Careful attention to pain patterns can yield important information. Patients with esophageal ulcerations may complain of odynophagia or dysphagia while eating, or heartburn after eating. Gastritis or duodenitis may result in early satiety or vomiting. Distal ileal stenosis or strictures will be associated with pain and nausea beginning an hour or more after a meal and may also be associated with abdominal distension and vomiting. Small bowel inflammation is frequently associated with a sensation of bloating and generalized malaise. Crampy lower abdominal pain reflecting colonic inflammation and rectal inflammation will additionally be marked by urgency of stooling and most commonly hematochezia. It is important to note that young children are frequently stoic and may under-report pain. They will also be less able than older children to describe or localize their pain.

Questions regarding patient’s bowel movements are sometimes difficult to address but are necessary. Parents do not generally witness their child’s stools once toilet training has been completed and many adolescents never look at their stools let alone talk about them. It is required not only to ask about the frequency of stooling but also to ask about the quality of the stool. Individuals have different definitions of diarrhea, so it is important to ask a patient or care giver to describe the bowel movement in some detail. “Does it fall apart when it hits the water?” is a question which is useful to distinguish between formed and loose stools. Nocturnal bowel movements are never normal, often reflect inflammation in the colon, and are highly suspicious for IBD. School-aged children may be afraid to report blood in the stools and adolescents may not look at their stools, so it is necessary to ask the patient if they are having bloody stools (and if they do not know to get them to look). Quantity of blood and frequency of stooling can help to assess severity of colitis. Urgency, increased stooling frequency, and tenesmus are symptoms indicative of rectal inflammation and may be seen in either CD or UC.