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Dr. Hive, I need some fast help


ILiveInFlipFlops
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At what point do you take a kid with stomach pain to the doctor? DD10 woke up this morning complaining of nausea. She never vomited, but she's had significant diarrhea off and on through the day. She's also been crying off and on because of the stomach pain, and now she's moaning and crying a lot. I'm worried about appendicitis, but she has no fever (none all day), no more real nausea, no vomiting, no extra or sharper pain when I press on her belly. She just says it aches in her lower abdomen, and it's not easing up now.

 

I can remember the pains from my last stomach virus, and they were pretty bad, but I'm not sure what to do here.

 

At this point, our options are urgent care or ER. Urgent care is closer and will probably be faster, but I don't think they can take x-rays or anything there. Can they diagnose appendicitis without that?

 

Or should we just wait it out a bit? What else can I do for belly pain if this is a stomach virus? She felt a little better after she had a few bites of food earlier, but then the pain came back.

 

WWYD?

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Because of the moaning and crying all day, I would take her in, just to be on the safe side.

 

Can you call the doc (even if closed and speak with the on call), to get a feel for urgent care vs. ER? I would think they would know what equipment the office had to diagnose appendicitis, or if it would be a waste of time and you would be referred to ER anyway. You could call the urgent care too, and ask this as well.

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I would check for rebound tenderness (does it hurt worse when you let up from pressing down) and I would have her lie down and firmly tap the bottom of her feet. Then I'd see if she has pain when jumping. If any of these cause an increase in pain, I would consider taking her in.

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One summer our oldest dd had a horrid stomach ache - we almost took her in, but the signs for appendicitis were not there. Six months later she had her gall bladder out it was malformed and full of stones. In retrospect I believe the poor kid had a gallstone that bad summer day. :-(

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Thanks everyone. She cried for about 10 minutes after I posted, and then the pain eased up again after she sat on the toilet for a few minutes. When she came out, I made her lay on my bed and pressed on her belly looking for any particularly painful spots or rebound pain, but I didn't find anything that made her worse or better. Afterward she curled up and said the bed felt so good, so I told her to try to sleep and we'd see what happened. She was out in minutes.

 

She IS a little prone to drama around being sick, which is part of what made my decision more difficult, but I know she's in real pain. Then, when I mentioned I was worried about appendicitis, the crying ramped up a lot because she was scared, so it was harder to tell what was pain and what was fear.

 

Sooo, I guess we'll see what we see when she wakes up. She's sleeping very peacefully right now. I hope that's good sign. JudoMom, I'll try your other suggestions if she's still in pain when she wakes up. Hopefully I don't have the ER in my future tonight!

 

I appreciate the help, everyone.

 

ETA: Oh, and gall and kidney stones did cross my mind, because I just had my GB removed and have recurring kidney stone problems! She was mainly complaining that the pain was in her lower belly though. She first pointed to her bellybutton area, but then when I was pressing around, it turned out to be an aching pain lower in her abdomen. So, I don't know. Again, I guess we'll find out soon enough!

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Could she have gas pains? When she was in the bathroom, did she pass a lot of gas? (I only ask this because you said her pain eased up after she sat on the toilet.)

 

When I was a kid, I had such terrible pain that my parents took me to the ER in the middle of the night -- and it turned out to be gas pains. But they were AWFUL! If I recall correctly, it took several hours for them to go away.

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With dd's appendicitis she complained of mild, then severe stomach pain for 12 hours, but did eventually start vomiting. The pain eventually moved from central abdomen to the area of the appendix. I didn't notice a fever. The first step at the ER (really more an after hours doctor's appointment) was to take blood. We went home and they called us back urgently when the results came in. I think they did an ultrasound at that point. Trust your instincts, and err on the side of caution without being alarmist is my advice.

 

ETA: Dd first complained of pain at dinner time, but did sleep fine that night, then complained all the next day, started vomiting early afternoon, ER 5pm, back to ER 7pm to be admitted.

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Thanks for asking, Cat. She slept for 2 hours, when I finally woke her up. She's been fine ever since--a little groggy from the unusual nap, but she ate a good-sized dinner and asked for more, and dessert. I told her no to both! No pain, no visits to the bathroom, no nausea, no fever. Maybe that last bad round was the peak? I have no idea. I'm guessing she's probably fine, but we'll see what tomorrow morning brings.

 

nd293, that's what I'm afraid of, and I'll be watching for it. Thanks for telling me what the progression was like at your house. It's very helpful.

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We took ds to the ER a couple of years ago when he experienced acute stomach pain and vomiting. We were concerned about appendicitis because ds was in tears and is usually quite stoic. It wasn't appendicitis, thankfully, but the doctor told us that if a child wants to curl up with the pain, it's generally not appendicitis. He said with appendix issues, a person's response is to arch the back. I don't know if that helps at all, but I thought of this when I read the OP. in our son's case, it turned out to be one of the worst cases of constipation the doctor had seen on X-ray. Our son had no idea, because he'd been "going," but apparently it happened anyway. I'm not saying this is your dd's situation, of course. I hope she feels better soon!

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We took ds to the ER a couple of years ago when he experienced acute stomach pain and vomiting. We were concerned about appendicitis because ds was in tears and is usually quite stoic. It wasn't appendicitis, thankfully, but the doctor told us that if a child wants to curl up with the pain, it's generally not appendicitis. He said with appendix issues, a person's response is to arch the back. I don't know if that helps at all, but I thought of this when I read the OP. in our son's case, it turned out to be one of the worst cases of constipation the doctor had seen on X-ray. Our son had no idea, because he'd been "going," but apparently it happened anyway. I'm not saying this is your dd's situation, of course. I hope she feels better soon!

 

My friend's son had the same thing happen, though not quite so dramatically. That's interesting, about the arching back. I've experienced that same feeling when passing kidney stones!

 

Sounds like she might have had some kind of food poisoning.

 

That's what I'm thinking, though we all had the same breakfast, lunch, and dinner yesterday and no one else is sick. These ambiguous tummy troubles are always such a mystery :glare:

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Whatever it was, I'm glad she's feeling fine now. It does sound like it could have been food poisoning, though -- sometimes one person will react severely to a tainted food and everyone else will feel fine or maybe just have a few mild symptoms.

 

Please update us tomorrow and let us know how she's doing!

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