10-15% of children definition: three or more episodes of pain severe enough to affect activities, occurring over a period of...
- 10-15% of children
- definition: three or more episodes of pain severe enough to affect
activities, occurring over a period of 3 months
Assessment
distinguish organic from non organic
History
- weight loss, appetite, energy
- associated vomiting, diarrhea
- characteristics of pain
- psychosocial issues
physical exam: abnormalities suggest organic nature
Red flags for organic etiology
- age < 5 years old
- fever
- pain away from midline
- anemia
- localized pain awakens child at night
- travel history
- prominent vomiting, diarrhea
- weight loss or failure to
- joint paingain weight
Organic (< 10%)
- chronic infection
- GI
- constipation - cause or effect?
- inflammatory bowel disease
- anatomic anomalies, masses
- esophagitis
- peptic ulcer disease, lactose intolerance
- pancreatic, hepatobiliary
- genitourinary disease
- gynecological
- cardiovascular
- neoplastic
Functional, Recurrent Abdominal Pain (RAP) (90%)
- school age, peak 8-10 years
- F > M
- vague, crampy periumbilical or epigastric pain, vivid imagery to
describe pain - should not awaken child
- no precipitating or relieving factors, no consistent pattern
- child appears well with normal growth
- associated with school absenteeism
Diagnosis
- must consider kidney disease, malrotation of bowel, IBD
- school phobia?
Investigations
- as indicated
- CBC, ESR, urinalysis, stools for O&P, C&S, occult blood
Treatment
- manage any emotional or family problems
- trial of high fibre diet, trial of lactose-free diet
- reassurance
