Some 10–15% of school-age children experience recurrent abdominal pain at some point, but only one in ten have an organic problem. A good clinical evaluation is essential as it is rare for organic problems to present with abdominal pain alone, although inflammatory bowel disease, chronic urine infections and parasites may do so.
Idiopathic Recurrent Abdominal Pain
The majority of children presenting with recurrent abdominal pain have no identifiable organic cause. In this circumstance the expression ‘recurrent abdominal pain’ is often used as a diagnostic term in itself implying that the pain is functional rather than organic. The pain can be very real and severe. The periodicity of the complaint and the intervening good health are characteristic. The children are often described as being sensitive, anxious and high-achieving individuals, although this is by no means always true. Management must be directed towards reassurance, maximizing a normal lifestyle and minimizing school absence. (see box) In the majority of children the pain resolves over time.
Management of a child with recurrent abdominal pain
(These strategies may also be helpful for nonorganic headaches and leg ‘growing’ pains)
- Assure the parents and child that no major illness appears to be present.
- Explain that the aetiology is not known but nonetheless the pain is very real.
- Do not communicate to the parents that the child is malingering.
- Identify those symptoms and signs which the parents should watch for and which would suggest the need for a re-evaluation.
- Develop a system of return visits to monitor the symptom. Having the family keep a diary of pain episodes and related symptoms can be helpful.
- During return visits allow time for both the child and parent to express stresses and concerns.
- Make every effort to normalize the life of the child, encouraging attendance at school and participation in regular activities.
- Liaise with school to ensure consistent attendance.