Approach to “Upset Stomach”

An “Upset stomach” is a common problem encountered by physicians involved in the care of children. It includes, diarrhea, vomiting or abdominal pain. Though often mild and self-limiting, at times there are uncommon life-threatening conditions that require urgent care. It is important for primary physicians to recognize “alarm signs” and make a referral to the specialist at the right time. At the same time it is important to recognize what is normal and re-assure the caregivers. A detailed history and a proper systemic examination are important at presentation, looking for any “red flags”. Investigations are seldom needed and the treatment is symptomatic. In acute diarrhea, adequate hydration is the cornerstone of management, which includes recognizing the degree of dehydration and treating with oral rehydration solution and Zinc. Dysentery i.e., bloody diarrhea needs treatment with antibiotics. In children with predominant vomiting and abdominal pain, it is vital to make sure one is not dealing with a “surgical “cause. If the child is not settling, a repeated examination is useful to look for the persistence or evolution of abdominal signs. Vomiting does not localize the problem to the gastro- intestinal (GI) tract and a complete systemic examination is needed to rule out an extra GI cause.