Abdominal pain and fever
If abdominal pain and fever occur in children in combination, in many cases an inflammation can be the cause of the pain. Since small children in particular project a lot of pain into the abdomen, not only the abdomen but always the entire child must be examined to find the cause. In children, appendicitis is one of the most common causes of abdominal pain.
The pain of appendicitis often starts in the middle abdomen around the navel and then moves slowly to the right lower abdomen. The reason for this is the progressive inflammation of the appendix with increasingly precisely localised pain. Besides fever, the pain is often accompanied by nausea, vomiting and constipation.
The pain has a dull, persistent character and increases in intensity. If the appendix bursts, the pain may initially subside. With increasing inflammation of the peritoneum (peritonitis), however, the pain in the lower abdomen becomes much stronger and can ultimately affect the entire abdomen.
As such peritonitis can be life-threatening, it is important to detect appendicitis early and to operate. Appendicitis can often be detected by ultrasound examination and the elevated inflammation parameters in the blood. In some cases, however, the diagnosis cannot be made by simple diagnostics, so that even if appendicitis is suspected, surgery is necessary.
As long as the inflammation is limited to the appendix, the operation can often be performed laparoscopically. In this case, only three small incisions are necessary to insert the camera into the abdomen. The remaining scars are very small and hardly visible.
Since the appendectomy is a routine procedure, complications are very rare and can usually be performed without problems even in children. However, if the inflammation has spread to the entire abdominal cavity, it is a serious disease which often requires major surgery. A simple stomach flu (gastroenteritis) can also cause abdominal pain and fever and is one of the most common diseases in children.
It often causes abdominal pain and nausea. It can also lead to diarrhoea and vomiting. In most cases the gastro-intestinal disease in small children is caused by rotavirus.
These are very contagious, so that the whole family can be affected by the disease. Since a gastro-intestinal flu usually lasts only for a very short time, the pathogen detection is often not necessary. Also a specific therapy is rarely necessary.
Only in very young children or severely impaired children is a hospital admission necessary to compensate for the loss of fluid through the vein. If the children are able to drink sufficiently on their own, an electrolyte solution for drinking and smaller amounts of food are often sufficient to compensate for the loss of fluid through vomiting and diarrhoea. The gastro-intestinal flu usually goes back as quickly as it started, so most children are healthy again after 3 to 4 days.
Often children also suffer from night-time stomach pains. Patients can be almost symptom-free during the day and are then awakened at night by severe colicky pain. In this case an exact diagnosis by the doctor should be carried out urgently.
If the abdominal pain is exclusively nocturnal and does not occur during the day, the diagnosis often remains in the dark. It is important in this context to examine the habits of the little patient more closely. For example, it should be clarified what and how much is eaten and drunk in the evening, when exactly the pain occurs at night, whether the child has really slept through the night or was woken by it, etc.
A so-called intussusception can also lead to nocturnal stomach pain. In this clinical picture there are temporary invaginations of the intestinal wall with sometimes extremely severe colicky pain. The diagnosis of an intussusception is extremely difficult because the intestinal wall also quickly returns to its original position and then no longer causes any discomfort.
An ultrasound examination can reveal an intussusception in the acute presence. A colonic irrigation can lead to an unfolding of the intestine. If an intussusception of the bowel occurs repeatedly, surgical treatment should be performed.
In the case of abdominal pain that only occurs at night, an inflammatory event is unlikely, since the pain would also be present during the day. In order to relieve the pain at night, an attempt at treatment with a hot water bottle can be made. However, if the pain then becomes stronger, the treatment should be discontinued.
Another decisive factor in making a diagnosis is how often night-time abdominal pain occurs. For example, abdominal pain that occurs suddenly once can have more serious causes than abdominal pain that occurs repeatedly at the same time. In the latter case, a psychosomatic component is also frequent and even likely. In any case, consideration should also be given to carrying out a blood test, in which elevated inflammation values would indicate an inflammatory event in the abdominal area.
