Abdominal Pain in Children

Abdominal pain is a common problem in children. Although most children with acute abdominal pain have self-limited conditions, the pain may herald a surgical or medical emergency. The most difficult challenge is making a timely diagnosis so that treatment can be initiated and morbidity prevented. This article provides a comprehensive clinical guideline for the evaluation of the child with acute abdominal pain.

The term "recurrent abdominal pain" as currently used clinically and in the literature should be retired. Functional abdominal pain is the most common cause of chronic abdominal pain. It is a specific diagnosis that needs to be distinguished from anatomic, infectious, inflammatory, or metabolic causes of abdominal pain. Functional abdominal pain may be categorized as one or a combination of: functional dyspepsia, irritable bowel syndrome, abdominal migraine, or functional abdominal pain syndrome (see table below titled "Recommended Clinical Definitions of Long-Lasting Intermittent or Constant Abdominal Pain in Children").

The most common medical cause is gastroenteritis, and the most common surgical cause is appendicitis. In most instances, abdominal pain can be diagnosed through the history and physical examination. Age is a key factor in evaluating the cause; the incidence and symptoms of different conditions vary greatly over the pediatric age spectrum. In the acute surgical abdomen, pain generally precedes vomiting, while the reverse is true in medical conditions.

Abdominal pain and gastrointestinal (GI) symptoms, such as vomiting or diarrhea, are common chief complaints in young children presenting in emergency departments (ED). It is the emergency physician’s role to differentiate between a self-limited process such as viral gastroenteritis or constipation and more lifethreatening surgical emergencies. Extra-abdominal conditions such as pneumonia or pharyngitis caused by streptococcal infection also can present with abdominal pain and must be considered.

Abdominal pain is one of the most common reasons for a parent to bring his or her child to medical attention. The evaluation of a "tummy ache" can challenge both parents and the physician.
Possible causes for a child's abdominal pain range from trivial to life threatening, with little difference in the child's complaints. Fortunately, abdominal pain in a child most often improves quickly. The difficulty for a parent or caregiver lies in deciding which complaints need emergency care and which do not.
Bacteria and viruses are responsible in case of abdominal pain due to infections. Gastroenteritis and stomach flu are some of the examples of infections that can cause stomach aches. Gastroenteritis is the inflammation and irritation of stomach and the gastrointestinal passage. Extra care must be taken by travelers, as the food and drinks can be contaminated at new locations and can lead to traveler’s getting diarrhea.

Abdominal pain in children may be mild or serious. It can be termed serious, if it is accompanied by diarrhoea and sickness or if it has lasted continuously for more than three hours or if it is accompanied by fever and the child’s neck glands are found swollen and his throat red or if the pain persists for several days.

The character of abdominal pain vary according to the site of the pain and the underlying cause. Thus in case of colic, a frequent cause of this problem, the pain may be sudden and spasmodic. There may be faintness, nausea and perhaps vomiting. The patient lies on his back and folds the legs and presses them over the abdomen to put pressure on it, which gives a sense of relief.