Pediatric Gastroenterology

Abdominal Pain in Pediatric Gastroenterology

Doctor talks to a little girl and her mom in the examination room.

One of the most common disorders in children is abdominal pain, and it requires urgent assessment and treatment. Despite its prevalence, it is the most confusing disorder, the predisposing factors are not well known, and the pathophysiological mechanisms are poorly understood. The common viewpoint in the pathogenesis implicates the interrelationship between changes in altered motility and hypersensitivity, which points out to several risk factors.

Chronic Abdominal Pain

This is a long-lasting intermittent or persistent abdominal pain of more than 14 days. This abdominal pain wanes and waxes for at least three incidents within three months. These episodes are characterized by indefinite pain that may be sharp or dull. The pain is periumbilical or poorly localized. It is severe enough to disrupt a child's daily activities such as school attendance, social activities, and participation in extracurricular activities.

Medical practitioner encounters this common pediatric problem in their day-to-day practice. Mostly, the pain is functional, that is, without concrete evidence of a pathologic disorder such as neoplastic disorder, inflammatory, metabolic, or anatomic condition.


The precise prevalence of chronic abdominal pain in children is anonymous. This condition affects approximately 0.3% to 19% of children globally. It has substantial financial and psychosocial costs. It is more prevalent in children aged 4-14 years. As children age, the prevalence decreases in boys, but not in girls.

The long-term effect of this disorder is not determined yet. Nevertheless, preliminary data indicates that children with chronic abdominal pain are more likely to have lifetime migraine headaches as well as psychiatric problems. The most important part of the pediatrician is to determine whether the child has an organic disorder.


One of the major causes of chronic abdominal pain is constipation. There is an association between obesity and recurrent abdominal pain. Parental anxiety in the first year of a child's life may lead to this malady. Other causes include:

  • Peptic ulcer disease
  • Sickle cell disease
  • Bezoar
  • Liver and gallbladder disease
  • Intestinal and stomach problems
  • Lactose intolerance
  • Urinary tract infection


Some of the symptoms include anorexia, joint pain, headache, nausea, vomiting, altered bowel symptoms, and excessive gas. Children suffering from chronic abdominal pain are often depressed or anxious. The presence of alarm symptoms may suggest a higher pretest possibility or prevalence of organic disease and therefore justifies the performance of diagnostic tests. Some of the alarm symptoms include proof of gastrointestinal blood loss, weight loss, significant vomiting, and continuous aching in the right upper or right lower quadrant, family history of inflammatory bowel malady, decelerated linear growth, hematemesis, and severe chronic diarrhea. Children with functional abdominal pain may have symptom clusters characterized as irritable bowel syndrome (IBS), abdominal migraine, aerophagia, functional dyspepsia, and functional abdominal pain.


Making a diagnosis of abdominal pain is a challenging task since it is unclear which further tests are necessary. The diagnostic approach to chronic abdominal pain depends on the history provided by the parent. The diagnosis has five components, that is, history, physical inspection, laboratory testing, imaging investigation, and response to empiric therapy. Apley's theory, which states that the longer the distance of the pain from the navel indicates a higher likelihood of organic disease, is quite true. A parent with a history of gastrointestinal problems is likely to have a child with recurrent abdominal pain.

It is vital to carry out further diagnostic tests such as comprehensive metabolic screening, inflammatory markers, stool analysis, and other laboratory tests. Extensive investigations are not very helpful. However, these basic tests are recommended;

  • Urinalysis and microscopy
  • FBC
  • ESR or CRP
  • Plain abdominal X-ray
  • Endoscopy
  • Abdominal ultrasound


Chronic abdominal pain cannot be dealt with in one day. It requires follow-up. A comprehensive plan of management depends on the diagnosis. A great part of management involves discussions, explanation, and above all, reassurance. There is no specific treatment for this disorder since none has been identified. Moreover, quality clinical trials for effective treatment are lacking, and this undermines evidence-based treatment.

Some of the Beneficial Treatments Include:

  • Cognitive-Behavioral Therapy and Hypnotherapy: may improve pain as well as disability consequences in the short-term. Nevertheless, most patients improve with time and reassurance. Family therapy is part of the CBT approach.
  • Medication: Should be administered to children with severe symptoms, which have not improved with simple management. Some of the medications are peppermint oil for IBS, H2- receptor antagonists for children depicting severe dyspeptic symptoms, antispasmodic agents, a small dosage of psychotropic agents to relieve pain, and pizotifen for those with an abdominal migraine.
  • Dietary Intervention: This may help to some extent. Nevertheless, there is no concrete evidence of its effectiveness. Taking fiber supplements and high fiber diets, lactobacillus or lactose-free diets, less caffeine, may be effective in the control of this disorder.
  • Social Environment Is Essential: Parents should be educated to raise the child normally and encourage the child to cope with pain. The school is also another vital social environment. When children with this disorder have been out of school for a long time, it is advisable to help the child resume classes.
  • Relaxation Techniques: Adolescents and older children with this disorder can learn some muscle relaxation techniques, which can ease the pain. Deep breathing exercises are the best example.

Children with recurrent abdominal pain pose extraordinary challenges to their parents and caregivers. The prevalent biopsychosocial model of chronic abdominal pain suggests that intervening to deal with biological factors, while offering coping skills as well as environmental support to inspire normal functioning, provides the maximum likelihood of optimistic treatment and reduced disability.