Description
Pediatric functional abdominal pain (FAP) is a common condition characterized by chronic, recurrent pain without identifiable organic cause. Management focuses on a biopsychosocial approach. Reassurance and education are essential to alleviate parental and patient anxiety. Dietary modifications, such as a low-FODMAP diet, can help in some cases. Pharmacological treatments, including antispasmodics or low-dose tricyclic antidepressants, may be used for severe cases. Psychological interventions, such as cognitive-behavioral therapy (CBT) and gut-directed hypnotherapy, address underlying stress and anxiety. Encouraging regular physical activity and maintaining a supportive environment are also key. Multidisciplinary care improves outcomes in complex or refractory cases.
Summary Listen
- Functional abdominal pain in children is a common condition, often chronic, and frequently classified by etiology: organic or functional. Organic causes are associated with underlying diseases and warning signs, while functional pain arises from multifactorial conditions without organic disease. A thorough medical history, physical examination, and appropriate initial investigations are crucial for diagnosis.
- Functional pain is characterized by dull, vague, and inconsistent pain, often periumbilical, that does not disturb sleep. Conversely, organic pain can wake a child, radiate to specific areas, and display increasing severity. Key warning signs for organic pain include onset before age five, involuntary weight loss, fever, joint pain, growth deceleration, and GI bleeding.
- Specific types of functional GI disorders include functional dyspepsia, abdominal migraine, IBS, and functional abdominal pain not otherwise specified. IBS is characterized by lower abdominal pain related to defecation, while functional dyspepsia presents upper abdominal pain. Characteristics vary, with abdominal migraine featuring acute, severe pain episodes potentially linked to migraines.
- Management of functional abdominal pain includes effective reassurance for parents and children, explanation of the gut-brain interaction, and various therapeutic approaches. Both pharmacological interventions and cognitive behavioral therapy, guided imagery, or hypnosis have a role. Addressing underlying functional constipation can also alleviate symptoms.
- An algorithm for managing functional GI disorders involves reassurance, lifestyle and food habit modifications, and discussing expectations. Pharmacological therapy is considered when lifestyle changes are insufficient, with options tailored to the specific symptom pattern. Non-pharmacological therapies, like psychological and behavioral therapy, play a crucial role.
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About the Speakers
Dr. Pandu Chouhan
Consultant Pediatric Gastroenterology, KIMS Hospital, Hyderabad
Financial Disclosure
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