When children return to school in the fall, parents often notice changes in their child’s health. Stomach viruses and other infections can become more common, and changes in school routines, eating habits, and daily schedules may affect digestion.
Most children with a short-term stomach illness get better within several days.
But sometimes digestive symptoms continue.
Repeated vomiting, ongoing diarrhea, abdominal pain, lack of appetite, poor weight gain, or unexplained weight loss can be signs that a child needs a more complete gastrointestinal evaluation.
These symptoms do not necessarily mean that a child has a serious disease. However, when symptoms persist or keep returning, it is important to understand what is causing them.
When Should Parents Be Concerned?
Parents should pay attention when gastrointestinal symptoms are persistent, severe, or begin to affect a child’s nutrition, growth, energy, school attendance, or daily activities.
Symptoms that may warrant evaluation by a pediatric gastroenterologist include:
- Recurrent or persistent vomiting
- Frequent or prolonged diarrhea
- Chronic or recurrent abdominal pain
- Lack of appetite
- Unexplained weight loss
- Difficulty gaining weight or growing normally
- Blood or mucus in the stool
- Urgent or unusually frequent bowel movements
- Significant bloating
- Persistent nausea
- Fatigue or decreased energy
- Gastrointestinal symptoms that repeatedly occur at night
A child does not need to have all of these symptoms to benefit from an evaluation.
Could It Be More Than a Stomach Virus?
There are many possible causes of chronic gastrointestinal symptoms in children.
Depending on the child’s symptoms, the doctor may consider conditions such as:
- Celiac disease
- Food intolerance or food-related gastrointestinal disorders
- Chronic infection
- Functional gastrointestinal disorders
- Gastroesophageal reflux
- Constipation with overflow diarrhea
- Inflammatory bowel disease (IBD)
- Crohn’s disease
- Ulcerative colitis
- Other digestive or nutritional disorders
Inflammatory bowel disease, or IBD, is one of the conditions that may need to be considered when symptoms are persistent or accompanied by weight loss, poor growth, blood in the stool, or other signs of intestinal inflammation.
Having these symptoms does not mean a child has IBD. Testing is needed to determine the cause.
What Testing May Be Needed?
There is no single test that can diagnose every pediatric gastrointestinal problem.
A pediatric gastroenterology evaluation usually begins with a detailed medical history, physical examination, and review of the child’s growth and symptoms. Additional testing depends on what the doctor finds.
Blood Tests
Blood work can help look for anemia, inflammation, nutritional problems, liver abnormalities, infection, and other conditions.
Depending on the situation, testing may include:
- Complete blood count (CBC)
- Comprehensive metabolic panel (CMP)
- ESR and CRP to evaluate inflammation
- Iron studies
- Celiac disease screening
- Liver tests
- Vitamin and nutritional testing when appropriate
Blood tests are helpful, but normal results do not always rule out gastrointestinal disease.
Stool Tests
Stool testing can provide important information about intestinal health.
Depending on the child’s symptoms, testing may include:
- Stool cultures for infection
- Testing for parasites
- Testing for blood in the stool
- Other infectious studies
- Fecal calprotectin
Fecal calprotectin is a stool marker that can help identify inflammation in the intestines. It may be useful when evaluating children with chronic diarrhea, abdominal pain, blood in the stool, or other symptoms that could be associated with intestinal inflammation.
Radiology and Imaging
Sometimes laboratory and stool tests are not enough.
Imaging studies can help doctors examine the digestive tract and surrounding organs.
Depending on the clinical situation, a child may need:
- Abdominal X-ray
- Abdominal ultrasound
- MRI
- Specialized intestinal imaging such as MR enterography
Imaging may be particularly helpful when evaluating possible Crohn’s disease or other conditions affecting the small intestine.
When Is an Upper Endoscopy Needed?
An upper endoscopy, also called an EGD, allows a pediatric gastroenterologist to examine the lining of the esophagus, stomach, and the first portion of the small intestine.
Small tissue samples called biopsies can be collected during the procedure. A pathologist then examines the tissue under a microscope.
An upper endoscopy may be considered when a child has:
- Persistent vomiting
- Chronic nausea
- Ongoing abdominal pain
- Difficulty eating
- Poor weight gain
- Suspected celiac disease
- Difficulty swallowing
- Other persistent upper gastrointestinal symptoms
When Is a Colonoscopy Needed?
A colonoscopy allows the pediatric gastroenterologist to examine the large intestine and the end of the small intestine.
Biopsies are usually obtained during the procedure. These samples can show microscopic inflammation even when the intestine appears normal during the examination.
A colonoscopy may be considered when a child has:
- Persistent diarrhea
- Blood in the stool
- Unexplained weight loss
- Poor growth
- Chronic abdominal pain
- Significant changes in bowel habits
- Abnormal inflammatory markers or stool testing
- Symptoms concerning for Crohn’s disease or ulcerative colitis
When appropriate, an upper endoscopy and colonoscopy may be performed during the same procedure to evaluate both the upper and lower gastrointestinal tract.
Why Early Evaluation Matters
Children are growing and developing, so persistent gastrointestinal problems can affect more than digestion.
Ongoing vomiting, diarrhea, poor appetite, or abdominal pain can interfere with:
- Nutrition
- Weight gain
- Growth
- Energy
- School attendance
- Sleep
- Daily activities
Early evaluation can help identify the cause of symptoms and determine the appropriate treatment.
Importantly, not every child with vomiting, diarrhea, abdominal pain, or weight loss has IBD. Many gastrointestinal conditions are treatable, and some symptoms may have relatively simple explanations.
The goal of pediatric gastroenterology testing is to determine what is happening and avoid overlooking a condition that may require treatment.
A Fall Reminder for Parents
A short episode of vomiting or diarrhea is common in childhood. But if your child’s symptoms continue, repeatedly return, or are associated with weight loss, poor appetite, poor growth, blood in the stool, or persistent abdominal pain, consider discussing the symptoms with your child’s pediatrician or a pediatric gastroenterologist.
A thorough evaluation may include blood work, stool testing, radiology or other imaging, upper endoscopy, colonoscopy, or a combination of these tests, depending on the child’s individual symptoms.
Your child’s symptoms deserve to be understood—not simply ignored.
Pediatric Gastroenterology, Hepatology & Nutrition provides specialized evaluation and care for infants, children, and adolescents with gastrointestinal, liver, nutritional, and digestive concerns.