Unexplained Abdominal Pain Below the Belly Button in Children

Abdominal pain located directly below the navel with an unknown cause?

Hello Doctor, my child was diagnosed and recovered from an illness in August 2022.
Since then, for unknown reasons, she has been experiencing abdominal pain about an inch below the navel, along with constipation (she used to have daily bowel movements before the diagnosis).
During this period, we took her to several pediatric gastroenterology hospitals in Taipei for examinations, including X-rays, ultrasounds, urine tests, stool tests, rectal nerve biopsy surgery, and CT scans.
The reports showed no issues, and the pediatric gastroenterologist even consulted with specialists in gynecology, infectious diseases, and neurology, but the medications prescribed did not alleviate the abdominal pain.
A week ago, we returned to the large hospital, where the doctor adjusted her medications.
In addition to prescribing probiotics, ulcer prevention medications, and stool softeners, the doctor also introduced phenobarbital and anti-anxiety medications.
However, after more than two weeks on these medications, her abdominal pain has not improved and has instead worsened! As of now, she has been suffering from abdominal pain for over two months and is unable to attend school.
The doctors at the large hospital suggested that this might be related to long COVID syndrome, and since there have been no previous cases like this, they are unsure what medications could help alleviate her abdominal pain symptoms.
Doctor, if you have encountered similar cases, please provide any suggestions to guide us in treating my child so that she can recover soon.
Thank you.

Mr. Wang, 40~49 year old female. Ask Date: 2022/11/30

Dr. Hu Guozheng reply Gastroenterology and Hepatology

Hello Mr.
Wang, I apologize for not having many cases in this area, and I have encountered few situations as severe as your daughter's.
However, there are many potential causes for abdominal pain.
For lower abdominal pain, aside from the gastrointestinal tract, the urinary system, reproductive system, nervous system, endocrine system, circulatory system, and even rarer metabolic disorders (such as porphyria) could all lead to unexplained abdominal pain.
I understand that both you and your doctor have made every effort to investigate various aspects.
Although a clear cause has not yet been identified, generally speaking, after so many examinations, any critical conditions should have been detected by now.
Therefore, aside from the possibility of long COVID syndrome, even if there are other rarer possibilities, they may also be difficult-to-diagnose conditions.
This situation may require time, monitoring the changes in her condition, and assessing whether further tests are needed at appropriate intervals.

Reply Date: 2022/11/30

More Info

Unexplained abdominal pain in children, particularly when it occurs below the belly button, can be a challenging issue for both parents and healthcare providers. Given the complexity of your child's symptoms and the extensive testing that has already been performed, it is understandable that you are seeking further guidance.

Firstly, it is important to recognize that abdominal pain in children can stem from a variety of causes, including gastrointestinal issues, functional disorders, infections, and even psychological factors. In your child's case, the pain has persisted for over two months following a COVID-19 diagnosis, which raises the possibility of post-viral syndromes, including what is sometimes referred to as "long COVID." This condition can manifest in various ways, including gastrointestinal symptoms such as abdominal pain and changes in bowel habits.

The fact that your child has developed constipation after previously having regular bowel movements is noteworthy. Constipation can lead to abdominal pain, and it can be exacerbated by dietary changes, stress, or even medication side effects. It is essential to ensure that your child is consuming a diet rich in fiber, drinking plenty of fluids, and engaging in regular physical activity to promote healthy bowel movements.

The medications prescribed, including probiotics and medications aimed at preventing ulcers, are common approaches to managing gastrointestinal discomfort. However, if these treatments have not provided relief, it may be necessary to explore other avenues. The use of phenobarbital and anti-anxiety medications suggests that the healthcare team is considering a potential neurological or psychological component to the pain. Stress and anxiety can significantly impact gastrointestinal function, leading to symptoms such as abdominal pain and altered bowel habits.

Given the complexity of your child's case, I recommend the following steps:
1. Follow-Up with a Pediatric Gastroenterologist: If you haven't already, consider seeking a second opinion from a pediatric gastroenterologist who specializes in functional gastrointestinal disorders. They may have additional insights or treatment options that have not yet been explored.

2. Consider Psychological Support: Since anxiety and stress can exacerbate gastrointestinal symptoms, it may be beneficial to involve a child psychologist or psychiatrist. They can help assess whether psychological factors are contributing to your child's pain and provide coping strategies or therapeutic interventions.

3. Dietary Review: Consult with a pediatric dietitian to evaluate your child's diet. They can help ensure that your child is receiving adequate nutrition while also addressing constipation. A dietitian can provide tailored advice on increasing fiber intake and hydration.

4. Symptom Diary: Keeping a detailed diary of your child's symptoms, dietary intake, bowel habits, and any potential triggers (such as stressors or changes in routine) can provide valuable information for healthcare providers. This may help identify patterns or correlations that could lead to a more accurate diagnosis.

5. Explore Alternative Therapies: Some families find relief through complementary therapies such as acupuncture, mindfulness practices, or yoga, which can help manage pain and reduce anxiety.

6. Regular Follow-Up: Continue to maintain regular follow-up appointments with your healthcare team to monitor your child's progress and adjust treatment plans as necessary.

In conclusion, unexplained abdominal pain in children can be multifactorial, and it often requires a comprehensive approach to diagnosis and management. By collaborating closely with healthcare providers and considering both physical and psychological aspects of your child's health, you can work towards finding a solution that alleviates their discomfort and improves their quality of life. It is crucial to remain persistent in seeking answers and advocating for your child's health.

Similar Q&A

Understanding Children's Abdominal Pain: When to Seek Help

Children occasionally complain of stomach pain, but it's not the kind associated with needing to use the restroom. She had dinner about three hours ago, and she mentions that the pain is worse when she moves, but it feels better when she is still. The pain is located just be...

Dr. You Ligang reply Gastroenterology and Hepatology
Hello, lower abdominal pain is mostly related to intestinal issues and is often connected to one's constitution or diet. The most common causes are irregular bowel movements or bloating. Increasing water intake, consuming more fruits and vegetables, exercising regularly, and...

Pain Around the Belly Button: Causes and Relief Strategies

I often lie down and play with my child, and when my child sits on my stomach, I experience unbearable pain. When I press around my navel, it hurts a lot, and I can feel a pulsating sensation. I frequently have bloating in my abdomen, along with alternating constipation and diarr...

Dr. Liang Jiade reply Gastroenterology and Hepatology
Hello, based on your description, the intermittent pain and bloating around the navel are mostly related to functional gastrointestinal disorders and dyspepsia. Additionally, since you experience alternating constipation and diarrhea, it is important to consider the timing of the...

Understanding Abdominal Pain in Children: When to Seek Help

Hello Dr. Huang: I would like to ask you about my 5-year-old niece. For the past two weeks, she has frequently complained of abdominal pain (near the navel), and tests at the hospital have shown no issues. Recently, her appetite has decreased, and she has been unable to eat much....

Dr. Huang Zheming reply Pediatrics
Hello, Xingchen: There are many causes of abdominal pain, most of which include 1. constipation; not having a bowel movement every day 2. air in the intestines 3. gastrointestinal inflammation (such as infectious, bacterial, or appendicitis) 4. hepatitis, nephritis, nephrotic syn...

Post-Operative Abdominal Pain in Teens: When to Seek Help

Hello, my 15-year-old child underwent laparoscopic surgery on November 3rd, with three incisions and two drainage tubes that were removed two weeks post-operation. The current wound is healing well, but recently he has been frequently complaining of dull pain above the navel and ...

Dr. Xie Wenhuai reply Surgery
It is recommended to perform a CT scan or ultrasound examination to rule out the possibility of an intra-abdominal intestinal abscess.