Managing chronic abdominal pain in children

March 1, 2012

Functional abdominal pain in children can be a tough nut to crack. Organic causes should always be excluded, but after that, treatment modalities are many and varied.

Key Points

Chronic abdominal pain in childhood is a puzzling and concerning condition. More than one-third of elementary and middle school children complain of weekly abdominal pain, and 24% of children report symptoms lasting more than 8 weeks.1 Irritable bowel syndrome (IBS)-type symptoms have been noted in 17% of high school and 8% of otherwise healthy middle school students.2

A child who chronically complains of abdominal pain is a challenge. Although the symptom usually indicates a benign problem, the parents may be terribly worried. The child may be in distress; the practitioner may order tests to avoid missing serious organic disease. Management of this problem can be time consuming and frustrating. Yet in only a small number of such children is there an underlying organic disease causing the pain. In most children, the pain is functional, that is, without demonstrable evidence of a pathologic condition such as an anatomic, metabolic, infectious, inflammatory, or neoplastic disorder.

Defining abdominal pain

Functional abdominal pain syndrome was introduced in the pediatric Rome III criteria as a diagnosis distinct from FAP to further classify youth with frequent abdominal pain who maintain their activities despite pain. Functional abdominal pain differs from functional dyspepsia in that FAP is periumbilical and diffuse rather than epigastric and from IBS in that the stool is of normal frequency and consistency.4