Acute abdominal pain is a common symptom in the pediatric population. As with adults, surgical causes must be excluded, but in children there is greater urgency due to lower physiological reserves. Being aware of the differential diagnoses of acute abdominal pain in children, both surgical and medical, is important knowledge for students, in addition to details about the assessment and management of key conditions.

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newborn baby feet

Image: “The feet of a male newborn baby.” by Evan-Amos – Own work. License: Public Domain

Differential Diagnosis of Pediatric Acute Abdominal Pain

There are a  variety of conditions that may cause acute abdominal pain in a child. The causes of abdominal pain in a child are separated into surgical causes, medical causes, and non-specific abdominal pain.

Causes of abdominal pain


Surgical causes

Acute appendicitis

Classically begins as peri-umbilical pain that then migrates to the right iliac fossa.


Most common between 3 and 18 months of age. Intermittent attacks of abdominal pain with screaming, pallor and drawing up of legs.


Occurs secondary to malrotation in an infant who classically presents with bilious vomiting due to small bowel obstruction.

Strangulated inguinal hernia

Tender groin lump present.


Generalised tenderness with signs of peritonism, including guarding and rigidity. The patient may lie still to avoid provocation of pain.


Epigastric or left upper quadrant pain that radiates to the back.

Testicular torsion

Tender, swollen testes.


History or signs of trauma present.

Medical causes


Triad of fever, diarrhea and abdominal pain.


Pain in the right upper quadrant.

Inflammatory bowel disease

May be associated with episodic abdominal pain over a long time period


Lower lobe pneumonia

Referred pain to upper abdomen accompanied by respiratory symptoms.

Urinary tract infection

Presence of urinary symptoms such as dysuria.

Diabetic ketoacidosis

Associated with hyperglycemic symptoms of polyuria, polydipsia and polyphagia, and dehydration.

Other causes of pediatric acute abdominal pain include:

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