Protruding Stomach in Child

Protruding stomach is a condition characterised by distension of the stomach, where the abdominal area appears to be swollen or larger than its usual size. In most of the cases, this occurs when there is entrapment of intestinal gases inside the abdominal cavity. It is a misconception that this condition is seen only in adults. Protruding stomach is seen in children as well. Children are equally prone to gastrointestinal issues and abdominal bloating. It can cause great discomfort among infants, as they are unable to express their discomfort and may cause worry among the parents as the child may refuse to eat.

In most of the cases, distension of stomach among children is nothing serious to worry about. It may be caused due to over eating, which improves after couple of hours. Child’s stomach can also appear to be protruded, if a straw is used for drinking, talking while eating, or eating a meal too quickly. This can cause swallowing up of air through their mouth leading to bloating of the stomach. However, if this issue appears repeatedly over a period of time, it may indicate presence of underlying medical conditions. Some of these possible conditions are discussed below:

Lactose Intolerance: It is a common belief among parents that dairy product such as milk cheese, yogurt etc. is good for the child’s health. However, if the child has lactose intolerance, these products can cause great discomfort to the child. It is a condition where the child’s digestive system does not produce lactase enzymes which are essential for digestion of dairy products. Lack of these enzymes causes fermentation of undigested lactose in the intestine, leading to production of large amount of gases causing bloating or protrusion of the stomach.

Celiac Disease: This is another digestive issue where the child is unable to digest gluten products. As seen with lactose intolerance, children who are known to have this condition suffer from bloating of abdomen due excessive gas accumulation, particularly after eating pasta, bread and other wheat containing food. The abdominal bloating may be accompanied by other symptoms such as vomiting, rash, diarrhea etc.

Constipation as a Reason for Protruding Stomach in Children: Constipation is a condition where the affected individual experiences irregular bowel movements often accompanied by difficulty with defecation and passing of hard stools. This is often associated with protrusion of the stomach among children along with abdominal discomfort, pain and tightness around the belly. This is often a temporary condition and resolves with improvement in bowel movement.

Giardia: This is an intestinal condition characterised by growth of parasites in the intestines of young children. This leads to failure of absorption of fatty substance from the food. Toddlers and young children are more prone to giardia than older children. It is a communicable and contagious condition which transmits from one child to another child through direct contact. The causative agent is a water borne parasite and thus enters the body upon consumption of contaminated water. Besides protrusion of the stomach, other symptoms include runny stool or watery diarrhea, abdominal discomfort or cramps, nausea, vomiting, fever etc.

Appendicitis: Bloating of stomach can indicate development of appendicitis. Appendicitis is often accompanied by severe abdominal pain (over the lower right side of the abdomen) along with protrusion of the stomach. The child may also develop fever and nausea. In any situation, if the above symptoms are experienced, it is advised to seek immediate medical help. Neglecting appendicitis can have dangerous consequences. If left untreated, it can lead to bursting of the appendix which can be fatal.

Other possible causes of protrusion of stomach include:

• Irritable bowel syndrome
• Flatulence
• Hormonal fluctuation

Protrusion or distension of the stomach caused by overeating resolves by itself. Drinking a glass on warm water can help in soothing the discomfort associated with it. However, if it is a recurrent issue, associated with other symptoms such as skin rashes, diarrhoea, fever etc. it is advised to visit a paediatrician for early detection on underlying issues. Medical evaluation involves obtaining a detailed case history followed by physical examination of the abdominal area and studying of the other symptoms.

Lab tests such as blood work and stool tests are often recommended. Children with lactose intolerance are advised to follow a diet that is lactose free (dairy free). Similarly, in case of celiac disease, the child is advised to follow a gluten free diet. Giardia infection is treated with anti-parasitic medications. In most of the cases, the anti-parasitic medications are prescribed for 5 to 7 days for complete elimination of the causative agent. Constipation is treated without laxatives in children. They are advised to follow a fibre rich diet with increased intake of fluids which eases the bowel movements. In case of appendicitis, removal of the appendix by surgical intervention is the only treatment.

In mild cases, where distension is accompanied by burping and flatulence, there is no need to change the dietary pattern of the child. Eating slowly and avoiding talking while eating often helps the situation. Frequent small meals rather than one large meal can control over eating and bloating associated with it.

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