Fever and abdominal pain in children
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Common Causes of Fever and Abdominal Pain in Children
Fever and abdominal pain are frequent reasons for children to visit emergency departments and clinics. The most common causes are usually self-limited illnesses such as viral infections, gastroenteritis, and upper respiratory tract infections, but more serious conditions like appendicitis, enteric fever, and multisystem inflammatory syndrome in children (MIS-C) can also present with these symptoms 2510.
Infectious Causes: Enteric Fever, Gastroenteritis, and Malaria
Enteric fever (typhoid and paratyphoid) is a significant cause of fever and abdominal pain in children, especially in endemic regions. In one study, abdominal pain and fever were the most frequent symptoms, with children aged 7-12 years most commonly affected. Ceftriaxone was found to be the most effective antibiotic for treatment . Gastroenteritis is another common cause, often accompanied by vomiting and diarrhea 510.
Malaria should be considered in children with recent travel to endemic areas. Severe malaria can present with high fever, abdominal pain, and complications such as hemolysis and cholecystitis .
Surgical and Serious Medical Conditions: Appendicitis and MIS-C
Appendicitis is the most common surgical cause of acute abdominal pain in children, particularly in adolescents. Signs that suggest a surgical cause include fever, bilious vomiting, bloody diarrhea, and abdominal tenderness 910. Ultrasound is the preferred initial imaging test for suspected appendicitis 910.
MIS-C, associated with COVID-19, can present with high fever and severe abdominal pain, sometimes mimicking appendicitis. Children with MIS-C often have prolonged fever, severe vomiting, diarrhea, and elevated inflammatory markers. Differentiating MIS-C from appendicitis is crucial, and laboratory tests for inflammatory markers and SARS-CoV-2 serology are recommended 78.
Other Causes: Systemic and Rare Diseases
Systemic diseases such as systemic juvenile idiopathic arthritis (SJIA) and macrophage activation syndrome (MAS) can present with fever and abdominal pain, sometimes with hepatosplenomegaly and abnormal blood counts. Q-fever and Takayasu arteritis are rare but important considerations, especially in children with relevant exposures or persistent symptoms 34.
Diagnostic Approach and Outcomes
Most cases of fever and abdominal pain in children are due to self-limited illnesses. However, about 1-2% may have a more serious underlying disease requiring close follow-up or surgical intervention . Initial evaluation should include a thorough history, physical examination, and targeted laboratory and imaging studies. Ultrasound is a valuable, non-invasive tool for evaluating abdominal pain in children 910.
Conclusion
Fever and abdominal pain in children are common and usually due to benign, self-limited conditions. However, clinicians must remain vigilant for serious causes such as appendicitis, enteric fever, MIS-C, and rare systemic diseases. Careful assessment, appropriate use of laboratory and imaging studies, and close follow-up are essential to ensure timely diagnosis and management 2578+2 MORE.
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