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My Nephew Is 7 Years And 6 Months Old. His

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Posted on Tue, 28 Jul 2020
Question: My Nephew is 7 years and 6 months old. His weight is 23 Kg. He has stomach pain since a few days now. it pains near the navel and left side of the stomach. He complains of pain when he wakes up and then it pains almost entire day. He passes stools on alternate days. He burps frequently and feels that food comes up to his mouth, like vomit. He is taking Digene 5 ml, twice a day, since 5 days now. But it does not seem to help. He has completed course of medicine for deworming and for good bacteria.
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
My Nephew is 7 years and 6 months old. His weight is 23 Kg. He has stomach pain since a few days now. it pains near the navel and left side of the stomach. He complains of pain when he wakes up and then it pains almost entire day. He passes stools on alternate days. He burps frequently and feels that food comes up to his mouth, like vomit. He is taking Digene 5 ml, twice a day, since 5 days now. But it does not seem to help. He has completed course of medicine for deworming and for good bacteria.
doctor
Answered by Dr. Muhammed Aslam TK (1 hour later)
Brief Answer:
Kindly give few more details

Detailed Answer:
Hi Bhomik,
Welcome to Ask A Doctor service
I understand your concern

Abdominal pain in children can arise from a lot of conditions. To have a clear idea, I need few more details:
1. Is this associated with any fever, nausea or vomiting?
2. Any relation of pain to food intake? Does this followed any triggering event like a change in diet or any drug intake?
3. How is his bowel- too tight, too loose or normal?
4. Is the pain severe enough to cause crying, waking him from sleep or school absenteeism?
5. Any disturbance of urine- like frequent urge to urinate or pain during urination?
6. Any similar illness in past, any complaints of anorexia or weight loss?


If the pain is only mild, he is active and playful, and no other associated symptoms, I won't be worried much. It is common for children of this age to have some pain in the central abdomen around umbilicus occasionally- called functional abdominal pain- and need not be worried.

Kindly get back with above details so that I can guide you better. Till then he may be given paracetamol(half of 650mg tab) for pain relief- maximum 3 times a day.

Waiting for your reply
Thank you
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
Kindly give few more details

Detailed Answer:
Hi Bhomik,
Welcome to Ask A Doctor service
I understand your concern

Abdominal pain in children can arise from a lot of conditions. To have a clear idea, I need few more details:
1. Is this associated with any fever, nausea or vomiting?
2. Any relation of pain to food intake? Does this followed any triggering event like a change in diet or any drug intake?
3. How is his bowel- too tight, too loose or normal?
4. Is the pain severe enough to cause crying, waking him from sleep or school absenteeism?
5. Any disturbance of urine- like frequent urge to urinate or pain during urination?
6. Any similar illness in past, any complaints of anorexia or weight loss?


If the pain is only mild, he is active and playful, and no other associated symptoms, I won't be worried much. It is common for children of this age to have some pain in the central abdomen around umbilicus occasionally- called functional abdominal pain- and need not be worried.

Kindly get back with above details so that I can guide you better. Till then he may be given paracetamol(half of 650mg tab) for pain relief- maximum 3 times a day.

Waiting for your reply
Thank you
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Muhammed Aslam TK (21 hours later)
Please below responses to specific questions asked .

1. No fever or nausea or no vomiting during last 4-5 months
2. There is no change in food intake. It's the usual food he eats everyday. He doesn't complain of pain while eating first few morsels. Then after second roti, he starts complaining of stomach pain. He hardly drinks any water. We have to keep reminding that he needs to drink enough water
3. He passes motion on alternate days. So initially it's hard and then normal stools.
4. The pain is not so severe. If he is distracted by any activity, he forgets. But sometimes he refuses to eat his food saying his tummy is paining.
5. No such pain
6. No such illness
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
Please below responses to specific questions asked .

1. No fever or nausea or no vomiting during last 4-5 months
2. There is no change in food intake. It's the usual food he eats everyday. He doesn't complain of pain while eating first few morsels. Then after second roti, he starts complaining of stomach pain. He hardly drinks any water. We have to keep reminding that he needs to drink enough water
3. He passes motion on alternate days. So initially it's hard and then normal stools.
4. The pain is not so severe. If he is distracted by any activity, he forgets. But sometimes he refuses to eat his food saying his tummy is paining.
5. No such pain
6. No such illness
doctor
Answered by Dr. Muhammed Aslam TK (2 hours later)
Brief Answer:
Need not worry

Detailed Answer:
Hi dear,

Thanks for the elaborate reply.
Now it is clear that his pain is not related to any significant illness. We can take this as functional abdominal pain as of now. Few things can be done to minimise this:

