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Most childhood abdominal pain is functional, not serious. A thorough evaluation can rule out organic causes, allowing children to return to normal activities without further testing.
Area of Science:
- Pediatric Gastroenterology
- Functional Abdominal Pain
Background:
- Chronic vague abdominal pain is common in children over 5.
- Peak incidence occurs between 8 and 10 years of age.
Observation:
- Over 90% of cases lack serious underlying organic disease.
- Careful history, physical exam, and basic labs (urinalysis, CBC) are key.
- Intravenous pyelogram and barium enema are valuable if organic disease is suspected.
Findings:
- Functional abdominal pain is the most frequent diagnosis.
- Duodenal ulcers and abdominal epilepsy are rare and often overdiagnosed.
- Reassurance that functional pain is real is crucial for management.
Implications:
- Convince parents that functional pain is real, not imaginary.
- Avoid further investigations unless new symptoms arise.
- Encourage immediate return to full childhood activities.
Abstract:
Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. Barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.