Recurrent abdominal pain (RAP), three distinct episodes of abdominal pain over 3 or more months, occurs in 10% of school-aged children. In only 5-10% of children will an organic cause be found so that in most the cause remains obscure. 8
An organic cause, however, must be considered and excluded. Organic disease is more likely if:
• the pain is other than periumbilical
• the pain radiates rather than remains localised
• the pain wakens the child from sleep
• the pain is accompanied by vomiting
• the child is not completely well between attacks
• there is associated weight loss
• there is failure to thrive
• childhood migraine equivalent (pain with extreme pallor)
• lactose intolerance (symptoms related to milk ingestion)
• intestinal parasites (may disturb child about 60 minutes after falling asleep)
• stool microscopy and culture
• urine analysis
• full blood count and ESR
Non-organic RAP Typical clinical features:
• acute and frequent colicky abdominal pain
• pain localised to or just above umbilicus
• no radiation of pain
• pain lasts less than 60 minutes
• nausea frequent and vomiting rare
• diurnal (never wakes the child at night)
• minimal umbilical tenderness
• anxious child
• obsessive or perfectionist personality
• one or both parents intense about child's health and progress
Although psychogenic factors are very relevant in individual cases there is scant hard evidence to support the widely held hypothesis 8 that such factors account for the vast majority of RAP. Some children will have obvious psychological problems or even be school avoidant, a common factor being family disruption.
• Give explanation, reassurance and support.
• Reassurance can only be given following a careful examination and thoughtfully chosen investigations.
• Emphasise that the disorder is common, and usually traverses childhood without ill effects.
• Identify any life stresses and provide insight therapy.
• Enquire about family structures and function, and school performance.
• Discourage identification with the sick role.
• Refer for psychological assessment and counselling if necessary.
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