1. Avoid forceful eating. Children tend to pretend or feel exaggerated pain when forced beyond what they like. 23 kg is pretty good for his age. Two rotis will be sufficient for a meal- give along with butter and pulses to improve quality. To improve his appetite, avoid junk foods and energy drinks in between meal time. Instead, biscuits or home made snacks can be given at around 10am and 4pm.
2. Avoid or reduce the amount of tea, coffee and other caffeinated items- this will reduce functional abdominal pain
3. Make him drink enough water and include plenty of fibre rich items in diet(green leafy vegetables, fruits, oats). This will promote daily soft stools and reduce any contribution from constipation and gastritis.
4. Finally, presence of burping and feeling of food coming up indicates presence of mild gastritis- for this, I would suggest giving pantroprazole 20mg tab once daily(before breakfast) for 7 days. Avoiding caffeinated items, junk foods, spicy items, pickles will help prevent recurrence.

For occasional pain that is disturbing, you can give him cyclopam tablet(3/4th) when needed. This contains paracetamol and dicyclomine.

Kindly stick on to these measure for 2 weeks and see the response. Most likely he will be fine by then. If not, kindly get back to us, so that we can guide through further evaluation. At this moment we need not any investigations.

Hope I have answered your query
If you do not have further queries, you can close the thread and rate the answer
Wish you good health
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
Need not worry

Detailed Answer:
Hi dear,

Thanks for the elaborate reply.
Now it is clear that his pain is not related to any significant illness. We can take this as functional abdominal pain as of now. Few things can be done to minimise this:

1. Avoid forceful eating. Children tend to pretend or feel exaggerated pain when forced beyond what they like. 23 kg is pretty good for his age. Two rotis will be sufficient for a meal- give along with butter and pulses to improve quality. To improve his appetite, avoid junk foods and energy drinks in between meal time. Instead, biscuits or home made snacks can be given at around 10am and 4pm.
2. Avoid or reduce the amount of tea, coffee and other caffeinated items- this will reduce functional abdominal pain
3. Make him drink enough water and include plenty of fibre rich items in diet(green leafy vegetables, fruits, oats). This will promote daily soft stools and reduce any contribution from constipation and gastritis.
4. Finally, presence of burping and feeling of food coming up indicates presence of mild gastritis- for this, I would suggest giving pantroprazole 20mg tab once daily(before breakfast) for 7 days. Avoiding caffeinated items, junk foods, spicy items, pickles will help prevent recurrence.

For occasional pain that is disturbing, you can give him cyclopam tablet(3/4th) when needed. This contains paracetamol and dicyclomine.

Kindly stick on to these measure for 2 weeks and see the response. Most likely he will be fine by then. If not, kindly get back to us, so that we can guide through further evaluation. At this moment we need not any investigations.

Hope I have answered your query
If you do not have further queries, you can close the thread and rate the answer
Wish you good health
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Muhammed Aslam TK (2 hours later)
Thanks Doctor for the detailed response. we will follow the advise mentioned. Lately my nephew has been complaining of pain on his left side which goes deeper, almost in the rib cage. Please let me know if this changes the diagnosis or if there is any cause of concern.
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
Thanks Doctor for the detailed response. we will follow the advise mentioned. Lately my nephew has been complaining of pain on his left side which goes deeper, almost in the rib cage. Please let me know if this changes the diagnosis or if there is any cause of concern.
doctor
Answered by Dr. Muhammed Aslam TK (4 hours later)
Brief Answer:
Let us wait

Detailed Answer:
Hi dear,

Pain that is on one side(not central abdomen) is usually not seen in functional abdominal pain. In our case, this may be from mild constipation or gastritis co existing. That is why I was planning to wait for 2 weeks with above said measures to see the response. If no response, we will evaluate then for other cases. In that case, an abdominal examination, ultrasound abdomen and a blood count with ESR might be needed. I did not mention these things to avoid undue confusion and worry now.

Right now, since the pain is only mild, and not associated with fever/vomiting/anorexia/weight loss, absolutely no cause of concern. Stay confident and wait. Aiming for 1-2 soft stools daily is important, with said dietary changes.

Hope you are clear now
Stay healthy
Thank you
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
Let us wait

Detailed Answer:
Hi dear,

Pain that is on one side(not central abdomen) is usually not seen in functional abdominal pain. In our case, this may be from mild constipation or gastritis co existing. That is why I was planning to wait for 2 weeks with above said measures to see the response. If no response, we will evaluate then for other cases. In that case, an abdominal examination, ultrasound abdomen and a blood count with ESR might be needed. I did not mention these things to avoid undue confusion and worry now.

