Chronic abdominal pain in children and adolescents: Approach to the evaluation
- Mary B Fishman, MD
Mary B Fishman, MD
- Associate Professor
- New York University School of Medicine
- Mark D Aronson, MD
Mark D Aronson, MD
- Editor-in-Chief — Adult Primary Care
- Editor-in-Chief — Hospital Medicine
- Section Editor — General Medicine
- Professor of Medicine
- Harvard Medical School
- Mariam R Chacko, MD
Mariam R Chacko, MD
- Professor of Pediatrics/Adolescent & Sports Medicine
- Baylor College of Medicine
- Section Editors
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
- George D Ferry, MD
George D Ferry, MD
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- Baylor College of Medicine
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
Chronic abdominal pain is common in children and adolescents [1,2]. The evaluation of the child or adolescent with chronic abdominal pain requires an understanding of the pathogenesis of abdominal pain, the most common causes of abdominal pain in children and adolescents, and the typical patterns of presentation.
The evaluation of the child or adolescent with chronic abdominal pain will be discussed here. The management of functional abdominal pain in children and adolescents, the causes of acute abdominal pain, and the evaluation of children with acute abdominal pain are discussed separately. (See "Functional abdominal pain in children and adolescents: Management" and "Causes of acute abdominal pain in children and adolescents" and "Emergent evaluation of the child with acute abdominal pain".)
In this topic, we will use the term “chronic abdominal pain” to describe intermittent or constant abdominal pain (of functional or organic etiology) that has been present for at least two months . However, in clinical practice, the distinction between acute and chronic abdominal pain rarely is distinct .
Our definition is similar to that provided in the 2005 American Academy of Pediatrics and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition clinical report . Although some clinicians require pain of three months’ duration to be considered chronic, the Rome III criteria for abdominal pain-related functional gastrointestinal disorders typically require symptoms for at least two months (table 1) .
The term “chronic abdominal pain” encompasses “recurrent abdominal pain”, classically defined by four criteria: 1) ≥3 episodes of abdominal pain; 2) pain sufficiently severe to affect activities; 3) episodes occur over a period of ≥3 months; and 4) no known organic cause . In the original case series, “recurrent abdominal pain of childhood” was considered to be the diagnosis . However, clinical and laboratory evaluations suggest that recurrent abdominal pain is not a single entity, but a symptom complex with organic and functional etiologies [8-12]. Thus, it is more accurate to use “recurrent abdominal pain” as a description rather than a diagnosis.
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- Organic disorders
- Functional disorders
- INITIAL EVALUATION
- Physical examination
- Laboratory evaluation
- Other studies
- PATIENTS WITH ALARM FINDINGS
- Laboratory evaluation
- Indications for referral
- PATIENTS WITHOUT ALARM FINDINGS
- Diagnosis of functional abdominal pain
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS