Gallstones are more common in adults than children, but the frequency of gallstones in children has increased over the past few decades. Some children may experience abdominal pain, especially in the upper right portion of the abdomen.
The pain may be intense and often comes in waves. When gallstones affect the liver, a child may develop signs of jaundice, such as very dark urine or yellow skin and eyes. However, not every child may have symptoms.
Gallstones may not indicate any underlying condition, but certain risk factors, such as genetics or diet, can increase the chances of developing them.
Read on to learn more about gallstones in children, including when to seek medical attention.
Several digestive fluids help the body metabolize food. The gallbladder secretes bile to help with digestion. But when digestive fluids accumulate and harden, they can create stones in the gallbladder.
While gallstones are not necessarily harmful, they can cause problems in the gallbladder, such as inflammation. Also, the stones may move and become trapped in the ducts of the gallbladder and liver, which can damage the liver, pancreas, or both.
Gallstones can cause intense pain, especially when they become stuck in one of the ducts. Because of the risk of infection and organ damage, gallstones that cause symptoms require prompt care.
Generally, two types of gallstones can occur:
Pigment gallstones occur when pigment, such as bilirubin, accumulates and causes stones. This is the most common type of gallstone in most children. However, according to one report, young females who have gone through puberty are more likely to develop gallstones.
A 2022 literature review indicates that the number of children with gallstones has risen by 1.9–4%. in recent years.
Certain medical conditions increase the risk of gallstones in children. These include:
- Wilson’s disease
- thyroid disease
- Down syndrome
- cystic fibrosis
- hemolytic diseases — a group of diseases affecting the blood
Some other risk factors for developing gallstones include:
- having a family history of gallstones
- certain genetic anomalies
- being female
- low physical activity
- a high fat diet
- having obesity — some studies show that it may play a role
- weight loss — since rapid BMI reduction can cause gallstones
However, even people who do not have any risk factors can still develop gallstones. A nutritious, balanced diet and regular physical activity may reduce the risk of gallstones in some children.
Gallstones that have not caused any complications often do not cause symptoms.
So, when symptoms appear, it may be a sign of complications. Some symptoms include:
- pain when pushing on the gallbladder area while taking a deep breath
- jaundice, which may cause dark urine, yellow eyes or yellow skin
- pain in the abdomen, especially in the upper right side
- stomach pain that radiates to the right shoulder
- nausea, vomiting, or diarrhea
- sometimes a fever
- guarding the abdomen, which is tensing of the abdominal muscles to protect the organs
If a child develops intense abdominal pain or jaundice, it is important to seek medical care.
Physical examination and assessing the child’s medical history can help the doctor determine whether they have gallstones. They may use the following tests to confirm a diagnosis:
- An abdominal ultrasound exam, which uses sound waves to bounce off the gallbladder and other organs to create an image
- Specialist imaging to examine the bile ducts, which are tubes that carry bile, include:
- magnetic resonance cholangiopancreatography (MRCP) to look at the bile duct in more detail
- endoscopic retrograde cholangiopancreatography (ERCP) to locate and possibly remove gallstones
- HIDA scans, which are imaging scans that show how the liver, gallbladder, and bile ducts are functioning
- Blood tests to look for infection, jaundice, or other issues that could be causing gallstones
Sometimes, doctors may find gallstones when they are looking for something else or as part of a workup for stomach pain.
If gallstones do not cause symptoms, they may not require immediate treatment.
Sometimes, a doctor will recommend removing the gallbladder. This is because gallstones tend to recur, and having gallstones is a risk factor for duct obstruction or other serious complications.
Gallbladder removal requires surgery, and a child will need to have general anesthesia in an operating room.
In some cases, a child may need other treatments for gallstone complications. These treatments may include:
- IV fluids
- additional medication
Some children may need to stay in the hospital.
Because gallstones can cause pancreatitis and liver damage or lead to dangerous infections, it is important to seek treatment for symptomatic gallstones.
Go to the emergency room if a child develops:
- intense pain in the upper abdomen that may come in waves after a meal
- jaundice, which can manifest as yellow skin, eyes, or nails, or dark urine
- symptoms of pancreatitis, such as intense abdominal pain or pale stool
Seek medical advice if a child has:
- stomach pain that comes and goes
- frequent bouts of vomiting or diarrhea
- a history of gallstones
A doctor may discover gallstones when looking for something else or as part of a workup for stomach pain. When gallstones cause symptoms, a doctor usually recommends surgery.
Gallstones themselves are not dangerous, but if they move, they can endanger other organs and cause infections. So it is essential to seek prompt medical care.
Parents and caregivers should treat intense abdominal pain as a medical emergency, particularly if it occurs with jaundice.