Right now, since the pain is only mild, and not associated with fever/vomiting/anorexia/weight loss, absolutely no cause of concern. Stay confident and wait. Aiming for 1-2 soft stools daily is important, with said dietary changes.

Hope you are clear now
Stay healthy
Thank you
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Muhammed Aslam TK (20 hours later)
thanks Doctor, we will wait for couple of weeks and keep you posted on his conditions.
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
thanks Doctor, we will wait for couple of weeks and keep you posted on his conditions.
doctor
Answered by Dr. Muhammed Aslam TK (3 hours later)
Brief Answer:
That is the best option

Detailed Answer:
Hi dear,

Waiting for a couple of weeks with said measures is the best option for him. Hopefully he will outgrow pain by then

Wishing for good health for you and family
Thank you

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
That is the best option

Detailed Answer:
Hi dear,

Waiting for a couple of weeks with said measures is the best option for him. Hopefully he will outgrow pain by then

Wishing for good health for you and family
Thank you

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Muhammed Aslam TK (2 days later)
We checked for pantroprazole 20mg tablet at local chemist. Chemist said the tablet should not be given to kids. Also, there is no syrup form available for pantaprazole . So can you please suggest an alternative which is available/suitable for kids
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
We checked for pantroprazole 20mg tablet at local chemist. Chemist said the tablet should not be given to kids. Also, there is no syrup form available for pantaprazole . So can you please suggest an alternative which is available/suitable for kids
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Follow up: Dr. Muhammed Aslam TK (33 minutes later)
Additionally, he gets red itchy sores on his skin sometimes. We have tried to check his diet for specific allergens but were not able to figure out. Can you please help understand what could be the cause of the sores. Is there any ointment or medicine he can take
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
Additionally, he gets red itchy sores on his skin sometimes. We have tried to check his diet for specific allergens but were not able to figure out. Can you please help understand what could be the cause of the sores. Is there any ointment or medicine he can take
doctor
Answered by Dr. Muhammed Aslam TK (58 minutes later)
Brief Answer:
Can use Ranitidine instead

Detailed Answer:
Hi dear,

Pantoprazole 20mg delayed release tablets are available, and can be given to children above 5 years and 15kg. Tablets are avoided in children below 3-4 years, fearing aspiration.

But, instead you can give him Ranitidine also. You can use Ranitidine suspension(15mg/ml) 5ml twice daily for the same duration.

Regarding sores mentioned, what are the specific areas commonly he gets this? Is there any history of allergic diseases(asthma, eczema, eye/nose allergy) in the baby or his parents? When he gets next time, it will be of help if you can send a picture too.

Such red itchy sores can suggest an insect bite reaction, milia, or skin allergy. Most such lesions will respond to antihistamines and sometimes a topical steroid. I used to give Levocetirizine 2.5mg at night and mild-moderately potent steroid creams like hydrocortisone 1% or Fluticasone 0.05% for 5-7 days. Steroids are prescription drugs.

Hope I have answered your query
Let me know if I can assist you further
Wishing you good health
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
Can use Ranitidine instead

Detailed Answer:
Hi dear,

Pantoprazole 20mg delayed release tablets are available, and can be given to children above 5 years and 15kg. Tablets are avoided in children below 3-4 years, fearing aspiration.

But, instead you can give him Ranitidine also. You can use Ranitidine suspension(15mg/ml) 5ml twice daily for the same duration.

Regarding sores mentioned, what are the specific areas commonly he gets this? Is there any history of allergic diseases(asthma, eczema, eye/nose allergy) in the baby or his parents? When he gets next time, it will be of help if you can send a picture too.

Such red itchy sores can suggest an insect bite reaction, milia, or skin allergy. Most such lesions will respond to antihistamines and sometimes a topical steroid. I used to give Levocetirizine 2.5mg at night and mild-moderately potent steroid creams like hydrocortisone 1% or Fluticasone 0.05% for 5-7 days. Steroids are prescription drugs.

Hope I have answered your query
Let me know if I can assist you further
Wishing you good health
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Muhammed Aslam TK (45 hours later)
Few details about My nephew's urticaria episodes.


He gets red rashes on his skin. Mostly it's on back and stomach.We have not been able to find out the main cause of this. The rashes are sometimes circular in shape or sometimes like a long stretch of lines. His affected body parts become very hot till the time he has these rashes there. It's very itchy for him.

At times, we feel that he may be allergic to some food items having preservatives like chocolate spread or some items having fermentation like bread. So I avoid giving him these food items. He doesn't consume junk food items except cheese. Intake of cheese has also reduced in last one month.

