Abdominal pain in a child — what can an ultrasound detect?

Possible causes of abdominal pain in a child

Abdominal pain in a child can have many causes — from trivial ones to those requiring urgent care. The severity of the complaint, its location and accompanying symptoms all matter. The most common causes include:

• viral or bacterial infections of the digestive tract
• constipation
• dietary errors and food intolerances
• urinary tract conditions
• inflammation of the intestinal mucosa
• injuries
• appendicitis

When abdominal pain should be a concern

A one-off episode of abdominal pain is usually no cause for concern. When the complaint lasts several hours or intensifies, a visit to the doctor is needed. In newborns and infants it is worth noting any change in behaviour, because the intensity of pain cannot be established directly.

A sudden, acute attack of abdominal pain requires immediate consultation. Urgent assessment is also needed for pain accompanied by vomiting, diarrhoea or a high fever — these symptoms may indicate an infection whose complication can be dehydration.

Indications for abdominal ultrasound

The doctor orders an abdominal ultrasound in urgent diagnosis when warning signs are present:

• severe, acute abdominal pain, especially if it is increasing or localised to one place
• abdominal injury after a fall from a height or a blow
• bile-stained or bloody vomiting
• urinary retention

The examination is also performed in the diagnosis of chronic complaints:

• recurrent abdominal pain once the paediatrician has ruled out parasites, allergy and dietary errors
• abnormal urine test results, for example blood or protein in the urine
• chronic diarrhoea and constipation
• growth arrest or weight loss

What the doctor assesses during the examination

During the ultrasound the doctor assesses the size, position and structure of the organs, looking for abnormalities such as congenital defects, inflammation, tumours or cysts. The examination covers, among others:

• the kidneys and bladder
• the liver and gallbladder
• the spleen and pancreas
• the mesenteric lymph nodes
• the intestines and the appendix

Gas in the intestines may make it harder to assess the stomach and parts of the bowel. The scope of the examination and its interpretation are determined by the doctor.

Ultrasound is also performed as a preventive check, although it is not a routine test at every health review. In the first year of life, unlike hip ultrasound and transfontanellar ultrasound, it is not one of the standard examinations.

How to prepare a child for the examination

Preparation consists of reducing the amount of gas in the digestive tract and moderately filling the bladder. The day before the examination it is worth giving the child a simethicone preparation and avoiding gas-forming foods, carbonated drinks and chewing gum.

The break from eating depends on the child's age:

• infant — feeding about 1–1.5 hours before the examination
• child aged 1 to 5 — a break of 2–3 hours
• older children and teenagers — a break of 4–6 hours

It is worth dressing the child in loose clothing that is easy to lift. Detailed instructions are given by the unit performing the examination.