Non-organic recurrent abdominal pain (RAP)
Recurrent viral illness (mesenteric adenitis)
Serious disorders not to be missed
recurrent urinary infection/ureteric reflux
parasitic infection of gut (e.g. pinworm, strongyloides, whipworm)
Inflammatory bowel disease (IBD)
Childhood migraine equivalent (periodic syndrome)
Food allergy (incl. lactose intolerance)
Temporal lobe epilepsy
Sickle cell disease
Is the patient trying to tell me something?
Highly likely as non-organic (functional) RAP is common. Consider anxiety and depression.
RAP, which is three distinct episodes of abdominal pain over 3 or more months, occurs in 10% of school-aged children. In only 5–10% will an organic cause be found. A very careful history includes the site, radiation, onset, duration and periodicity of the pain, and aggravating, relieving and associated factors. Ask if the pain wakes the child at night, interferes with activities and is associated with anorexia, vomiting, diarrhoea, dysuria or weight loss, or is related to food. Family history of abdominal pain, migraine, IBD or IBS. Enquire about social history, school difficulties, stressors and anxiety.
Avoid the trap of excessive investigations.
In approximately 90% of RAP patients referred to hospital no underlying cause is found, but take the problem seriously.
Talk to the child alone, if possible.
Organic disease is indicated by pain distant from the umbilicus and/or waking with pain at night, associated with vomiting, loss of appetite or weight, change in bowel habit, failure to thrive and inability to undertake normal activities.