Evaluation of abdominal pain in children

Overview 
Theory 
Emergencies 
Diagnosis 
Resources 

Last reviewed: 6 Aug 2025

Last updated: 12 Dec 2024

Pediatric abdominal pain is a common problem that often poses a diagnostic dilemma. The vast majority of episodes are benign and self-limiting, but persistent abdominal pain may signify an underlying pathology requiring urgent intervention. Acute abdominal pain can also be caused by a wide range of conditions, some of which are emergencies (e.g., acute appendicitis). Timely evaluation and intervention are critical in children presenting with abdominal pain.

A broad spectrum of etiologies can cause abdominal pain, and diagnosis can be challenging. In most cases, a thorough history and physical exam can narrow the differential diagnoses. Additional investigations may be required to confirm the diagnosis.

Furthermore, even with the assistance of parents or guardians, a comprehensive history is often difficult to obtain, and diagnosis therefore relies heavily on the clinical acumen of the practitioner.

Differentials

Common

Constipation
Acute appendicitis
Gastroenteritis
Urinary tract infection
Abdominal trauma (blunt or penetrating)
Cholelithiasis/cholecystitis
Primary dysmenorrhea
Pneumonia
Functional abdominal pain
Infantile colic

Full details

Uncommon

Intussusception
Meckel diverticulum
Mesenteric adenitis
Hirschsprung disease
Ulcerative colitis
Crohn disease
Small bowel obstruction
Volvulus
Large bowel obstruction
Necrotizing enterocolitis
Peptic ulcer disease
Celiac disease
Viral hepatitis
Biliary dyskinesia
Acute pancreatitis
Splenic infarction/cysts
Nephrolithiasis
Sepsis
Testicular torsion
Ovarian torsion
Ruptured ovarian cyst
Pelvic inflammatory disease (PID)
Pregnancy complications
Empyema

Full details

Contributors

Authors

Charles L. Snyder, MD

Professor of Surgery

University of Missouri

Kansas City Children's Mercy Hospital

Kansas City

Disclosures

CLS declares that he has no competing interests.

Jeong Hyun, MD

Assistant Professor of Surgery

Stanford University

Lucile Packard Children's Hospital

Stanford

Disclosures

JH has several research grants for translational work with Crohn disease for Stanford University.

Acknowledgements

Professor Charles L. Snyder and Dr Jeong Hyun would like to gratefully acknowledge Dr KuoJen Tsao, Dr Kathryn Tinsley Anderson, Dr Luke R. Putnam, Dr Shinil K. Shah, Dr Nathan D. Allison, and Dr Peter A. Walker, previous contributors to this topic.

Disclosures

KT, KTA, LRP, SKS, NDA, and PAW declare that they have no competing interests.

Peer reviewers

Kimberley Chien, MD

Associate Professor of Clinical Pediatrics

Weill Cornell Medicine

New York

Disclosures

KC declares that she has no competing interests.

Ann O. Scheimann, MD, MBA

Associate Professor of Pediatrics

Johns Hopkins School of Medicine

Baltimore

Disclosures

AOS declares that she has no competing interests.

Karla Au. Yeung, MD

Assistant Professor

Pediatric Gastroenterology and Nutrition

The Johns Hopkins Hospital

Baltimore

Disclosures

KAY declares that she has no competing interests.

Raymond G. Buick, MB BCh, BAO, FRCS (Edin), FRCS (Eng)

Consultant Paediatric Surgeon

Department of Paediatric Surgery

Birmingham Children's Hospital

Birmingham

Disclosures

RGB declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Di Lorenzo C, Colletti RB, Lehmann HP, et al; AAP Subcommittee, NASPGHAN Committee on Chronic Abdominal Pain. Chronic abdominal pain in children: a technical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005 Mar;40(3):249-61.Full text Abstract

Di Lorenzo C, Colletti RB, Lehmann HP, et al; American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain; NASPGHAN Committee on Abdominal Pain. Chronic abdominal pain in children: a clinical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005 Mar;40(3):245-8.Full text Abstract

Tabbers MM, DiLorenzo C, Berger MY, et al; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014 Feb;58(2):258-74.Full text Abstract

Diercks DB, Adkins EJ, Harrison N, et al. American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Approved by ACEP Board of Directors February 1, 2023. Ann Emerg Med. 2023 Jun;81(6):e115-52.Full text Abstract

Dahabreh IJ, Adam GP, Halladay CW, et al. Diagnosis of right lower quadrant pain and suspected acute appendicitis. Dec 2015 [internet publication].Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Evaluation of abdominal pain in children

Summary

Differentials

Common

Uncommon

Contributors

Authors

Charles L. Snyder, MD

Disclosures

Jeong Hyun, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Kimberley Chien, MD

Disclosures

Ann O. Scheimann, MD, MBA

Disclosures

Karla Au. Yeung, MD

Disclosures

Raymond G. Buick, MB BCh, BAO, FRCS (Edin), FRCS (Eng)

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Patient information

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice