Recurrent abdominal pain is a common paediatric problem affecting 10-20% of school children. In children less than 2 years the pain is often associated with an organic cause. However in older children only 10% of cases have an organic cause. The symptom is frightening to the average parent and causes great discomfort to the child leading to absence from school and lack of involvement in play.
The physician must approach the diagnosis of chronic abdominal pain with confidence and never doubt that the child is in actual pain. He must build a trusting relationship with the parent and child.
A detailed comprehensive history may provide clues to the etiology. (Identification of a relationship between the pain and meals or bowel movement may provide a clue to the diagnosis of peptic diseases constipation or irritable bowel syndrome). IBS is familial and is characterized by abdominal pain and intermittent constipation and diarrhoea without an organic cause. Recurrent abdominal pain unassociated with other significant symptoms is usually functional.
A meticulous physical examination including growth parameters is important not only for detection of abnormal findings but also for reassurance. It coveys the physician interest in the patient and his complaints.
Etiology
The common causes of recurrent abdominal pain in children are (in order of frequency):
1. Functional
2. Lactose intolerance
3. Constipation
4. Musculoskeletal pain
5. Parasitic infection
6. Gastritis/reflux oesophagitis
7. Peptic ulcer disease
8. Inflammatory bowel disease
9. Pancreatitis and hepatobiliary disease
10. Urinary tract infection
11. Migraine
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