The differential diagnoses for pediatric abdominal pain are broad and encompass almost every organ system. In addition, distinguishing acute from chronic abdominal pain may be particularly difficult in children. Although the most common etiologies are not immediately life threatening, the ability to diagnose urgent pathology remains paramount. A thorough history and physical exam, and an understanding of the more common diseases affecting the child's age group, are essential.


Gastrointestinal (GI) sources are the most common etiology of abdominal pain in children, encompassing infectious, congenital, functional, and mechanical causes.


  • A common condition, with a reported pooled prevalence of 9.5%.[1]

  • Childhood constipation is typically characterized by infrequent bowel evacuations, large stools, and difficult or painful defecation.[2]

  • Symptoms usually result from low-fiber, poor-nutrient intake, and too little water, which leads to high levels of colonic reabsorption of water and hardening of the stool. Additional risk factors include genetic predisposition, infection, stress, obesity, low birth weight, cerebral palsy, spina bifida, and learning difficulties.

  • Constipation starts as an acute problem but can progress to fecal impaction and chronic constipation.

  • It tends to develop during three stages of childhood: weaning (infants), toilet training (toddlers), starting school (older children).


  • Develops when the appendiceal lumen becomes obstructed by stool, barium, food, or parasites.

  • Can occur in all age groups, but is rare in infants. A cohort study in Sweden found that 2.5% of children had had appendicitis by age 18 years.[3]

  • If left untreated, acute appendicitis progresses to ischemia, necrosis, and eventually perforation. The overall rate of perforation is about 30%.[4] Risk of perforation increases if appendectomy is delayed.[5]com.bmj.content.model.assessment.Caption@668bda29[Figure caption and citation for the preceding image starts]: Necrotic appendixFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].com.bmj.content.model.assessment.Caption@2183fb58[Figure caption and citation for the preceding image starts]: CT scan demonstrating fecalith (white arrow) outside the lumen of the appendix consistent with perforated appendixFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].


  • May be due to acute or chronic viral infection (especially rotavirus), or bacterial or parasitic infection.

  • Causes vague, cramping abdominal pain in association with fever, vomiting, and diarrhea.

  • Eosinophilic gastroenteritis, defined as a condition affecting the GI tract with eosinophil-rich inflammation without a known cause for the eosinophilia, can result in significant abdominal pain.[6]

  • Hemolytic uremic syndrome, characterized by microangiopathic hemolytic anemia, thrombocytopenia, and nephropathy, can occur as a complication of gastroenteritis caused by verotoxin-producing Escherichia coli. Abdominal pain is a common presenting symptom.[7]


  • Occurs when a proximal segment of the intestine telescopes into the lumen of an immediately distal segment. In most cases, the intussusception is in the ileocecal area. com.bmj.content.model.assessment.Caption@31630168[Figure caption and citation for the preceding image starts]: Intussusception: blood vessels become trapped between layers of intestine, leading to reduced blood supply, edema, strangulation of bowel, and gangrene. Sepsis, shock, and death may eventually occurCreated by the BMJ Knowledge Centre [Citation ends].

  • Usually occurs in infants between 3 and 12 months of age. Peak incidence is 5 to 7 months of age.[8]

  • Intussusception should be suspected in an infant in this age group presenting with colicky abdominal pain, flexing of the legs, fever, lethargy, and vomiting.

  • In infants <2 years of age, episodes of intussusception are most likely caused by mesenteric lymphadenopathy secondary to an associated illness (e.g., viral gastroenteritis). In older children, mesenteric lymphadenopathy is still the most likely cause, but other etiologies should be considered (e.g., intestinal lymphomas, Meckel diverticulum). Therefore, children ≥6 years or with jejunojejunal or ileoileal intussusception should be evaluated for a malignant lead point.

  • Ileoileal intussusception may also be indicative of Henoch-Schonlein purpura (HSP). HSP is a vasculitis that affects small veins and primarily occurs in children <11 years of age.

Meckel diverticulum

  • A finger-like projection located in the distal ileum arising from the antimesenteric border; usually 40 to 60 cm from the ileocecal valve, measuring 1 to 10 cm long and 2 cm wide. com.bmj.content.model.assessment.Caption@12e317db[Figure caption and citation for the preceding image starts]: Intraoperative photo of Meckel diverticulumFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].

  • The majority of symptomatic patients present before the age of 2 years.

