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Chronic abdominal pain in children.
R Ganesh1, R Arvind Kumar, N Suresh
1Department of Paediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Nungambakkam, Chennai, Tamil Nadu. ganeped79@rediffmail.com
The National Medical Journal of India
|October 8, 2010
Summary
Chronic abdominal pain (CAP) in children presents a diagnostic challenge. A practical approach involves detailed history, physical exam, and targeted investigations to differentiate organic from functional causes for effective management.
Area of Science:
- Pediatric Gastroenterology
- Clinical Medicine
- Public Health
Background:
- Chronic abdominal pain (CAP) affects approximately 10% of school-aged children and adolescents.
- Organic causes are identified in 30%-40% of recurrent abdominal pain cases in India, with parasitic infections decreasing.
- There is a lack of consensus and data on the etiology, epidemiology, and management of CAP in India.
Purpose of the Study:
- To present a practical, step-by-step clinical approach for diagnosing and managing chronic abdominal pain in children.
- To guide healthcare providers in differentiating between organic and functional causes of CAP.
- To outline an evidence-based investigation and management strategy tailored to pediatric CAP.
Main Methods:
- Detailed patient history and thorough physical examination to categorize pain (site, symptoms, organic vs. functional).
- Stratified investigations: simple tests for suspected functional pain (Level I), further tests for alarm signs (Level Ia), invasive procedures like endoscopy (Level II), and specialized tests (Level III).
- Management based on identified etiology for organic CAP and tailored pharmacological/psychological interventions for functional CAP.
Main Results:
- A structured approach aids in categorizing CAP based on clinical presentation.
- Investigations are tiered according to suspicion of organic or functional etiology, optimizing resource utilization.
- Management strategies differ significantly between organic and functional CAP, requiring individualized treatment plans.
Conclusions:
- A systematic clinical approach is crucial for effectively managing chronic abdominal pain in children.
- Differentiating organic from functional causes through history, examination, and targeted investigations is key.
- Tailored management strategies, considering etiology and pain type, improve outcomes for pediatric CAP.
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