"Mommy, my belly hurts," is a common complaint for children and adolescents.
Adults who complain of abdominal pain often undergo a computed tomography, or CT, scan. Children are much more sensitive to imaging radiation than adults, and the higher radiation dose of a CT scan is often not appropriate for children. Childhood diseases also are different from adult diseases and need a completely different imaging approach.
Simple X-rays of the abdomen are very helpful as the first imaging choice when dealing with pediatric abdominal pain. Unlike CT scans, the radiation dose of an abdominal X-ray is very low. These images can reveal common, easy-to-solve problems such as constipation or more serious abnormalities such as bowel obstruction.
Ultrasound is also an excellent imaging choice for the pediatric abdomen and pelvis, and is the preferred method of initial imaging of a child's belly. The visceral organs — liver, spleen, pancreas, gallbladder, kidney, urinary bladder and uterus/ovaries — are easily seen and evaluated using sound waves, particularly in small, thin youngsters.
Additionally, ultrasound offers real-time imaging so the actual areas of pain may be pinpointed and expertly evaluated. For instance, persistent pain in the right upper quadrant of the abdomen might be due to gallbladder dysfunction, a common adult problem but very uncommon in kids. If ultrasound can clearly demonstrate that the source of pain is the gallbladder, further imaging tests, such as a nuclear medicine scan, could be considered to more definitively evaluate the gallbladder function.
CT scan, though, still has a role in viewing the pediatric abdomen. Although rare in kids, kidney/ureter stones are often better demonstrated with CT scan. Appendicitis is another childhood abnormality that CT scan can definitively diagnose, particularly if the initial ultrasound is uncertain.
Upper gastrointestinal and small bowel exams are other methods to view the pediatric abdomen, especially if vomiting or diarrhea is present. Because radiation is used for this test, caution with limited radiation usage needs to be considered. After drinking special contrast material (dye), X-rays of the GI tract are obtained and evaluated, looking for bowel blockages, inflamed gut or the commonly seen gastroesophageal reflux.
Abdominal pain in kids is common but, luckily, rarely due to serious diseases. Conventional X-rays and ultrasound of the abdomen remain the best ways to initially evaluate and view these common childhood complaints.
Dr. Vesna Martich Kriss, a pediatric radiologist with Kriss Pediatric Imaging, practices at Baptist Health Diagnostic Services Brannon Crossing.