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Abdominal Pain


 

 

Recurrent or Chronic Abdominal Pain (CAP) in Children

  • This is 3 or more episodes of abdominal pain over at least 3 months duration that is severe enough to affect daily activities in a child ≥3 years of age.
  • CAP in children is common – affecting 10-14% children in the UK
  • Only 5-10% of children with CAP have an underlying organic cause
  • Investigations do not help distinguish between organic and functional abdominal pain in the absence of alarm symptoms and signs and should ideally be avoided*
  • Functional abdominal pain is managed optimally by making a positive diagnosis, providing reassurance and education, avoiding extensive investigations and focussing on a return to normal function rather than resolution of pain.
  • Alarm symptoms and signs should prompt further investigation and, where appropriate referral to General Paediatrics.

 

 


Functional (Non-Organic) Abdominal Pain

  • Usually central and often epigastric
  • More likely associated with a family history of abdominal pain, headache and depression
  • Often an association with history of illness in siblings
  • Associated with anxiety and headaches
  • Being bullied at school and child abuse, including sexual abuse and neglect, may present with recurrent unexplained abdominal pain.
  • Childhood IBS accounts for 70% of all paediatric recurrent abdominal pain
  • Other symptom groups include: Functional Dyspepsia, Abdominal Migraine, Functional Abdominal Pain (FAP), FAP syndrome

 

 

General Management of Functional Abdominal Pain in Primary care:

Management of functional abdominal pain focuses on improving quality of life, reducing parent and child concerns about the seriousness of the condition and reducing the disability associated with the pain. Although evidence is lacking for most pharmacological treatments of functional abdominal pain, psychological therapies such as CBT and hypnotherapy have been shown to be beneficial.

Parents should be advised to reduce concerned responses to their child’s pain, focusing on distraction instead. They should identify and remove things that reinforce symptoms (such as time off school with access to TV and treats etc.)

The school may need reassurance with a letter from the doctor explaining the pain is non-organic but acknowledging its genuine in nature. Pain during class is managed by continuation of the usual routine, not be removed to a sick room. Gradual re-introduction of a child to school e.g. Half days is not advised as it can reinforce symptoms by focusing on sickness rather than wellness.

Avoid excessive investigations.

 

Referral to General Paediatrics:

  • If alarm symptoms or signs present and no treatable diagnosis following investigations
  • Positive coeliac screen

 

 

References:

RCHT Acute Abdominal Pain Paediatric Pathway V3.0 October 2020

Chronic Abdominal Pain in Children: help spotting the organic diagnosis. Wright NJ, Hammond PJ, Curry JI. Archives of Disease in Childhood – Education and Practice 2013;98:32-39

Recurrent Abdominal Pain in Children Patient UK Professional Article: https://patient.info/doctor/recurrent-abdominal-pain-in-children-pro

Angus-Leppan H, Saatci D, Sutcliffe A, Guiloff R J. Abdominal Migraine BMJ 2018; 360:k179 doi:10.1136/bmj.k.179

 

Date: January 2022

Review Date: January 2023

Contributors: Dr Chris Williams Consultant Paediatrician RCHT, Dr S Burns RMS GP lead Paediatrics

Version: 1.1