Guide for parents
Your child's tummy: common problems, diet and warning signs
Tummy aches, loose motions, vomiting and constipation are among the most common reasons children see a doctor. Most are short-lived and get better at home with fluids and simple care. This guide explains what parents can do, what to feed, and the warning signs that need a doctor quickly.
In short
Most tummy problems in children are mild and pass in a few days. During loose motions or vomiting, the most important thing is to prevent dehydration with ORS and to keep feeding. See a doctor quickly if your child is very sleepy, passes little urine, has blood in the stool, green vomit, or severe or constant tummy pain.
Who I see
I see teenagers aged 12 and above for stomach, liver and digestive problems, including endoscopy when it is needed. For babies and younger children, please start with your paediatrician, who can refer you to a paediatric gastroenterologist if needed.
What is common at each age
Under 1 year
Babies
- Spitting up after feeds is common and usually settles by about 1 year
- Breastfed babies may pass stools after every feed or once in several days; both can be normal if the baby feeds well and the stool is soft
- Loose motions or vomiting can dehydrate a baby quickly, so see a doctor early
1 to 11 years
Young children
- Loose motions from infection, especially in summer and the rains
- Constipation, often starting with toilet training or school
- Tummy aches with constipation, worry or a cold
12 to 18 years
Teenagers
- Acidity from skipped meals, late nights and fast food
- Tummy pain and bloating linked to exam stress (IBS)
- Weight gain and fatty liver, now increasingly common
Common problems and what helps
Loose motions (diarrhoea)
Most are caused by viral infections and settle in 5 to 7 days. The main danger is losing too much water and salt.
What helps
- Give ORS after every loose stool, in small sips, even if the child is also vomiting
- Keep breastfeeding, and keep giving normal light food such as khichdi, curd rice, banana and dal-chawal
- Your doctor may advise zinc, which helps the gut recover
- Avoid packaged juices, cold drinks and glucose drinks, which can make diarrhoea worse
- Do not give anti-diarrhoea medicines or antibiotics unless a doctor prescribes them
- Wash hands with soap after the toilet and before food
See a doctor the same day if your child is very sleepy or irritable, has sunken eyes, passes little urine, cannot drink, has blood in the stool or a high fever. Babies under 6 months should be seen early.
Vomiting
Usually caused by a stomach infection, and settles within a day or two.
What helps
- After vomiting, wait 15 to 20 minutes, then give small sips of ORS every few minutes
- Slowly increase the amount, and offer light food once the vomiting settles
- Keep babies upright for a while after feeds
Green vomit, vomiting blood, vomiting with severe tummy pain or a swollen tummy, or vomiting after a head injury needs emergency care.
Constipation
Very common. It often starts with toilet training, starting school, or a diet low in fibre. After one painful motion, children may hold back stool, which makes it worse.
What helps
- Plenty of water through the day
- Fruit, vegetables, dal and whole grains at every meal
- Toilet time for 5 to 10 minutes after meals, with the feet resting on a stool
- Praise, never scold, for using the toilet
- Active play every day
- Too much milk, especially in toddlers, can cause constipation; ask your doctor how much is right
- Do not give laxatives, enemas or home remedies without your doctor's advice
See a doctor if constipation lasts more than 2 weeks, if there is blood in the stool, a swollen tummy, vomiting or weight loss, or if it began in the first weeks of life.
Tummy pain
Tummy aches that come and go are common in school-age children and are often linked to constipation, worry or hunger. Pain that is severe, constant or in one spot is different.
What helps
- Ask about stools first: constipation is the most common cause
- Look for patterns, such as pain on school mornings or after milk
- Regular meals and enough sleep
- Talk with your child about school and worries
See a doctor urgently for pain that is severe or constant, moves to the lower right side of the tummy, wakes the child at night, or comes with fever, vomiting, weight loss or blood in the stool.
Also watch for
These are less common, but parents should know what to look for.
Worms
Children in India often get worms from soil and unwashed hands. Signs include tummy pain, poor appetite, itching around the bottom at night, and anaemia. Schools and anganwadis give deworming tablets twice a year under the National Deworming Day programme; ask your doctor about deworming at home.