  • The prevalence is estimated to be up to 3%.[9]

  • Intestinal obstruction is a known complication and may be observed in as many as 40% of all symptomatic Meckel diverticula (according to some series).[10][11]

Mesenteric adenitis

  • Refers to inflammation of the mesenteric lymph nodes. This process may be acute or chronic.

  • It is often mistaken for other diagnoses, such as appendicitis; up to 23% of patients undergoing negative appendectomy have been found to have nonspecific mesenteric adenitis.[12]

  • One retrospective study reported that, compared with children who have appendicitis, patients who have mesenteric adenitis are more likely to have high fever (above 102.2°F [39°C]) and dysuria, and are less likely to have migratory pain, vomiting, or typical abdominal signs of appendicitis on examination.[13]

Hirschsprung disease

  • Most commonly diagnosed in the first year of life, but can present later in childhood; slightly higher male preponderance.

  • Congenital condition characterized by partial or complete colonic obstruction associated with the absence of intramural ganglion cells. Because of the aganglionosis, the lumen is tonically contracted, causing a functional obstruction. The aganglionic portion of the colon is always located distally, but the length of the segment varies. com.bmj.content.model.assessment.Caption@2a81cd3c[Figure caption and citation for the preceding image starts]: Abdominal x-ray of a neonate with abnormal stooling pattern and constipation. The dilated transverse and descending colon is suggestive of Hirschsprung diseaseFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].

  • May be associated with Down syndrome and multiple endocrine neoplasia type IIA.

Intestinal obstruction

  • Small or large bowel obstruction may be the result of various etiologies and can occur at any age. Abdominal pain may not occur until the obstruction has progressed to include extensive abdominal distension or intestinal ischemia. Intestinal obstruction may mimic intestinal ileus, which usually does not require surgical intervention.

  • The etiology of intestinal obstruction can be congenital or acquired. Congenital causes include atresias or stenosis, which present in the newborn period. Acquired causes include small bowel adhesions, strangulated or incarcerated hernias, and tumors.

  • Congenital causes:

    • Duodenal atresia or stenosis may cause complete or partial obstruction of the duodenum as a result of failed recanalization during development. This results in either stenosis with incomplete obstruction of the duodenal lumen (allowing some but not all gas and liquid to pass) or an atresia where the duodenum ends blindly causing a true complete obstruction.

    • Jejunoileal atresia or stenosis is a complete or partial obstruction of any part of the jejunum or ileum. Although uncertain, it is believed to result from a vascular accident during development. Jejunal stenosis may still have bowel lumen continuity with a narrowed lumen and thickened muscular layer. There are four types of atretic bowel, and all result in a complete obstruction due to a blind-ending lumen.

    • Hernias may be internal or external and congenital or acquired.

    • Colonic atresia is an extremely rare complete obstruction of any part of the colon, although it usually occurs near the splenic flexure. Like jejunoileal atresia, it is thought to occur as a result of a vascular[Figure caption and citation for the preceding image starts]: Abdominal x-ray demonstrating double bubble gas pattern consistent with duodenal atresiaFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].

    • Meconium ileus is an important cause of intestinal obstruction in the neonatal period; cystic fibrosis should be suspected as an associated disease. There may also be associated pancreatic abnormalities.

    • Duplication cysts occur most commonly in the small intestine; they may serve as a lead point for volvulus and intussusception and can also result in obstruction. With duodenal duplication cysts, peptic ulcer disease, hemorrhage, or perforation may result secondary to ectopic gastric mucosa.

  • Acquired causes:

    • May occur at any age.

    • Tumors may be intraluminal or extra-intestinal.

    • Hernias may be internal or external and congenital or acquired. com.bmj.content.model.assessment.Caption@3da791aa[Figure caption and citation for the preceding image starts]: Infant with right groin bulge consistent with incarcerated inguinal hernia. The lack of overlying skin edema and erythema does not rule out strangulation of the small intestineFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].

    • A history of previous intra-abdominal surgery or inflammation (such as necrotizing enterocolitis) should prompt concern for adhesive small bowel obstruction.

    • Omental cysts, although rare, can present with intestinal obstruction; may be confused with ovarian cysts on ultrasound.

    • In patients with cystic fibrosis, partial bowel obstruction may sometimes be referred to as distal intestinal obstruction syndrome (DIOS) or meconium ileus-equivalent syndrome. This entity is not related to meconium. This refers to a distal small bowel obstruction caused by impacted bowel contents; it typically occurs in adolescents and adults with cystic fibrosis.


