BACKGROUND
Most chronic abdominal pain in children and adolescents is functional, lacking objective evidence for organic pathology. Approximately 15% of schoolchildren experience weekly episodes of abdominal pain and 8% consult a doctor.1
Diagnosing functional abdominal pain (FAP) in childhood is challenging because the condition lacks established diagnostic criteria. However, children are poorly served if as a result FAP becomes a diagnosis of exclusion.2 This article outlines an approach to assessing such children and provides suggestions on management. Making a positive diagnosis and agreeing a treatment plan relies on the art of practising medicine and GPs are best placed to adopt a holistic approach to such children.
HISTORY
Children usually describe the pain as periumbilical or else affecting multiple sites. Headaches are frequently associated with FAP. Nausea rarely has an organic basis in children and likely indicates functional symptoms. In contrast, vomiting, gastrointestinal bleeding, weight loss, or diarrhoea suggest an organic cause.
Pain on morning wakening, which improves in the afternoon and becomes severe again prior to bedtime suggests FAP. A hallmark of FAP is school absenteeism whereas children with organic diseases attend regularly. The children rarely remain in bed instead lying on the couch watching television. At night, pain may delay the onset of sleep but seldom awakens them. Parents may emphasise the severity …