Hardly a day in the school health office goes by without at least one visit from a student complaining of abdominal pain. Studies conducted in communities and schools have reported that up to 13-38% of children and adolescents experience abdominal pain weekly. Pain is not just a physical experience but a complex psychosomatic one that can stem from various stressors. These stressors include diminished physical activity, sleep problems, poor eating habits, bullying or harassment, schoolwork pressure, and complex family situations. When any of these factors are present, the body can respond with physical pain, which can be both debilitating and challenging to manage, particularly for kids. For school nurses, performing a thorough assessment and addressing the underlying causes of pain is essential to help rule out potential emergencies, alleviate symptoms, and promote overall well-being. Part one of this blog series will review common, non-emergent causes of abdominal pain in students, general assessment guidelines, and focused interventions.

Causes of Abdominal Pain 

Sometimes, getting to the bottom of what’s causing all the tummy troubles coming through school health offices can take real detective work on the part of the school nurse. While there are many potential causes, the most common medical complaint of abdominal pain in children is gastroenteritis, which may include diarrhea, nausea, and vomiting. Other common causes include constipation, urinary tract infections, strep throat, and encopresis. Differentiating the differences between these non-emergent stomachaches and serious abdominal emergencies like appendicitis is critical. 

Assessment of Abdominal Pain

Despite the frequency of abdominal pain complaints, every stomachache should be taken seriously, including getting a focused history, which often can reveal the likely cause.

• When did the pain start, what’s the severity, and where is it hurting?
• Was there any abdominal trauma?
• When and what did the student last eat?
• Has the student been adequately hydrating?
• When was their last bowel movement, and was it “normal” for them?
• Are they experiencing any other symptoms?
• Is anything else going on that might be causing stress or worry?

After obtaining a thorough history, a focused physical assessment helps hone in on what might be causing the stomachache.

• What are the student’s vital signs?
• What is their body positioning, and what are their activity abilities?
• Are there signs of dehydration?
• Is their abdomen distended?
• Are bowel sounds present?
• Is there guarding or rebound tenderness of palpation?

Treatment & Management of Abdominal Pain

Depending on the results of the history and assessment, interventions may vary. For mild abdominal pain without a discernible cause, non-pharmacological treatments can help relieve discomfort and keep students in school. These include resting in a comfortable position, hydration, providing a small snack, applying heat, an invitation to use a private restroom, and using distraction tools. If school policies allow and if appropriate, OTC medications may be used for symptoms including gas or heartburn.

The vast majority of abdominal pain complaints from students visiting the school nurse are minor in nature but require careful evaluation by the school nurse. Part two of this blog series will cover abdominal pain emergencies and when a referral for emergency care might be indicated.