  • This can occur in any age group, but is most common in children <1 year old; at least 60% of children present before 1 month of age.[14] Midgut volvulus is the most common type. Sigmoid volvulus can also occur.

  • Green (bilious) vomiting is a cardinal symptom of duodenal obstruction secondary to midgut volvulus.[14]

  • Intestinal malrotation is a term used to encompass the entire spectrum of anatomic arrangements that result from incomplete rotation of the gut during embryonic development. Volvulus of the entire small bowel and part of the colon is only possible when malrotation exists.

  • In malrotation, the most significant pathologic concerns are a lack of gut fixation to the retroperitoneum and narrow midgut mesenteric base that predisposes patients to midgut volvulus, which occurs when the duodenum or colon twist around this mesenteric base.

Necrotizing enterocolitis

  • A disease primarily of premature infants, particularly those weighing less than 1500 g. The pathogenesis is multifactorial and not well understood, although ischemia, reperfusion injury, and infectious pathogens may play a role.

  • Typical symptoms are feed intolerance, abdominal distension, and bloody diarrhea at 8 to 10 days of age.[15] Other signs and symptoms include apnea, lethargy, abdominal tenderness, abdominal wall erythema, and bradycardia.

Peptic ulcer disease

  • Gastric and duodenal ulcers are uncommon among the pediatric population.[16] When they occur, they are classified as primary or secondary peptic ulcers.

  • Primary ulcers occur without predisposing factors and are most commonly located in the duodenum or pyloric channel. They manifest most often in older children and adolescents with a positive family history. Rarely, primary peptic ulcers can occur in the first month of life, presenting with bleeding and possible perforation. Most are located in the stomach. Primary ulcers may be associated with Helicobacter pylori.

  • Secondary ulcers are usually associated with stress, burns, trauma, infection, neonatal hypoxia, chronic illness, and ulcerogenic medications or lifestyle habits (e.g., NSAIDs, salicylates, corticosteroids, smoking, intake of caffeine, nicotine, or alcohol). It is important to treat the predisposing condition. Exacerbations and remissions can last for weeks to months.

Inflammatory bowel disease

  • This category includes ulcerative colitis and Crohn disease.

  • Ulcerative colitis affects the rectum and extends proximally, and is characterized by diffuse inflammation of the colonic mucosa and a relapsing, remitting course. Ulcerative colitis is uncommon in people younger than 10 years old.

  • Crohn disease may involve any or all parts of the entire GI tract from mouth to perianal area. Unlike ulcerative colitis, Crohn disease is characterized by skip lesions. The transmural inflammation often leads to fibrosis, causing intestinal obstruction. The inflammation can also result in sinus tracts that burrow through and penetrate the serosa, thereafter giving rise to perforations and fistulas. The peak age of onset is between 15 and 40 years.

  • Ulcerative colitis often presents with bloody diarrhea, whereas this is an unusual presentation in Crohn disease. Both conditions cause cramping abdominal pain, anorexia, and weight loss when they present late in the course of the disease. Depending on the intestinal location of Crohn disease, it may mimic other disease processes such as acute appendicitis.

Celiac disease

  • Systemic autoimmune disease triggered by dietary gluten peptides found in wheat, rye, barley, and related grains.

  • Immune activation in the small intestine leads to villous atrophy, hypertrophy of the intestinal crypts, and increased numbers of lymphocytes in the epithelium and lamina propria. Locally these changes lead to GI symptoms and malabsorption.

  • Celiac disease is a common disorder in the US and in Europe. A relatively uniform prevalence has been found in many countries, with pooled global seroprevalence and biopsy-confirmed prevalence of 1.4% and 0.7%, respectively.[17]

  • Patients may present with recurrent abdominal pain, cramping, or distension.[18] Other common symptoms include bloating and diarrhea. Dermatitis herpetiformis, an intensely pruritic papulovesicular rash that affects the extensor limb surfaces, almost universally occurs in association with celiac disease.


  • Cholelithiasis describes the entity of stones in the gallbladder (usually asymptomatic or an incidental finding). Biliary colic refers to the classic description of intermittent, recurrent right upper quadrant (RUQ) pain that resolves without intervention. This is usually caused by intermittent obstruction of the cystic duct due to cholelithiasis and contraction of a distended[Figure caption and citation for the preceding image starts]: Gallbladder ultrasound demonstrating cholelithiasis with characteristic shadowingFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].com.bmj.content.model.assessment.Caption@133cd7f5[Figure caption and citation for the preceding image starts]: Abdominal x-ray with opacities in the RUQ consistent with gallstonesFrom the collection of Dr Kuojen Tsao; used with permission [Citation ends].

