Clinical Review

Chronic abdominal pain in children

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39189.465718.BE (Published 10 May 2007) Cite this as: BMJ 2007;334:997
  1. M Y Berger, general practitioner1,
  2. M J Gieteling, trainee general practitioner1,
  3. M A Benninga, paediatric gastroenterologist2
  1. 1Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, Netherlands
  2. 2Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
  1. Correspondence to: M Y Berger m.berger{at}erasmusmc.nl

    Chronic abdominal pain is a common disorder in children and adolescents worldwide. It affects the child's wellbeing, and the costs from missed school days and use of healthcare resources are high.

    Children with chronic abdominal pain represent a heterogeneous population comprising both organic and functional gastrointestinal disorders. Functional disorders are those that cannot be explained by structural or biochemical abnormalities. Differences in prevalence of organic disease are reported depending on the setting, ranging from 5% in the general population to 40% in a paediatric gastroenterologist practice.1 General practitioners feel confident in labelling chronic abdominal pain as an easy to manage functional disorder. After minimal further testing, these children and their parents can be reassured by explaining that the symptoms are common and rarely associated with disease. However, when diagnostic uncertainty increases, pain does not resolve over time, or parents are hard to reassure, extensive testing and referral easily set in. As a consequence paediatricians perceive chronic abdominal pain as a time consuming and therapy resistant disorder.

    SUMMARY POINTS

    • Chronic abdominal pain in children is not usually caused by organic disease

    • Diagnostic triage focuses on the assessment of alarm symptoms by means of history and physical examination

    • Additional diagnostic evaluation is not required in children without alarm symptoms

    • Family characteristics rather than patient characteristics influence the chronicity of abdominal pain

    • A specific intervention cannot be recommended owing to lack of evidence of a beneficial effect

    • The challenge is to identify children at risk of a prolonged course of pain and its correlated functional disability

    Sources and selection criteria

    We used the Cochrane library to identify relevant systematic reviews that evaluated the effectiveness of pharmaceutical, psychological, and complementary interventions for chronic abdominal pain in children.

    Medline searches were used to find relevant systematic reviews on diagnosis and treatment of abdominal pain in children using the keywords “abdominal …

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