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The stomach can cause visceral pain to the middle epigastrium and parietal pain extended to the left upper quad. It can also be referred into the child's shoulder.

Because children have difficulty describing abdominal pain, pay close attention to nonverbal clues, such as wincing, lethargy, or unusual positioning(laying on side with knees to the stomach). Observing the child while he coughs, walks, or climbs may offer some diagnositc clues. Also remember thata parent's interpretation of the child's complaints is a subjective interpretation of what the parent believes is wrong.

Abdominal pain in children may signal a more serious disorder or a disorder that produces different associated signs and symptoms than in adults. For example appendicitis is more likely to result in rupture and death in children and vomiting may be its only other sign. Acute pyelonephritis may cause abdominal pain, vomiting, and diarrhea, but not the classic urologic signs found in adults. peptic ulcer, which is becoming increasingly common in teenagers causes nocturnal pain and colic that may not be relieved by food, unlike peptic ulcer in adults.

Abdominal pain in children can also result from lactose intolerance, allergic tension fatigue syndrome, volvulus, meckel's diverticulum, intussusception, mesenteric adenitis, Diabetes mellitis, juvenile rheumatoid arthritis and many uncommon disorders, such as heavy metal poisoning. remember too, that a child's complaint of abdominal pain may reflect an emotional need, such as a wish to avoid school or to gain adult attention.

So what should you do?

Gather as much information from the child as you can if the problem doesn't resolve. Take history and notes for reference to the physicians. Ask if he has had the pain before. have him describe the pain and write it down. For example is it dull, sharp, stabbing or burning? Ask if anything relieves the pain or makes it worse. Ask if the pain is constant or intermittant and when it began. constant steady abdominal pain suggests organ perforation, ischemia or inflammation or blood in the peritoneal cavity. Intermittent, cramping abdominal pain suggests the patient may have an obstruction of a hollow organ. If pain is intermittent find out the duration of a typical episode. ask the patient where the pain is located and if it radiates to other areas. Find out if movement, coughing, exertion, vomiting, eating, elimination, or walking worsens or relieves the pain. The patient may report abdominal pain as indigestion or gas pain, so have him describe in detail. Ask about any substance abuse and any history of vascular, GI, GU, or reproductive disorders. Ask about any appetite changes and the onset and frequency of nausea or vomiting. Find out about increased flatulence, constipation, diarrhea and changes in stool consistency. When was the last bowel movement? Ask about urinary frequency, urgency and pain.

Perform a physical exam and check for rigidity in the stomach. Is it hard to the touch or is the child flexing the muscles. Look for distention, lay him down and check for similarity from side to side.

If this is sudden and severe abdominal pain, take his vitals quickly, check for pulses below the waist and gather as much history as you can in case of emergency surgery.

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Q: What causes abdominal cramping worse on left upper quadrant in 12 year old boy?
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