CHRONIC ABDOMINAL PAIN IN CHILDREN
What is chronic abdominal pain?
 Three or more episodes of abdominal pain over at least three months duration that is severe enough
to affect daily activities in a child over three years of age.
 Chronic abdominal pain in children may have an organic cause or may be functional abdominal pain.
 General practitioners often have the task of distinguishing between organic and functional causes of
chronic abdominal pain.
How common is it?
Chronic abdominal pain affects 10-14% of school age children. Over two thirds of children with chronic
abdominal pain visit a doctor at least once. Identifiable organic causes will be present in 5-10% of these.
Alarm Symptoms & Signs suggestive of organic disease
 Weight loss or failure to thrive
 Gastrointestinal bleeding
 Chronic diarrhoea or vomiting
 Persistent right upper or right lower quadrant pain
 Unexplained fever
 Family history of inflammatory bowel disease
 Jaundice
 Urinary symptoms
 Back or flank pain
 Abnormal examination
Organic causes of abdominal pain
There are many organic causes of chronic abdominal pain. Examples include UTI, constipation, gastrooesophageal reflux disease, coeliac disease, inflammatory bowel disease, sickle cell disease, Meckel’s
diverticulum, recurrent intussusceptions, gallstones, renal tract stones, PUJ obstruction, small bowel
lymphoma, diabetes, ovarian pathology, referred pain from testes.
Functional abdominal pain
Discomfort is usually localised around the peri-umbilical region. The child is growing and developing
normally with none of the alarm symptoms mentioned above.
Children with functional abdominal pain can be sub-categorised into 5 groups (Rome III criteria- see
reference below for details).
If any of the alarm symptoms & signs are present the following investigations are needed
 Bloods - FBC, UEs, LFTs, Amylase, CRP, Glucose, Coeliac screen
 Urinalysis
 Stool sample
 USS abdomen
These investigations may be initiated in general practice or by secondary care, depending on the situation.
If none of the alarm symptoms & signs are present, what should I do?
 If no alarm symptoms and signs are present then only a coeliac screen is required.
 If the coeliac screen is negative, manage as functional abdominal pain.
 Other investigations do not help distinguish between organic and functional abdominal pain in the
absence of alarm symptoms and signs.
Authors: Dr Rachel Casey / Dr Raman Lakshman
Contact: rachel.casey@nhs.net
28/02/15
www.westsuffolkccg.nhs.uk
Management of functional abdominal pain
 Make a positive diagnosis and explain how diagnosis was made.
 Reassure that the pain is real but there is no evidence of dangerous underlying disease.
 If appropriate, discuss the relationship between stress and pain and consider possible triggers for the
symptoms.
 Focus on returning to normal activities rather than on complete resolution of the pain e.g. school
attendance, hobbies etc.
 Offer follow-up and reassure that the situation can be reviewed if new symptoms arise.
When should I make a referral to secondary care?
 If any of the alarm symptoms or signs mentioned above are present as secondary care investigations
may be needed e.g. laparoscopy, faecal calprotectin
 If functional symptoms are difficult to manage
 Parental request
 Diagnostic doubt
References
Chronic abdominal pain in children: help in spotting the organic diagnosis
Naomi Jane Wright, Philip J Hammond and Joe I Curry
Arch Dis Child Educ Pract Ed 2013 98: 32-39 originally published online November 10 2012
doi: 10.1136/archdischild-2012-302273
Authors: Dr Rachel Casey / Dr Raman Lakshman
Contact: rachel.casey@nhs.net
28/02/15
www.westsuffolkccg.nhs.uk