  • Cholecystitis refers to inflammation of the gallbladder precipitated by obstruction of bile through the cystic duct. Symptoms do not usually resolve spontaneously, and there are specific findings on diagnostic imaging. Cholecystitis may be acalculous (without stones) or calculous (with stones). Choledocholithiasis is the term describing a gallstone(s) in the common bile duct.

Biliary dyskinesia

  • Characterized by symptoms of biliary colic (intermittent, recurrent RUQ pain that resolves without intervention) in the absence of documented stones in the gallbladder; the diagnosis should be considered in those with symptoms suggestive of biliary colic but with negative laboratory tests and ultrasound in their workup for symptomatic cholelithiasis.

  • Caused by abnormal or altered contraction of the gallbladder resulting in biliary colic. Patients frequently have gone through a comprehensive workup prior to being diagnosed with this entity; increasing recognition and testing for the disease has led to more frequent diagnosis in children.

Viral hepatitis

  • The viral hepatitides include A, B, C, D, and E.

  • Hepatitis A virus remains a significant etiology of acute viral hepatitis and jaundice, particularly in developing countries, in travelers to those countries, and in sporadic food-borne outbreaks in developed countries.

  • Hepatitis B virus (HBV) frequently causes acute hepatitis and is the most common cause of chronic hepatitis in Africa and the Far East.

  • Hepatitis C virus (HCV) represents the leading cause of chronic viral hepatitis in developed countries.

  • Hepatitis D virus is a defective virus that needs the presence of hepatitis B to cause clinically recognizable disease.

  • Hepatitis E virus represents a major cause of mortality in developing countries, especially among pregnant females.

Acute pancreatitis

  • Refers to inflammation of the pancreas; it does not necessarily imply that infection is present.

  • Pancreatitis in children is often due to drugs, infection, anatomic abnormalities, or trauma.[19] Corticosteroids, adrenocorticotropic hormones, estrogens including contraceptives, azathioprine, asparaginase, tetracycline, chlorothiazides, and valproic acid may induce pancreatitis. Congenital causes include choledochal cyst causing abnormal pancreas and bile drainage and pancreas divisum. Infectious causes include mumps and infectious mononucleosis.

  • Excessive alcohol and gallstones are the most common causes of pancreatitis in adults; these causes are relatively less common in children, although they may still occur. Pediatric pancreatitis is rare, but the growing population of children with gallstones will likely increase future[Figure caption and citation for the preceding image starts]: CT scan of teenage girl presenting with mid-epigastric abdominal pain as a result of gallstone pancreatitis. The large fluid collection in the pancreatic bed (white arrow) and lack of pancreatic enhancement suggest liquefactive necrosis of the pancreasFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].

Splenic infarction and cysts

  • Cysts are classified as either primary or secondary (acquired). Primary cysts are usually congenital and have a true epithelial lining. Eighty percent of splenic cysts are pseudocysts related to infection, infarction, or trauma.[20] Most cysts are incidental diagnoses, although some patients may present with dull, left-sided abdominal pain. In pediatric patients, the most common splenic masses are congenital and/or acquired cysts.[21]com.bmj.content.model.assessment.Caption@33004c61[Figure caption and citation for the preceding image starts]: CT scan demonstrating fluid-filled cyst within the spleenFrom the collection of Dr Kuojen Tsao; used with permission [Citation ends].com.bmj.content.model.assessment.Caption@467de4f[Figure caption and citation for the preceding image starts]: Intraoperative photo of large splenic cystFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].

  • Splenic infarction occurs when there is occlusion of the splenic blood supply. It may affect the whole organ or only a portion of the spleen, depending on the blood vessels involved. The incidence of splenic infarction is difficult to assess.

Abdominal trauma

  • A multicenter prospective study found that abdominal trauma accounted for 3% of admissions to pediatric trauma units.[22]

  • Generally classified as penetrating or blunt. Occult blunt abdominal trauma should always be considered in the setting of vague or inconsistent history. The liver, spleen, and kidneys are the most commonly injured intra-abdominal organs in blunt trauma. Most cases of blunt injury to the liver and spleen are managed nonoperatively.

