Description
Chronic abdominal pain in children requires a comprehensive, multidisciplinary approach. Begin with a detailed history focusing on pain characteristics, dietary habits, psychosocial stressors, and family history. Conduct a thorough physical examination to identify red flags such as weight loss, gastrointestinal bleeding, or fever. Initial investigations may include blood tests, stool studies, and abdominal imaging. Functional abdominal pain disorders like irritable bowel syndrome are common, especially if no organic cause is found. Management includes reassurance, dietary modifications, behavioral therapy, and pharmacologic treatment when necessary. Coordination with pediatric gastroenterology, psychology, and nutrition specialists can enhance outcomes and improve the child’s quality of life.
Summary Listen
- Chronic abdominal pain is a common pediatric GI complaint, with functional abdominal pain being the most prevalent etiology. Functional abdominal pain is characterized by pain in the absence of identifiable organic causes.
- Functional GI disorders encompass a variety of conditions presenting with multiple symptoms but lacking underlying organic causes. These disorders are categorized into vomiting syndromes, abdominal pain disorders, and defecation disorders. Functional abdominal pain disorders are further classified into functional dyspepsia, abdominal migraine, irritable bowel syndrome (IBS), and functional abdominal pain not otherwise specified (NOS).
- Key red flag signs and symptoms that suggest organic causes of abdominal pain include onset before age 5, involuntary weight loss, unexplained fever, growth deceleration, GI bleeding, dysphagia, persistent vomiting, and chronic diarrhea. Similarly, signs like localized tenderness, masses, organomegaly, arthritis, perianal disease, or elevated inflammatory markers point towards organic etiologies.
- When assessing chronic abdominal pain, a detailed history and physical examination are crucial. Initial investigations include a complete blood count, urine analysis, stool routine, and ESR/CRP. Further testing, such as fecal calprotectin, endoscopy, or imaging studies, should be considered based on specific clinical indications and suspected underlying organic conditions.
- Management of functional abdominal pain involves establishing a therapeutic alliance with the child and parents, reassurance, education about the gut-brain interaction, and pharmacological and non-pharmacological interventions. The location of the pain can also suggest certain potential etiologies. Epigastric pain is often associated with functional dyspepsia while peri-umbilical pain can be linked to functional abdominal pain NOS or abdominal migraine.
- Pharmacological treatments for functional abdominal pain target underlying mechanisms such as primary and secondary hyperalgesia. Options include neuromodulators like SSRIs and TCAs. Non-pharmacological approaches encompass lifestyle modifications, dietary changes, behavioral therapy, and complementary medicine like yoga.
- Functional constipation is often a contributing factor to functional abdominal pain. Management involves disimpaction, maintenance therapy with laxatives, and addressing underlying behavioral factors. Careful evaluation for fecal loading is essential, and treatment should be tailored to the severity of the constipation.
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About the Speakers
Dr. Pandu Chouhan
Consultant Pediatric Gastroenterology, KIMS Hospital, Hyderabad
Financial Disclosure
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