356 Paediatric Emergencies
ABDOMINAL PAIN, DIARRHOEA AND VOMITING(b) in infants, pain may be inferred from spasms of crying,
restlessness, drawing up of the knees and refusal to feed.
(ii) Associated features such as vomiting, fever and rigors.
(iii) Bowel habit: constipation, diarrhoea and the time of the last
bowel motion or passage of flatus.
3 Significant features include pain >3 h, associated pyrexia and vomiting.
4 Check the vital signs and perform a full general examination looking for a
raised temperature, rash and upper respiratory tract infection.
(i) Examine the abdomen for distension, palpable masses and signs
of localized tenderness, guarding and rebound.
(ii) Auscultate for bowel sounds and inspect the hernial orifices and
genitalia.
5 The common causes of abdominal pain are best considered in two groups:
(i) Surgical
(a) appendicitis
(b) Meckel’s diverticulitis
(c) peritonitis
(d) intestinal obstruction: adhesions, malrotation,
intussusception and mid-gut volvulus
(e) inguinal hernia with incarceration or strangulation
(f) testicular torsion
(g) trauma, including child abuse.
(ii) Medical
(a) mesenteric adenitis
(b) gastroenteritis
(c) constipation
(d) urinary tract infection (UTI)
(e) hepatitis
(f) Henoch–Schönlein purpura
(g) diabetic ketoacidosis
(h) pneumonia
(i) tonsillitis
(j) meningitis.
6 Send bloods for U&Es if dehydrated, and FBC with blood cultures if sepsis or
peritonitis is suspected.7 Always test the urine for glucose and, if UTI is suspected, send for micro-
scopy and culture.Warning: beware not to miss the diagnosis of dehydration in an