Chronic abdominal pain in children: help in spotting the organic diagnosis
- 1Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
- 2Department of Paediatric Surgery, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
- Correspondence to Naomi Jane Wright, Paediatric Surgery Department, Great Ormond Street Hospital for Children, London WC1N 3JH, UK;
- Received 14 May 2012
- Revised 24 July 2012
- Accepted 4 October 2012
- Published Online First 10 November 2012
Aisha, a 9-year-old Asian girl, was referred to the paediatric outpatient clinic by her general practitioner (GP) with a 4 month history of episodic central abdominal pain. Each episode would last a few hours, affecting her about three times per week, usually during the day, but also occasionally at night. This was associated with infrequent, non-bilious vomits but did not appear to be related to diet. She was missing some days of school because of her symptoms. She said she liked school, did not like missing days away from her friends and denied any bullying. Between episodes she was a well and active girl. She had no history of diarrhoea or constipation, was growing well, had no urinary symptoms and had not reached menarche.
She was born at term via normal vaginal delivery and had no neonatal problems. She had no significant past medical history, was not on any medications and was fully immunised. There was no history of foreign travel and no family history of bowel problems.
General physical examination was unremarkable. Abdominal examination revealed no distension, organomegaly, palpable masses or herniae and no tenderness on the day of her clinic visit. She was on the 75th centile for weight, which was consistent with previously documented weights.
Based on this history Aisha fulfils the criteria for a diagnosis of chronic abdominal pain (CAP), which is commonly defined as three or more episodes of abdominal pain over at least 3 months duration that is severe enough to affect daily activities in a child over 3 years of age. She has typical history and examination findings of a patient with functional abdominal pain; the discomfort is localised around the peri-umbilical region, she is growing and developing normally, and there are no alarm symptoms or signs suggestive of underlying organic disease.
Alarm symptoms and signs …