1. Abdominal Pain

• periumbilical, vague, and/or variable in location
• can be pronounced but is distractible and associated with abdominal muscle tenderness
• inconsistent precipitating factors (movement, meals), relieving factors, time of onset, duration
• episodes occur in clusters lasting weeks to months
• may be associated with altered stool form

1. Features suggesting an organic etiology:

• abdominal pain with eating
• abdominal mass or distension
• anemia, hematochezia, melena
• clubbing
• diarrhea (+/- bloody)
• dysuria
• failure to thrive
• fever
• nausea/vomiting
• nocturnal awakening
• perianal lesions
• weight loss
• the further the pain is from the umbilicus, the more likely the pain is organic

1. Serum

• CBC, electrolytes, BUN, creatinine, calcium, ESR, liver function tests

2. Urine

• urinalysis, C&S

3. Stool

• occult blood, C&S, O&P

4. Imaging Studies

• abdominal x-ray and/or ultrasound

1. Reassurance

• diagnosis based on a thorough history, physical, and screening laboratory tests
• a very common and benign disorder that is not life threatening and does not carry a risk of other diseases
• of those children presenting with abdominal pain, only 8-10% have an organic etiology
• precise cause unknown but may be related to stress, i.e., like a tension headache
• problem may persist for a prolonged period
• provide regular follow-up and support

2. Promote a Healthy Lifestyle

• balanced diet with bran
• regular exercise
• maintain school attendance

3. Psychotherapy

• or supportive counselling sessions for somatic and psychologic complaints and/or stress management