day 8 of the ordeal and she seemed better although not 100%. Tuesday she began holding her belly often and crying and then it would pass. Yesterday her belly still hurt sporadically, but she did play some. She is not constipated. As of this morning (day 11) she still feels bad. She holds her belly sporadically and favors her right side. She will have periods of time where she seems ok but I know she is not because she even has dark circles under her eyes. She is just not herself at all and I don't know what to do. My dr. doesn't seem to know either or be all that concerned. I1 days is a long time! She is 2 by the way.
Posted Sat, 5 May 2012 in Abdominal Pain
Answered by Dr. Prasad 5 hours later
Dear Candy,

Thanks for your query.

The initial symptoms - severe crampy abdominal pain, vomiting and fever suggested infective conditions such as abdominal infections, genitourinary tract infections and less an abdominal pathology with secondary infection. Broad spectrum antibiotic was rightly used then and as your reported it was indeed effective in bringing down the infection and thus relieving the symptoms.

Now, I expected that she should have been better. Or Is she gradually recovering every day?

The exact location of pain, presence of other symptoms while urinating, loose stool and presence of genital discharge (though mild) are clues to that help clinicians to come to a conclusion. You have not reported any of these symptoms. I can understand that it is hard to figure out if these symptoms indeed exist as your daughter is still very young. Considering these limitations, pediatricians generally rely on abdominal examination, blood and urine tests and ultrasound examination very often to diagnose the condition.

Having said that the symptoms could be due to one of the following causes
1.     Intestinal colic probably secondary to healing infection.
2.     Passing ureteric stones
3.     Rarely intra-abdominal lesions such as a cyst that was initially secondarily infected.
(I apologise for not being specific here, however you have to agree that without abdominal examination and the scans as supporting evidences, it is hard to give a specific opinion)
To summarize- "Your daughter might be slowly recovering from a possible infective conditions. If she is active, playing well, not vomiting and passing stool normally; the chance that her symptoms are concerning is remote. It may take a few more days (probably another 2-3 days) to completely recover. If they are noticed after 2 weeks since the infection or if other unusual symptoms (which I mentioned as clues) occur, you may have to get back to her primary pediatrician for review. Abdominal examination and ultrasound scans may be necessary then."

I hope was reassuring. If you have any more clarifications, I will be pleased to clarify it.

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