From the Guidelines
Yes, children can experience epigastric abdominal pain after a recent viral infection. This is commonly known as post-viral gastropathy or post-infectious abdominal pain. Following a viral illness such as influenza, gastroenteritis, or even a common cold, children may develop pain in the upper middle portion of the abdomen that can last for several weeks. This occurs because viral infections can cause inflammation of the stomach lining or intestinal tract, temporarily disrupting normal digestive function.
Key Considerations
- Treatment typically involves supportive care with clear liquids, small frequent meals, and over-the-counter pain relievers like acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) if needed, as recommended by recent studies 1.
- Avoid NSAIDs like ibuprofen as they may irritate the stomach further.
- Most cases resolve within 2-4 weeks without specific intervention.
- However, if the pain is severe, persists beyond a month, is accompanied by weight loss, bloody stools, persistent vomiting, or high fever, medical evaluation is necessary to rule out other conditions like peptic ulcer disease or appendicitis, as suggested by the American College of Radiology 1.
Important Evidence
- A recent study published in the Journal of the American College of Radiology 1 highlights the importance of considering the clinical history, risk factors, and symptoms when evaluating epigastric pain in children.
- Another study published in the same journal 1 provides guidance on the appropriate use of imaging studies in the evaluation of epigastric pain, emphasizing the need for a thorough clinical assessment before ordering diagnostic tests.
- The American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19 1 also provides relevant information on the management of children with epigastric pain and suspected viral infections.
From the Research
Epigastric Abdominal Pain in Children
- Epigastric abdominal pain can be a symptom of various conditions, including gastroenteritis, gastritis, and acute pancreatitis 2.
- In children, acute gastroenteritis is a common cause of abdominal pain, and it can be caused by viral infections 3.
- Viral infections can cause epigastric abdominal pain, as seen in a case report of a patient with SARS-CoV-2 infection who developed severe epigastric pain and peritonism 4.
- The evaluation of acute abdominal pain in children should include a thorough physical examination, laboratory tests, and imaging studies, such as ultrasonography 5.
- Gastritis, which can cause epigastric abdominal pain, can be diagnosed using upper gastrointestinal fibre endoscopy and biopsies 6.
Causes of Epigastric Abdominal Pain
- Viral infections, such as SARS-CoV-2 4
- Gastroenteritis, which can be caused by viral infections 3
- Gastritis, which can be caused by H. pylori infection, drugs, or stress 6
- Acute pancreatitis, which can cause epigastric abdominal pain 2
Evaluation and Management
- Physical examination, including evaluation of hydration status and abdominal tenderness 3, 5
- Laboratory tests, such as complete blood cell count, urinalysis, and lactate levels 5
- Imaging studies, such as ultrasonography, which is the preferred initial imaging modality in children 5
- Treatment, which depends on the underlying cause, such as oral rehydration therapy for gastroenteritis 3 or proton pump inhibitors and antibiotics for H. pylori infection 6