Jaundice
In children, jaundice is most often caused by hepatitis A from contaminated food and water. Most recover fully, but see a doctor for any yellow eyes, and urgently if the child is drowsy, confused or bleeding. In a newborn, yellow eyes after 2 weeks of age, or pale, chalky stools, need tests without delay.
Swallowed coins, batteries and magnets
Most small objects pass on their own, but a swallowed button battery or magnet is an emergency, even if the child seems well. Go to the emergency department straight away.
Blood in the stool
In young children this is often from a small tear (fissure) caused by hard stool, but infection and other causes need a check. See a doctor, and urgently if there is a lot of blood or the child is unwell.
Get emergency care if your child
- Is very sleepy, floppy or hard to wake
- Has not passed urine for 8 hours, or has a dry mouth and no tears
- Has green vomit, or vomits blood
- Has severe tummy pain, or a hard, swollen tummy
- Passes a lot of blood in the stool, or black stools
- Has swallowed a button battery, a magnet or something sharp
Call 112 or go to the nearest emergency department.
Longer-lasting problems, especially in teenagers
Some tummy problems last for months. They need a proper check, not repeated home remedies.
Acidity and IBS in teenagers
Skipped breakfasts, late-night eating, fast food, exam stress and too little sleep are common causes. Regular meals, an early dinner, less junk food and enough sleep help most teenagers. Pain that wakes them at night, weight loss or vomiting needs a check-up.
Coeliac disease
Poor growth, long-lasting loose motions or tummy pain, or anaemia that does not improve can be caused by coeliac disease, a reaction to gluten in wheat that is not rare in north India. A blood test checks for it. Do not stop wheat before the test, as this can hide the result.
Fatty liver in children
Fatty liver is now seen in overweight children and teenagers. More active play, less screen time, and fewer sugary drinks and fried snacks are the main treatment. An overweight child should have a liver test and ultrasound if the doctor advises.
Healthy eating for a healthy gut
Children need regular meals, enough fibre and water, and fewer packaged foods. Home-cooked family food is the best food; special tonics are not needed.
Eat more
- Fruit and vegetables every day
- Dal, chana, curd, paneer and eggs for protein
- Whole grains: atta roti, poha, dalia and millets
- Water through the day, with a bottle for school
- A home-made tiffin
Cut down
- Packaged chips, instant noodles and biscuits
- Cold drinks, packaged juices and energy drinks
- Sweets and chocolates as daily treats
- Eating in front of screens
- Too much milk in toddlers, which can cause constipation and anaemia
Good to know
- For the first 6 months, babies need only breast milk; then start home foods along with breastfeeding
- Do not give honey before 1 year of age
- Wash hands, fruits and vegetables, and use boiled or filtered water
- Tonics, gripe water and home remedies are not needed; ask your doctor first
A simple school day of eating
- Breakfast
- Vegetable paratha with curd, besan chilla, or poha with peanuts
- School tiffin
- A roti roll with sabzi or paneer, a fruit, and a water bottle
- After school
- A glass of milk or lassi, with roasted chana or a fruit
- Dinner
- Dal, roti or rice, a vegetable and salad, at least 2 hours before bed
Tests and medicines in children
Most tummy problems in children need no tests. Stool tests, blood tests or an ultrasound are done when symptoms last or warning signs are present.
Do not give any medicine, including antacids, painkillers, anti-vomiting or anti-diarrhoea medicines, without a doctor's advice. Children's doses depend on their weight and age.
Endoscopy in children is safe when done by a team trained for their age, with sedation or anaesthesia. I perform endoscopy for teenagers aged 12 and above; younger children are referred to a paediatric gastroenterologist.
Common questions
Should I stop food and milk during loose motions?
No. Keep breastfeeding and give normal light food along with ORS. Stopping food slows recovery.
Are antibiotics needed for loose motions?
Usually not. Most loose motions in children are caused by viruses. Antibiotics help only in some infections, such as bloody diarrhoea, and only when a doctor prescribes them.
How should I make ORS?
Use a WHO-ORS packet and mix it exactly as written on the packet, with clean drinking water. Make a fresh batch every 24 hours.
Do you see children?
I see teenagers aged 12 and above. For younger children, please see your paediatrician first.