Although gallstones are more commonly seen in adults, a small percentage of children are diagnosed with this condition each year. Gallstones, or cholelithiasis, can develop silently and cause symptoms such as abdominal pain, nausea or digestive discomfort.
In paediatric cases, gallstones may be small and asymptomatic for extended periods, until they suddenly grow larger and cause pain or complications. Awareness of this possibility helps parents seek timely medical evaluation and appropriate management.
What Are Gallstones?
Gallstones are hardened deposits that form in the gallbladder. They can form when substances in bile, like cholesterol or bilirubin, harden into tiny crystals. These gallstones can vary in size and may lead to pain, inflammation or blockage of bile flow. They may be an indication of more severe conditions, such as gallbladder cancer or other chronic diseases.
What Causes Gallstones in Kids?
Gallstones in children do not always have an obvious or underlying cause. Overall risk often reflects a combination of medical history, lifestyle factors and genetic predisposition. The most common risk factors include:
- Haemolytic Disorders: Conditions such as sickle cell disease or hereditary spherocytosis increase bilirubin levels, which can lead to gallstone formation.
- Obesity and Diet: Children with higher body mass indices may develop cholesterol-based stones, especially if diets are high in fats and low in fibre.
- Prolonged Fasting or Malnutrition: Reduced gallbladder emptying during extended periods without adequate nutrition can promote stone formation.
- Long-term Intravenous Nutrition: Children receiving parenteral nutrition for chronic conditions are at higher risk.
- Genetic or Anatomical Factors: Congenital anomalies of the biliary tract may predispose some children to gallstones.
- Medication Influences: Certain drugs can affect bile composition and increase the likelihood of stone development.
Signs and Symptoms of Gallstones in Children
The most common symptom of gallstones in children is pain in the upper right abdomen. It is often difficult to diagnose, as children may not be able to describe the pain accurately. Symptoms may also be intermittent, lasting from 30 minutes to several hours. Your child may be able to describe the sensation of pain with the following traits:
- Focused around the upper right of the belly
- Sharp, cramping
- Recurring
- Occurring directly after meals, especially high-fat foods
- Extending to the back
If a gallstone is causing a blockage in the bile duct, children may also experience these symptoms as a side effect:
- Abdominal pain, particularly in the upper right area, sometimes radiating to the back or shoulder
- Nausea and vomiting, especially after meals
- Jaundice, which appears as yellowing of the skin or eyes
- Pale stools or dark urine
- Loss of appetite or unexplained weight loss
How Are Gallstones Diagnosed in Children?
Early diagnosis is key to preventing complications such as bile duct obstruction, pancreatitis or infection. Diagnosis begins with a thorough medical history and physical examination.
Additional imaging procedures may include:
- Ultrasound: This non-invasive test is usually the first imaging study performed. It can identify gallstones, gallbladder wall thickening and signs of bile duct obstruction.
- Hepatobiliary Scan (HIDA Scan): A HIDA scan is used when gallbladder function needs to be assessed or when stones are not clearly seen on ultrasound. It helps evaluate how bile moves through the gallbladder and bile ducts.
- Magnetic Resonance Cholangiopancreatography (MRCP): MRCP provides detailed images of the bile ducts and surrounding structures. It is useful for detecting stones, blockages or anatomical abnormalities that may not be visible on other imaging tests.
Blood tests may also be performed to assess liver function, bilirubin levels and markers of infection.
When Is Surgery Needed for Children With Gallstones?
Not all gallstones in children require surgery. Surgery is usually recommended for symptomatic gallstones, recurrent abdominal pain or when there are further complications. In most children, gallbladder removal is performed laparoscopically.
Children with asymptomatic gallstones may be monitored through regular clinical reviews and periodic ultrasound scans. However, if gallstones obstruct the bile ducts, endoscopic removal may be needed, either before surgery or as a standalone treatment in selected cases.
Treatment decisions are individualised and based on the child’s overall health, underlying medical conditions and the severity of symptoms.
How to Prevent Gallstones in Children
While not all gallstones are preventable, parents play a crucial role in protecting their children by fostering healthy habits and discipline from an early age. Support for good routines can significantly improve outcomes and reduce the risk of complications.
- Encourage a balanced diet rich in fibre and moderate in fat.
- Maintain a healthy weight and encourage regular physical activity.
- Teach children consistent mealtime routines and portion control.
- Avoid prolonged fasting or extreme diets.
- Manage underlying conditions that increase risk.
- Monitor children on long-term intravenous nutrition closely.
- Remain vigilant for signs that require medical attention and act promptly.
Early awareness, timely diagnosis and proper intervention, combined with parents’ vigilance in recognising warning signs and supporting healthy routines, are essential to ensuring the child’s safety.
Resolving Paediatric Gallstones At Our Gallbladder Clinic
Gallstones in children can be unexpected and difficult to recognise, particularly when symptoms are mild or intermittent. Understanding the causes, warning signs and treatment options enables parents to respond with confidence and prevent long-term complications by obtaining appropriate care early.
At the Hepatobiliary & Pancreatic Surgery Centre, gallbladder care is led by our experienced Consultant Hepatobiliary & Pancreatic Surgeon, Dr Wong Jen San, who provides comprehensive management before and after surgery.
If your child is experiencing ongoing symptoms and you are concerned about potential gallbladder issues, contact us promptly for a consultation.