At times We feel that he may be allergic to his own sweat, as these rashes appear on his body without him eating any of the food items mentioned above. Sometimes when he is upset, the rashes appear. When he was around 3 years, I thought that some particular kind of
fabric or some toy caused the rashes.

So we don't know the main cause of this urticaria.

History: He has been having this since last 4 years. It was very severe 2 years ago. We tried all allopathy meds. They didn't work. Then I switched to homeopathy medicine. With homeopathy medicine, the problem became more intense. After stopping homeopathy, the problem almost subsided except reoccurring on very few instances. Again these rashes are appearing for last one month.

Medicine administered so far:
1. Montair LC kid tablets
(Containing Levocetirizine + Montelukast) - 1 months course done two years ago. Recently did 15 days course again
2. Atarax syrup containing Hydroxyzine as and when rashes occur.
3. Applying ritch lotion and baby powder on affected areas.


we have photos of rash. I have uploaded under reports.
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
Few details about My nephew's urticaria episodes.


He gets red rashes on his skin. Mostly it's on back and stomach.We have not been able to find out the main cause of this. The rashes are sometimes circular in shape or sometimes like a long stretch of lines. His affected body parts become very hot till the time he has these rashes there. It's very itchy for him.

At times, we feel that he may be allergic to some food items having preservatives like chocolate spread or some items having fermentation like bread. So I avoid giving him these food items. He doesn't consume junk food items except cheese. Intake of cheese has also reduced in last one month.

At times We feel that he may be allergic to his own sweat, as these rashes appear on his body without him eating any of the food items mentioned above. Sometimes when he is upset, the rashes appear. When he was around 3 years, I thought that some particular kind of
fabric or some toy caused the rashes.

So we don't know the main cause of this urticaria.

History: He has been having this since last 4 years. It was very severe 2 years ago. We tried all allopathy meds. They didn't work. Then I switched to homeopathy medicine. With homeopathy medicine, the problem became more intense. After stopping homeopathy, the problem almost subsided except reoccurring on very few instances. Again these rashes are appearing for last one month.

Medicine administered so far:
1. Montair LC kid tablets
(Containing Levocetirizine + Montelukast) - 1 months course done two years ago. Recently did 15 days course again
2. Atarax syrup containing Hydroxyzine as and when rashes occur.
3. Applying ritch lotion and baby powder on affected areas.


we have photos of rash. I have uploaded under reports.
doctor
Answered by Dr. Muhammed Aslam TK (3 hours later)
Brief Answer:
Suggests urticaria

Detailed Answer:
Hi dear,
Thank you for the details given.

The symptoms suggest a diagnosis of urticaria. The extend of investigations needed and prognosis depends on whether this is acute urticaria or chronic urticaria.

If the lesions disappear rapidly(usually with in 1-3 hours of appearing), this suggests recurrent attacks of acute urticaria. If lesions persists beyond 24 hours, and episodes lasts beyond 6weeks, chance of chronic one or of urticarial vasculitis.

Acute urticaria is mild and benign, and need not be worried much. The said medicines are enough to control an acute attack. If we are able to find out a trigger, we can avoid that. Food items(especially egg, milk, wheat, peanuts, tree nuts, soy, shellfish, fish), drugs, viral fevers are the culprits most often. An allergic skin testing is available in some centres to screen for common food allergens. No need to totally avoid above food items- if we are able to find a correlation, avoid that(trying these items one at a time may help to find out). Less common triggers are cold, sun light, pressure/stroking over skin.

Chronic one is more difficult to treat and needs some investigations to rule out underlying systemic diseases. This is better managed by regularly following up with a dermatologist.

In short, if the episodes are becoming infrequent, lesions clears in 1-3 hours of appearance, and an episode does not last beyond 6 weeks, you can continue the same medicines as and when needed with supervision from pediatrician. On the other hand, if lesions take more than 2-3 hours to clear from a particular site, or an episode lasts beyond 6 weeks, this need detailed evaluation by a dermatologist. Here, you may be asked for few investigations.

Hope I have answered your query
Let me know if I can assist you further
Dr Muhammed Aslam, Paediatrician
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
Suggests urticaria

Detailed Answer:
Hi dear,
Thank you for the details given.

The symptoms suggest a diagnosis of urticaria. The extend of investigations needed and prognosis depends on whether this is acute urticaria or chronic urticaria.

If the lesions disappear rapidly(usually with in 1-3 hours of appearing), this suggests recurrent attacks of acute urticaria. If lesions persists beyond 24 hours, and episodes lasts beyond 6weeks, chance of chronic one or of urticarial vasculitis.