  • It is important to exclude duodenal and/or pancreatic injuries with bicycle handlebar injuries and/or direct blows to the abdomen. Hollow viscus injuries (e.g., stomach and intestines) are more common with penetrating trauma.

  • It is essential to consider child abuse/nonaccidental trauma in this patient population (e.g., a kick to the abdomen).


Urinary tract infection (UTI)

  • Infection may arise along any part of the urinary tract including the urethra, bladder, ureter, and kidney. Diagnosis and treatment is paramount to prevent potential long-term side effects, including renal or urinary tract scarring and hypertension.

  • Estimates of the true incidence of UTI depend on rates of diagnosis and investigation. UTI is more common in girls. UTIs affect approximately 4% and 10% of children by ages 1 year and 6 years, respectively.[23]

  • Bacterial infections are the most common cause, particularly Escherichia coli infection.

Primary dysmenorrhea

  • Dysmenorrhea, or painful menstruation, is one of the most common gynecologic conditions affecting females of reproductive age.[24]

  • Primary dysmenorrhea is characterized by menstrual pain in the absence of pelvic pathology.


  • Refers to stones that may be located anywhere in the genitourinary tract; the majority of stones are noted in the kidneys, followed by the bladder and ureter.

  • Most patients have a predisposing factor, such as a family history of nephrolithiasis, high-risk diet (e.g., high oxalate intake), or chronic disease (e.g., renal tubular acidosis).

  • Stones less than 5 mm in diameter will generally pass spontaneously.

Testicular torsion

  • A urologic emergency caused by the twisting of the testicle on the spermatic cord, leading to constriction of the vascular supply and time-sensitive ischemia and/or necrosis of testicular tissue.[25]com.bmj.content.model.assessment.Caption@71913249[Figure caption and citation for the preceding image starts]: Young boy with right testicular pain. The testicle is swollen, tender, and erythematous as a result of torsion of the appendix testes. The clinical signs and symptoms mimic those of testicular torsionFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].com.bmj.content.model.assessment.Caption@1e5f446d[Figure caption and citation for the preceding image starts]: Infant boy with swollen, tender, and erythematous left testicle. The testicle is retracted consistent with testicular torsionFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].com.bmj.content.model.assessment.Caption@2f0d6083[Figure caption and citation for the preceding image starts]: Torsion of an appendix testis resulting in acute infarctionFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].

  • Has a bimodal distribution, with extravaginal torsion affecting neonates in the perinatal period, and intravaginal torsion affecting males of any age but most commonly adolescent boys.[25]

  • Pain from torsion of a testicular appendage may develop more gradually (over days to weeks) and frequently is pinpoint (superior pole of testes). In addition, systemic symptoms such as nausea and vomiting are not usually present.

Ruptured ovarian cyst

  • Ovarian cyst rupture is rare and may occur in conjunction with torsion.

  • Symptoms usually occur prior to the expected time of ovulation and may mimic ruptured ectopic pregnancy. Pain arises from local peritonitis secondary to hemorrhage.[26][27][28]

Ovarian torsion

  • Although it can affect females of any age it most commonly occurs in the early reproductive years.[29]

  • In children, torsion of the ovary is often associated with the presence of an ovarian tumor, most commonly a teratoma.

  • Twisting or torsion of the ovary compromises the arterial inflow and venous outflow, producing ischemia, which, if not relieved promptly, can affect the viability of the ovary. com.bmj.content.model.assessment.Caption@1522568b[Figure caption and citation for the preceding image starts]: Intraoperative photo of ovarian mass that presented as ovarian torsionFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].com.bmj.content.model.assessment.Caption@6d593d1c[Figure caption and citation for the preceding image starts]: CT scan of a young girl presenting with ovarian torsion. The large pelvic cystic lesion contains calcifications (white arrow) consistent with a teratoma or dermoid cystFrom the collection of Dr KuoJen Tsao; used with permission [Citation ends].

Pelvic inflammatory disease (PID)

  • Represents a spectrum of upper genital tract infections that includes any combination of endometritis, salpingitis, pyosalpinx, tubo-ovarian abscess, and pelvic peritonitis; usually caused by Neisseria gonorrhoeae or Chlamydia trachomatis and less commonly by normal vaginal flora including streptococci, anaerobes, and enteric gram-negative rods.

  • Adolescents are at higher risk of developing PID compared with older women.[30] Sexually transmitted infections are a key risk factor.

  • PID in a young child should prompt workup for possible sexual abuse, as it is extremely rare for PID to occur in the absence of sexual activity.

