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Suggest treatment for severe abdominal pain in a child

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Posted on Sat, 23 Jul 2016
Question: Hi All,

My son 5 years old, he is suffering with stomach pain (he is pointing navel) and vomiting, he has the problem for a week. I have tried ondem for two days and then OFM for five days and now giving him zincovit as per doctor's advice. As long as he takes OFM he was fine. Now again he has the same problem. Could please let me know what is the problem for him and advice how he should be treated to resolve his stomach ache and vomiting.



Thank you
doctor
Answered by Dr. Sumanth Amperayani (17 minutes later)
Brief Answer:
Need more information before suggesting you what to do

Detailed Answer:
Hi.... I understand your concern I need more information before suggesting you what to do further.

My questions -

1. Is the stomach pain excruciating or very severe so that he is a rolling on the bed when the stomach pain comes?

2. Is there any vomiting or Diarrhea or constipation along with the stomach pain?

3. Is this stomach pain occuring only now or is this a recurrent problem?

4. Is there any rash over the body or joint pains and joint swelling associated with stomach pain?

5. Is there any family history of gallbladder stones are kidney stones in the relatives circle or in the immediate family?

6. Is he wanting to go for motion immediately after feeding or is he having any teeth grinding at night or is there any worms in the stools (if you have observed)?

7. How is the child appetite since this week?

8. Is there any associated fever?

Please get back to me with answers to the above questions so that I can guide you scientifically further.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sumanth Amperayani (3 hours later)
Hi XXXXXXX

Thank you for your detailed reply. Please find my answers below.

1. Is the stomach pain excruciating or very severe so that he is a rolling on the bed when the stomach pain comes?
I hope it is not very severe. He is silent and inactive, lying down, when we asks and he himself telling that my stomach is paining and refuses the regular food.
Mostly at that time, i will give him 10 or 15 ml gripe water. after some time he will vomit all till his stomach is empty.

2. Is there any vomiting or Diarrhea or constipation along with the stomach pain?
Vomiting is there once or twice a day. No Diarrhea and no constipation.


3. Is this stomach pain occuring only now or is this a recurrent problem?
It is started only before a week time. Before that he don't have.

4. Is there any rash over the body or joint pains and joint swelling associated with stomach pain?
No. Nothing like that.

5. Is there any family history of gallbladder stones are kidney stones in the relatives circle or in the immediate family?
Yes. His Father and Grand father(father's father) has kidney stones problem.

6. Is he wanting to go for motion immediately after feeding or is he having any teeth grinding at night or is there any worms in the stools (if you have observed)?

He has a constipation problem from his childhood (after stopping breast feeding)
He has teeth grinding at night for the past 2 or 3 years.
I did not observe his stools. I have given him 'bandy' in last December 2015.

7. How is the child appetite since this week?
It is normal and good in the days he don t have stomach pain. i mean when he was taking OFM (5 days). otherwise also he will have good breakfast. As far as i noticed the stomach pain is coming after lunch (after 2 or 3 hours after lunch). till that time he will be normal. only when pain comes he could not eat.

8. Is there any associated fever?
He has no fever.

I hope you will resolve my son's all problems (stomach pain, vomiting and teeth grinding). Thank you!
doctor
Answered by Dr. Sumanth Amperayani (20 minutes later)
Brief Answer:
He needs an ultrasound abdomen and repeat the dose of Bandy

Detailed Answer:
Hi..... Greetings from XXXXXXX Thank you for the detailed answers.

My suggestions -

From the history I have noted from you I suggest three possibilities and what you should do inturn for each of them.

1. Mesenteric adenitis.
2. Renal colic or stones in the urinary tract.
3. Worm infestation.

To be done -

1. Right now what you can do is stop giving antibiotic like OFM as this is not related to infection.

2. Give give him syrup Bandy 10 ml today and another 10 ml after 10 days. If there are any worms, they will be evacuated out.

3. Get an ultrasound of the abdomen done. This will serve two purposes - as to clear whether there are any kidney stones or if there are any mesenteric lymph nodes. I am suggesting this because there is a strong family history of renal stones.

4. Coming to your query about grinding of the teeth at night - as it has been a long standing problem it might not get relieved immediately. I asked about teeth grinding because it is an indirect evidence of worm infestation. There are no specific medicines to treat this. At the same time as it is going on since a long time it might not be related to worm infestation. In your son it could be because of habit also. As the age progresses this habit will eventually regress.

5. Vomiting could be because of the pain abdomen itself. If we address the pain abdomen problem then the vomiting will subside by it self. You can give symptomatic treatment for vomiting with ondansetron, but this is a prescription medicine and you will need one for it.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link.
Once the page opens there will be an option below my image as – ASK ME A QUESTION – click on it.

Please find the link below -

www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani (3 days later)
Hello Doctor,

Thank you for your answers. We have met the doctor and he told not to give bandy now as they suggest it for yearly once. And he suggested to give him one tablet Lanzol 15 mg before food once a day. After taking this tablet next day also he has the same problem and we have done ultra sound and urine routine test.

Ultra Sound Findings:
1. Mild debris noted in the urinary bladder -? Cystitis
2. A small mesenteric lymphadenitis in peri umbilical region

I have attached the Urine report for your reference.

After tests done, we have told that there is some infection in the urinary bladder. so just continue the same medicine (Junior. Lanzol 15 mg). No major issues found in the test.