Acute urticaria is mild and benign, and need not be worried much. The said medicines are enough to control an acute attack. If we are able to find out a trigger, we can avoid that. Food items(especially egg, milk, wheat, peanuts, tree nuts, soy, shellfish, fish), drugs, viral fevers are the culprits most often. An allergic skin testing is available in some centres to screen for common food allergens. No need to totally avoid above food items- if we are able to find a correlation, avoid that(trying these items one at a time may help to find out). Less common triggers are cold, sun light, pressure/stroking over skin.

Chronic one is more difficult to treat and needs some investigations to rule out underlying systemic diseases. This is better managed by regularly following up with a dermatologist.

In short, if the episodes are becoming infrequent, lesions clears in 1-3 hours of appearance, and an episode does not last beyond 6 weeks, you can continue the same medicines as and when needed with supervision from pediatrician. On the other hand, if lesions take more than 2-3 hours to clear from a particular site, or an episode lasts beyond 6 weeks, this need detailed evaluation by a dermatologist. Here, you may be asked for few investigations.

Hope I have answered your query
Let me know if I can assist you further
Dr Muhammed Aslam, Paediatrician
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Muhammed Aslam TK (21 hours later)
Thank you for your response on urticaria. My nephew has been complaining of persistent abdominal pain since past couple of days and ranitidine does not seem to help. Based on the advise of a local doctor, we have done abdominal x-ray, ultrasound and urine test. I am attaching the reports. Can you please review the reports and let me know what could be the cause of the pain? also, what should be our course of action now.
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
Thank you for your response on urticaria. My nephew has been complaining of persistent abdominal pain since past couple of days and ranitidine does not seem to help. Based on the advise of a local doctor, we have done abdominal x-ray, ultrasound and urine test. I am attaching the reports. Can you please review the reports and let me know what could be the cause of the pain? also, what should be our course of action now.
doctor
Answered by Dr. Muhammed Aslam TK (4 hours later)
Brief Answer:
Pediatric surgery opinion

Detailed Answer:
Hi dear,
Sad to know that he is still not out of the pain.

I have gone through the reports in detail. The x-ray and urine reports are absolutely fine. Ultrasound also is almost normal, except there is increased post void residual volume(PVRU). This means that he is not able to void his bladder fully. Usually we expect PURV to be below 20ml, while here it is 45ml. If this was measured after ensuring complete voiding, this is significant(I used to specifically ask parents to ensure complete voiding). This can suggest an obstruction to flow of urine from bladder(as in a tight foreskin, urethral stenosis or anomalies). In such cases, we expect some bladder wall thickening also, which is not mentioned in the report.

Anyhow, since he is suffering a lot, it would be fine if you can get him examined with a pediatric surgeon also. Sometimes, they may ask for a repeat ultrasound or MCU(contrast x ray of urinary tract). Also, doing a stool occult blood test will make the evaluation more complete.

Let me know if I can assist you further
Wishing for good health

Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
Pediatric surgery opinion

Detailed Answer:
Hi dear,
Sad to know that he is still not out of the pain.

I have gone through the reports in detail. The x-ray and urine reports are absolutely fine. Ultrasound also is almost normal, except there is increased post void residual volume(PVRU). This means that he is not able to void his bladder fully. Usually we expect PURV to be below 20ml, while here it is 45ml. If this was measured after ensuring complete voiding, this is significant(I used to specifically ask parents to ensure complete voiding). This can suggest an obstruction to flow of urine from bladder(as in a tight foreskin, urethral stenosis or anomalies). In such cases, we expect some bladder wall thickening also, which is not mentioned in the report.

Anyhow, since he is suffering a lot, it would be fine if you can get him examined with a pediatric surgeon also. Sometimes, they may ask for a repeat ultrasound or MCU(contrast x ray of urinary tract). Also, doing a stool occult blood test will make the evaluation more complete.

Let me know if I can assist you further
Wishing for good health

Above answer was peer-reviewed by : Dr. Kampana
doctor
Answered by
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Dr. Muhammed Aslam TK

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My Nephew Is 7 Years And 6 Months Old. His

My Nephew is 7 years and 6 months old. His weight is 23 Kg. He has stomach pain since a few days now. it pains near the navel and left side of the stomach. He complains of pain when he wakes up and then it pains almost entire day. He passes stools on alternate days. He burps frequently and feels that food comes up to his mouth, like vomit. He is taking Digene 5 ml, twice a day, since 5 days now. But it does not seem to help. He has completed course of medicine for deworming and for good bacteria.