Flank Pain in Children

Flank Pain in Children

Flank pain is pain that is located on the side of the body between the upper abdomen and the back. This area is called the flank. The pain may occur over a short period of time (acute), or it may be long-term or recurring (chronic). It may be mild or severe. Flank pain can be caused by many things, including:

• Tumors.
• Appendicitis.
• Muscle soreness or injury.
• Kidney stones or kidney disease.
• Kidney infection.
• Constipation.
• Strep throat.
• Stress.
• A skin rash caused by the chickenpox virus (shingles).
• A lung infection (pneumonia).
• Fluid around the lungs (pulmonary edema).

Follow these instructions at home:

• Have your child drink enough fluid to keep his or her urine clear or pale yellow.
• Have your child rest as told by his or her health care provider.
• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Keep a journal to track what has caused your child’s flank pain and what has made it feel better.

Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child’s pain is not controlled with medicine.
• Your child has new symptoms.
• Your child’s pain gets worse.
• Your child has a fever.
• Your child’s symptoms last longer than 2–3 days.
• Your child has trouble urinating or is urinating very frequently.

Get help right away if:

• Your child has trouble breathing or is short of breath.
• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.
• Your child’s abdomen hurts or it is swollen or red.
• Your child has nausea or vomiting.
• Your child feels faint or passes out.
• There is blood in your child’s urine.

What research says about Flank Pain in Children

Study 1

A retrospective study reviewed the medical records of 124 children referred for various complaints who had 24-h urine calcium excretion greater than 2 mg/kg/d or random urine calcium-creatinine ratio greater than 0.18 mg/mg.

The Results of this study

Fifty-two children with various clinical complaints had RAP or flank pain. These comprised of 22 males and 30 females, 9 mo to 15.9 y of age, mean 6.7 +/- 3.5 y. A family history of urolithiasis was present in 50% of all the children.

Only 6 of the 52 children with abdominal pain had renal stones. In addition to abdominal pain, 27 children had hematuria and 10 had urinary incontinence.

Mild metabolic acidosis was present in three children, parathyroid hormone activity elevated in two and serum vitamin D activity was increased in nine.

All children were treated with increased fluid intake and a reduction in dietary sodium and oxalate and some required treatment with thiazide and antispasmodics.

Forty-five cases responded to treatment, 5 failed to improve from therapy, and 2, which were not followed up as patients, were not available.

The Conclusion of this study: 

52 children with RAP or back pain due to IH and recommend that IH be considered in the differential diagnosis of RAP or flank pain in childhood.

Study 2

To evaluate the role of idiopathic hypercalciuria (IH) as a cause of recurrent abdominal pain (RAP) in children. We retrospectively reviewed the medical records of 124 children referred for various complaints who had 24-h urine calcium excretion greater than 2 mg/kg/d or random urine calcium-creatinine ratio greater than 0.18 mg/mg. Fifty-two children with various clinical complaints had RAP or flank pain. These comprised of 22 males and 30 females, 9 mo to 15.9 y of age, mean 6.7 +/- 3.5 y. A family history of urolithiasis was present in 50% of all the children. Only 6 of the 52 children with abdominal pain had renal stones. In addition to abdominal pain, 27 children had hematuria and 10 had urinary incontinence. Mild metabolic acidosis was present in three children, parathyroid hormone activity elevated in two and serum vitamin D activity was increased in nine. All children were treated with increased fluid intake and a reduction in dietary sodium and oxalate and some required treatment with thiazide and antispasmodics. Forty-five cases responded to treatment, 5 failed to improve from therapy, and 2, which were not followed up as patients, were not available. We describe 52 children with RAP or back pain due to IH and recommend that IH be considered in the differential diagnosis of RAP in childhood.