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Recurrent Abdominal Pain in Children

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Recurrent abdominal pain has been defined as a chronic abdominal pain which is longstanding, either intermittent or constant, and is severe enough to interfere with a child’s normal activity. It is one of the most common symptoms in children and the cause is very often functional (where no organic disorder can be found). Girls are more often affected than boys and chronic abdominal pain occurs most commonly between the ages of 4 and 14. Diet and obesity are also factors that are involved in the occurrence of recurrent abdominal pain in children.

Causes of recurrent abdominal pain in children

The causes of recurrent abdominal pain may be functional or organic.

Functional causes : No cause can be found in most cases but underlying psychological problems such as sexual abuse, stressful events or emotional factors in the family may have a role to play in the recurrence of abdominal pain in children. A family history of such pain is also likely.

Organic causes : The following possible causes of recurrent abdominal pain in children should be considered

  • Irritable bowel syndrome
  • Abdominal migraine
  • Constipation
  • Urinary tract infections
  • Menstruation and salpingitis in older girls
  • Testicular torsion in boys
  • Peptic ulcer
  • Gastritis
  • Crohn’s disease
  • Milk protein/ lactose/other food intolerances
  • Dietary indiscretion
  • Ulcerative colitis
  • Gastroesophageal reflux
  • Mesenteric adenitis
  • Hydronephrosis
  • Pancreatitis
  • Liver and gall bladder disease
  • Appendicitis
  • Meckel’s diverticulum
  • Complications of diabetes
  • Lower lobe pneumonia
  • Lead poisoning
  • Tuberculosis
  • Rheumatic fever
  • Typhoid
  • Brucellosis
  • Tumors

Sometimes both functional and organic causes may coexist.

Signs & Symptoms

Functional abdominal pain may present as intermittent or continuous abdominal pain along with headache, insomnia, pain in the limbs, anxiety, depression, enuresis or behavioral problems in children. The pain is more likely to be in the central or epigastric region and blood count, stool examination or urine analysis is negative.

In organic causes of recurrent abdominal pain there may be associated symptoms like diarrhea, constipation, vomiting, fever, loss of appetite, headache, weight loss or poor growth. Blood, stool or urine reports are likely to be positive.

Fever and abdominal pain in children

Recurrent abdominal pain may be accompanied with fever, often unexplained. If fever is the associated symptom along with the abdominal pain, then the following causes should be kept in mind:

  • Urinary tract infection
  • Appendicitis
  • Tuberculosis
  • Rheumatic fever
  • Typhoid
  • Brucellosis
  • Lower lobe pneumonia.

Diarrhea and vomiting with abdominal pain in children

When there is persistent vomiting or chronic severe diarrhea associated with the recurrent abdominal pain we must think of the following:

  • Abdominal migraine
  • Peptic ulcer
  • Celiac disease, Crohn’s disease or irritable bowel syndrome.

Investigations

For recurrent abdominal pain, normally a blood count, ESR, urine analysis and culture, stool examination and x-ray is sufficient. Abdominal ultrasound and endoscopy is done only if indicated.

Treatment

Treatment of recurrent abdominal pain should be directed at the causative factor. Stress factors in a child’s background may need referral to other professionals.

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