Second day my son is good and he does not have this compliant. again third day he is getting pain. We are confused and worried like we did not find the correct problem and the solution.

My son is going to be 5 years in next month (July 16th). his weight is 13.5 kg and height is 104.2 cm. I am also very much worried about his physical health.

Here are my questions.
1. Please look into my son's reports and let me know what is his problem and why he gets stomach pain.
2. What is your treatment advice for him.
3. Any tips to improve his physical health?

Thanks,
xxxxxxxxxxxxxxxxx
doctor
Answered by Dr. Sumanth Amperayani (3 hours later)
Brief Answer:
Looks like mesenteric adenitis

Detailed Answer:
Hi... coming to your queries directly -

1. After going through your reports I feel that it is Mesenteric adenitis and not cystitis. I am telling this because the urine routine report is absolutely normal which cannot be the case if it had been cystitis.

2. My treatment advice for him would be to give only pain relieving medication like paracetemol at the appropriate dose. This is not gastritis for junior lanzol to work so I suggest that you stop it.

3. Deworming can be done any number of times. Deworming tablets will not work like vaccination - like if you give once there will not be any worms in the tummy for another year... if symptoms are there we need to give it, there need not be 1 year gap.

4. Your son's percentiles of height and weight have been calculated by me. His height is appropriate but he is underweight.

I take this opportunity to tell you certain scientific facts and relieve your distress -
1. An active is a well kid even if she/ he is not eating well.
2. Development of a kid is as important as or I would say even more important than growth alone.
3. As the kids grow their interest in food decreases and interest in play activities increases so that they eat small quantity and run away to play. As parents we need to be more patient and feed than less quantity but more aliquots per day.
4. This age rather than the quantity of the food I suggest you concentrate more on the number of times you feed her and also make whatever you feed her calorie dense by adding good amount of ghee to it.
5. I suggest you not to use appetite stimulants on long run as they may cause drowsiness.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link.
Once the page opens there will be an option below my image as – ASK ME A QUESTION – click on it.

Please find the link below -

www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani (5 hours later)
Hi XXXXXXX

Thank a lot for your detailed reply!!

If I understand correctly, pain relief medication is the only treatment for
'Mesenteric adenitis'. or Is there any other course of treatment to be done Ex: (antibiotics like TAXIM-O) or go for X ray and followup to resolve the problem.

I did read about 'Mesenteric adenitis' on the web, however would like your inputs on how it should be treated?

Is there any specific care or restriction in food for few days to maintain or reduce the inflamation, as he is already under-weight and eats very less after this problem which sometimes is like skipping dinner and also vomits in some case?

Thanks,
xxxxxxxxxxxxx
doctor
Answered by Dr. Sumanth Amperayani (24 minutes later)
Brief Answer:
No need for medication - it is self limiting

Detailed Answer:
Hi.... coming to your queries -

1. There is no need for any other medication for mesenteric adenitis and the too such minimal one as your child is having.

2. Each case has to be tailored according to the patient needs and specific problems. Your son does not require anything extra.

3. There need not be any food restriction.

4. Vomiting also requires only symptomatic medication, no need for any long-term medication.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani (1 hour later)
Hi XXXXXXX

Thank you so much all your detailed answers.

Not to miss anything in my sons report, I just wanted to let you know the detail about Urinary Bladder part. (Sorry I don't have a scanned copy)

URINARY BLADDER:
Moderately distended and shows small 1.7 x 0.3 cms XXXXXXX echogenic debris.
Wall thickness is normal.
No evidence of calculus.
Evidence of a small(8mm) mesenteric lymphadenitis noted in the right peri umbilical region.

Please let me know if you want to add anything after seeing this.

I am very much satisfied with your all answers. Thanks again Sir!

Thanks,
xxxxxxxxxxxx
doctor
Answered by Dr. Sumanth Amperayani (11 minutes later)
Brief Answer:
This small debris cannot be cystitis with normal wall thickness

Detailed Answer:
Hi xxxxxxxxxxxxxx..... this small debris cannot account for or can be taken as an evidence of cystitis when the bladder wall thickness is normal.

I do not have anything to add please.

Though I do not have the luxury of clinically examining your child, I have based my professional opinion on the history I got from you and as an add on factor - the investigation reports.

I am willing to clarify on any other issue or doubt you have.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sumanth Amperayani

Pediatrician, Pulmonology

Practicing since :2003

Answered : 8348 Questions

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Suggest treatment for severe abdominal pain in a child

Brief Answer: Need more information before suggesting you what to do Detailed Answer: Hi.... I understand your concern I need more information before suggesting you what to do further. My questions - 1. Is the stomach pain excruciating or very severe so that he is a rolling on the bed when the stomach pain comes? 2. Is there any vomiting or Diarrhea or constipation along with the stomach pain? 3. Is this stomach pain occuring only now or is this a recurrent problem? 4. Is there any rash over the body or joint pains and joint swelling associated with stomach pain? 5. Is there any family history of gallbladder stones are kidney stones in the relatives circle or in the immediate family? 6. Is he wanting to go for motion immediately after feeding or is he having any teeth grinding at night or is there any worms in the stools (if you have observed)? 7. How is the child appetite since this week? 8. Is there any associated fever? Please get back to me with answers to the above questions so that I can guide you scientifically further. Regards - Dr. Sumanth