Pregnancy complications

  • Miscarriage and ectopic pregnancy should be a concern in any female of reproductive age presenting with lower abdominal pain, amenorrhea, and vaginal bleeding.

  • Miscarriage is defined as an involuntary, spontaneous loss of a pregnancy before 22 completed weeks.[31] The majority of spontaneous miscarriages occur in the first trimester.[32]

  • Ectopic pregnancy occurs when a fertilized ovum implants and matures outside the uterine endometrial cavity, with the most common sites being the fallopian tube (97%), the ovary (3.2%), and the abdomen (1.3%).[33] Use of oral contraceptives before age 16 years is associated with increased risk of ectopic pregnancy.[34] The classic presentation includes lower abdominal pain, amenorrhea, and vaginal bleeding. Hemorrhage from a ruptured ectopic pregnancy can be fatal.


Primary respiratory illnesses such as pneumonia or empyema may present as abdominal pain in the pediatric population. Recurrent pneumonia in children is usually the result of a particular susceptibility, such as disorders of immunity and leukocyte function, ciliary function, anatomic abnormalities, or specific genetic disorders such as cystic fibrosis.[35]

Functional abdominal pain

Functional abdominal pain is also referred to as nonspecific abdominal pain; pain is usually chronic or recurrent. Visceral hyperalgesia is the final outcome of sensitizing medical and psychosocial events, on a background of genetic predisposition.[36] Functional abdominal pain disorders are classified according to Rome IV criteria, which describe functional dyspepsia, irritable bowel syndrome, abdominal migraine, and functional abdominal pain - not otherwise specified.[36][37]

  • Typically affects children between 5 and 14 years of age.

  • Prevalence estimates vary from 10% to 30% in samples of school students, to 87% in some gastroenterology clinics.[38]

  • Family history of functional disorder common (irritable bowel syndrome, mental illness, migraine, anxiety).

  • Clarifying the type of functional disorder is important to determine which treatments are most likely to improve symptoms.

Functional dyspepsia

  • Defined as one or more of the following bothersome symptoms on at least 4 days per month: postprandial fullness, early satiation, epigastric pain, or burning not associated with defecation. After appropriate evaluation the symptoms cannot be fully explained by another medical condition.[36]

Irritable bowel syndrome

Three criteria must be fulfilled for 2 months prior to diagnosis:[36]

  1. Abdominal pain at least 4 days per month associated with one or more of:

    1. Related to defecation

    2. Change in stool frequency

    3. Change in stool form.

  2. In children with constipation, the pain does not resolve with resolution of constipation.

  3. After appropriate evaluation the symptoms cannot be fully explained by another medical condition.

Abdominal migraine

All of the following criteria must be fulfilled for at least 6 months prior to diagnosis and on at least two occasions:[36]

  1. Paroxysmal episodes of intense, acute periumbilical, midline, or diffuse abdominal pain lasting at least 1 hour. The abdominal pain must be the most severe and distressing symptom.

  2. Episodes separated by weeks or months.

  3. Pain is incapacitating and interferes with normal activities.

  4. Stereotypical pattern and symptoms in the individual.

  5. Pain associated with 2 or more of:

    1. Anorexia

    2. Nausea

    3. Vomiting

    4. Headache

    5. Photophobia

    6. Pallor.

  6. After appropriate evaluation the symptoms cannot be fully explained by another medical condition.

Functional abdominal pain - not otherwise specified

Three diagnostic criteria must be fulfilled at least four times per month, for 2 months prior to diagnosis:[36]

  1. Episodic or continuous abdominal pain that does not occur solely during physiologic events (e.g., eating, menstruation)

  2. Insufficient criteria for irritable bowel syndrome, functional dyspepsia, or abdominal migraine diagnosis

  3. After appropriate evaluation the symptoms cannot be fully explained by another medical condition.

Alarm features in children with chronic abdominal pain, which may indicate an organic or motility-related rather than a functional cause, include:[36]

  • Family history of inflammatory bowel disease, celiac disease, or peptic ulcer disease

  • Persistent right upper or right lower quadrant pain

  • Dysphagia

  • Odynophagia

  • Persistent vomiting

  • Gastrointestinal bleeding

  • Nocturnal diarrhea

  • Arthritis

  • Perirectal disease

  • Involuntary weight loss

  • Deceleration of linear growth

  • Delayed puberty

  • Unexplained fever.

Use of this content is subject to our disclaimer