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This guideline covers chronic abdominal pain in children and young people.
95% of recurrent abdominal pain is functional and can be managed in primary care. There are many organic causes but all are rare. Inflammatory bowel disease (IBD) and coeliacs can be excluded in primary care by history, examination and basic investigations.
Colic in infants
Girl with pelvic pain
Clinical features of organic and functional causes of recurrent abdominal pain
Clinical features | Organic causes | Functional causes |
Site of pain | Anywhere but pain radiating to back (pancreatitis), loin pain (renal colic) or RUQ (biliary colic) | Usually central and sometimes epigastric. |
Family history | Often no family history. First degree relative with IBD or coeliac confers 5% and 10% lifetime risk respectively. | Family history of functional bowel disorders, anxiety or depression more likely. |
Psychological factors | Less likely. | Anxiety and depression more likely. |
Headache |
Less likely. | More likely. |
History |
Food bolus obstruction/dysphagia. Persistent vomiting, especially if bilious. Chronic severe diarrhoea, especially if colitic features (urgency with night time stooling or faecal incontinence). Unexplained fever. Gastrointestinal blood loss. | Alarm symptoms less likely. |
Abnormal signs |
Involuntary weight loss. Abnormal growth (height or weight crossing centile width). Clubbing, arthritis, perianal tags and anal fissures (Crohn's), focal abdominal tenderness or mass. | Absent. |
Investigations |
Raised platelets, low albumin, anaemia or raised CRP are best discriminators of IBD but can be normal. Faecal calprotectin has a good negative predictive value for IBD but has false positives. | If FBC, CRP and faecal calprotectin are all normal IBD is unlikely. False negative coeliac serology unlikely unless family history of coeliac or IgA deficiency. |
Abused children are prone to functional bowel disorders although abuse is rare in those with a functional bowel condition.
Adolescent girls; don't forget to ask about sexual activity and menstruation. Consider pregnancy test.
Tests are not always needed but if considering a blood test do all of the following in one go:
Abdominal Ultra Sound (US) is not routinely indicated but could be considered if:
H. Pylori does not cause functional abdominal pain. If dyspepsia despite PPI or relapses off PPI; referral for consideration of oesophago-gastroduodenoscopy (OGD) may be more appropriate than testing for H.Pylori stool antigen since most infections are asymptomatic.
Pre-choice Triage is currently active for this specialty.
Please include recent weight in referral letter if available.
Children already under care of paediatrician should be referred back to same paediatrician
e-Referral Service Selection
Recurrent Abdominal Pain in Children
Practical management of functional abdominal pain in children L K Brown, R M Beattie, M P Tighe. Archives Disease Childhood. 2016
Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Angela A Huertas-Ceballos, Stuart Logan, Cathy Bennett, Colin Macarthur Cochrane review. 2008
Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents. Angela Kaminski, Adrian Kamper, Kylie Thaler, Andrea Chapman, Gerald Gartlehner. Cochrane review. 2011.
This guideline has been signed off on behalf of NHS Devon.
Publication date: February 2017