Tummyaches. Maybe one of our most common complaints and one of our biggest enigmas. Is every kid with a tummyache or an episode of throwing up sick? Short answer: no. Long answer: it depends on a lot of factors. Let’s discuss.
Stomachaches can come from a number of issues (this is not an exhaustive list):
- Stomach virus
- Menstrual cramps
- Stress or anxiety
- Known diagnoses such as Crohn’s, Ulcerative Colitis, irritable bowel disease, feeding problems, or reflux to name a few.
- Urinary tract infection
- Strep throat
- Food allergies, sensitivities and intolerances
When presented with a student complaining of a stomachache or vomiting we need to ask a few questions:
- Where does it hurt exactly? Point with one finger to the spot. This helps us know if we need to delve in further to determine if they need to be evaluated for appendicitis (lower right quadrant), if they have to poop (upper and/or lower left quadrants), or if they are hungry/have indigestion possibly (periumbilical/epigastric), if it’s menstrual (pelvic/cramps), or even if it’s just some anxiety (generalized all over “hurts”). Obviously we can’t diagnose any of these things specifically but we can pinpoint any areas of concern and decide what we need to do to help them.
- What were they doing when the stomachache started? Were they running around at recess right after eating lunch and got a stitch in their side or upset stomach? Were they doing something in class that caused them to worry a little too much (like a test or a difficult subject)? Was it right after having pizza or Takis or something that would cause some indigestion? Or were they happily going about their day when it struck them?
- If the complaint includes vomiting: what preceded the vomiting incident? Did they choke on food? do they have a bad cough that made them throw up? Did they witness someone else throw up and throw up also in solidarity? Did they see or smell something gross that made them throw up?
- Did they throw up a little bit or a lot? We all know they will always say they threw up a lot. What I want to know is was it just a little bit in your mouth? All your food on the floor? A little bit of mucus that you spit out? Unwitnessed trashcan and bathroom throw ups are often more like spit-ups that are misconstrued as “vomiting” to the younger kids.
- How do they feel now? Still nauseated? Gonna throw up again? Stomach still hurts? Or are they all better now that it’s over?
- Does it hurt when they go pee? Kids might have pelvic pain or belly pain related to a UTI which would possibly cause dysuria in addition to the belly pain.
For further assessment we want to consider:
- Do they have a fever?
- Do they have accompanying diarrhea?
- When is the last time they went poop? Little ones mostly do not remember when that was but worth asking.
- Do they have an existing health issues that might contribute such as food allergies, UC, IBS, Crohn’s, lactose intolerance, or taking meds?
- Watch them walk or ask them to jump in place and watch their face: do they have increased pain with jumping or walking type movement? This would be indicative of potential appendicitis.
- If everyone is comfortable with it you can have the student lie down and you can palpate the belly and see if they have any pain on palpation. Note where the pain is if any.
- What was for lunch and breakfast today? What was for dinner last night? Have they been eating? Do they have access to nutritious food?
- Do they have other symptoms such as sore throat and/or headache or rash? Signs of strep throat can include stomachache, headache, sore throat, vomiting, sandy textured rash to trunk, and fever.
- Observe how they look right now. Are they pale or greenish? Do they look sick? Is their demeanor normal?
- If it is appropriate to ask, it would be helpful to know if the student uses marijuana or any other illicit drugs. Chronic use of marijuana has been known to lead to cyclic vomiting syndrome or Cannabinoid Hyperemesis Syndrome which includes severe abdominal pain and uncontrollable vomiting. Use of some other drugs and withdrawal from them can also lead to intractable abdominal pain and vomiting as well. Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome
- If applicable and appropriate to ask, is the student pregnant or possibly pregnant?
- Are there any concerns of eating disorders in the student?
Now that you’ve asked a zillion questions and checked them out, what can you do about their complaint of tummyache?
- Send them to the bathroom to try and poop. In my experience most kids don’t want to poop at school which I completely understand but always worth a try. If pooping is a continuing issue for the student then you can recommend that the parent try a probiotic to help their digestive system. I love Garden of Life vitamins.
- If allowed in your district try Tums antacid if it seems like indigestion. An alternative would be sucking on a peppermint. My caveats with peppermints are to be aware of the risks: consider the ingredients in the candy and students religious beliefs and dietary limitations (Halal, kosher, food allergies and intolerances etc), be aware that peppermints pose a risk for choking.
- Health counselling: educate students on choosing healthy foods or non-spicy foods if they are having possible indigestion related to diet. If they are having limited access to food then that should be addressed as soon as possible.
- Allow them to take a rest for a bit. Give the student 10 minutes to lie down and rest and often they will feel better and be ready to go about their day.
- Give a snack if appropriate. If the student hasn’t eaten today for whatever reason try giving a snack such as crackers (presuming they are not allergic or personally averse to the ingredients), or ginger ale (again presuming that is appropriate for the specific student).
- Give PO fluids. Drinking a little bit (or a lot) or water can help often.
- Give hot/warm tea if permitted. Chamomile tea, or non caffeinated ginger tea can help calm the stomach.
- If permitted for your school/district try ginger candies. Ginger is an excellent stomach calmer and many pregnant people swear by it for nausea. Keep in mind that again, candy poses a risk for choking, allergies, and could potentially be against religious beliefs depending on the ingredients. I personally would consult the parent prior to giving this and have not actually given ginger candies at school but it is always an option to explore. Here is an article about ginger and nausea.
- Try having a “yucky bucket”. Take a gallon jug, clean it well, cut off the top and you have a barf bucket with a handle! You could potentially have one per classroom if you can collect enough of them. Sometimes just having the attention of the bucket and seeing the nurse does the trick. You can also use dollar store buckets but recycling old milk jugs is nice for the environment too.
- Obviously if they give concern for a more serious issue like appendicitis you would be calling their grown-ups immediately for evaluation. You would be calling EMS if indicated.
- If they are actively sick and vomiting then call their grown-ups and home they go!
- If suspicious for any other issues then manage accordingly, ie: pregnancy, UTI, strep throat. Call grown-up and recommend visiting the doctor. Follow your state laws regarding pregnancy and drug related issues and privacy. Here is an article from AAP discussing minors and privacy laws for your reference.
- When in doubt always call the parent and run it by them to see what they think. Sometimes having the student speak to the parent helps the student get themselves together to get back to class also.
- Avoid giving meds like Ibuprofen or Aleve because they will make abdominal pain and/or vomiting worse. If they have a fever and you need to give meds then stick with Tylenol if it is appropriate and allowed for that student.
- Try using a heating pad or a hot water bottle on the belly. Sometimes the heat can relax the muscles and relieve cramping related to menstruation, or vomiting and diarrhea.
- Here is a great article about home remedies for stomachaches with explanations: https://www.parentcircle.com/effective-home-remedies-for-stomach-ache-in-children/article
Do you have any advice, tips, or tricks for bellyaches that I didn’t mention? Follow and message me and let me know!