Gallstones can occur in children of any age.
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Although gallstones were once thought to be rare in children, the condition is becoming more prevalent, especially in obese children. Gallstones can occur at any stage of childhood. Approximately 40 percent of pediatric gallstones are found in children between the ages of 2 and 14 years. An estimated 50 percent of pediatric gallstones are found in adolescents, age 14 through 18. The remaining 10 percent are found in children under the age of 2. Gallstones can cause severe episodes of pain, nausea and vomiting.
Risk factors for developing gallstones during childhood vary according to the type of stone. Cholesterol stones are more likely to develop in children with cystic fibrosis, a family history of gallstones or obesity, and in those taking chemotherapy. However, many cholesterol gallstones have no apparent cause. Black or brown pigment gallstones are usually caused by an increased rate of red blood cell breakdown, such as occurs in children with sickle cell disease.
Some children have silent gallstones that cause no symptoms. These gallstones are often discovered during testing for an unrelated condition. However, approximately 60 percent of children with gallstones experience episodes of abdominal pain, nausea and vomiting called biliary colic. Sudden severe pain and swelling in the gallbladder area may occur if the child also has inflammation of the pancreas, common bile duct or gallbladder. The location of the pain varies with the age of the child. Those over the age of 6 tend to report pain in the right upper region of the abdomen, while younger patients typically complain of more generalized abdominal pain.
When a doctor examines a child with gallstones, the findings may be normal unless inflammation or infection is involved. Fever and tenderness in the right upper abdomen may signal inflammation of the gallbladder, a condition called acute cholecystitis. Jaundice -- a term used to describe yellowing of the skin and the whites of the eyes -- may indicate that a gallstone is obstructing a bile duct.
Blood tests can be helpful in determining the cause of a child's symptoms, but abdominal ultrasound is generally a more useful method of testing for gallstone disease. Other tests may include abdominal x-rays and a cholescintigraphy (HIDA) scan to detect blockage of the common bile duct. A HIDA scan involves injecting a small amount of radioactive tracer into a vein, after which the liver, gallbladder and other related structures are scanned with imaging equipment.
If a child is experiencing pain, nausea and vomiting from symptomatic gallstones, the treatment of choice is usually surgical removal of the gallbladder. Gallbladder removal relieves the pain and prevents recurring episodes of gallstone-related discomfort. However, silent gallstones that are not causing discomfort generally do not require surgery. If the gallstones cause discomfort later, surgery can be performed at that time.
Medications such as ursodiol (Actigall, URSO) and chenodiol (Chenodal) that are sometimes used to dissolve gallstones in adults have not been proven safe or effective for children.