Abdominal pain in children

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Synonyms and keywords: Abdominal pain in kids

Overview

Abdominal pain is a common presenting symptom in pediatrics primary care. Most of times it's due to benign causes without risk for complications, but severe abdominal pain maybe an alarming sign for abdominal pathology that requires surgical intervention.

Historical Perspective

• [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
• In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
• In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

• Abdominal pain in children may be classified according to age into two groups:
  • Abdominal pain in children below five years old.
    
  • Abdominal pain in children above five years old.
    
• Other method for classification of abdominal pain can be according to the duration of the pain:
  • Acute Abdominal pain(less than 1 week).
  • Chronic Abdominal pain(more than 1 week).

Pathophysiology

• The pathogenesis of abdominal pain is related to either insult to intra-abdominal structures or extra-abdominal structure. Also it can be due to injury to somatic structures that's overlay the abdominal wall .
• On Summary the pathophysiology of abdominal pain maybe due to :
  • Visceral Pain:
    • Result when there's a damage to nerve within the abdomen.
    • Due to the fact that visceral nerves fibers that responsible for pain sensation are non-myelinated, the visceral pain is Vague, dull, poorly localized and slow on onset.
    • Different types of stimuli including chemical, osmotic and even normal peristalses can stimulate these fibers.
    • Visceral pain is always sensed when the threshold of intensity or duration is reached.
    • Mild stimuli may result in sensing non-painful or vaguely un-comfortable sensation, in contrast to powerful stimulation to visceral nerve fibers which causes pain.
    • Example for pain caused due to over-sensation of visceral nerve fibers is functional abdominal pain.
  • Somatic Pain:
    • Due to insult to somatic structures(parietal peritoneum, fascia, muscles, and skin of the abdominal wall)..
    • Somatic nerves fibres are myelinated that can rapidly transmit well localized painful stimuli.
    • Visceral pain can progress to somatic pain when the insult from intra-abdominal structures progress to affect the somatic structures(for example parietal peritoneum)as happens in acute appendicitis which start as visceral pain after that it progress to somatic pain..
  • Referred Pain:
    • Pain sensation that referred from other site on the body..
    • This occur due to stimulation of spinal cord somatic sensory cell bodies which activated by stimuli from visceral afferent fibers, which located on the same level on the spinal cord).

Causes

There is a wide range of causes for pediatric abdominal pain which maybe due to a disease in variety of systems. In general, differentiating between acute and chronic pain in children is not easy, Despite it's being benign conditions in most children presenting with abdominal pain but some serious conditions may be the cause of the abdominal pain. On the table below there's some systems and related diseases that can cause abdominal pain in children:

Causes of Abdominal pain In Children

System	Disesease
Gastrointestinal	Appendicitis, Gastrointestinal reflux disease, constipation ,irritable bowel syndrome, celiac disease ,Meckel's divreticulum, Intussusception, Volvulus.functional dyspepsia (FD), abdominal migraine (AM), functional abdominal pain (FAP) and functional abdominal pain syndrome (FAPS)
Genitourinary	Nephrolithiasis , urinary tract infection.
Infections	viral (mesenteric adenitis), gastroenteritits,Multisystem Inflammatory Syndrome in Children (MIS-C) caused by covid-19
Gynecologic	Dysmenorrhea.
Psychology	Anxiety
Others	Toxins (lead poising) , Sickle cell disease.

Differentiating [disease name] from other Diseases

For further information about the differential diagnosis, click here.

Epidemiology and Demographics

• The pooled prevalence of abdominal pain in children is approximately 13.5% per 196,472 individuals worldwide.
• In 2001,the incidence of nonspecific abdominal pain was estimated to be 25% cases per 1,000 individuals in Netherland.

Age

• Age can help in differentiating causes of abdominal pain::
  • Neonates and infants:
    • Most common presentation in this age group is due to congenital anomalies and prematurity. For example Necrotizing enterocolitis and Meckel's diverticulum, Hirschsprung's disease, volvulus, stenosis or congenial atresia causing intestinal obstruction. Also intussusception can cause abdominal pain in this age group.
  • School-age children:
    • Most common causes of abdominal pain in this age group are idiopathic constipation and infectious causes. other causes may include Functional abdominal pain and abdominal migraine.
  • Adolescents:
    • In female adolescents causes related to menstruation, ovarian torsion and pregnancy might be the underlying cause of the pain.
    • In male adolescents testicular torsion should be considered.
    • Other causes to consider in both genders that's cause abdominal pain in this age group include irritable bowel syndrome, sexually transmitted diseases and inflammatory bowel disease.

Gender

• Females are more commonly affected with abdominal pain than males.

Race

• There is no racial predilection for abdominal pain in children

Risk Factors

• Common risk factors in the development of abdominal pain in children:
  • Anxiety , preceding emotional or physical trauma and prior gastrointestinal infection are risk factors for functional abdominal
  • Some environmental factors along with specific genetic predisposition are linked to crohn's disease.

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

• The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:

• [criterion 1]
• [criterion 2]
• [criterion 3]
• [criterion 4]

Symptoms

• [Disease name] is usually asymptomatic.
• Symptoms of [disease name] may include the following:

• [symptom 1]
• [symptom 2]
• [symptom 3]
• [symptom 4]
• [symptom 5]
• [symptom 6]

Physical Examination

• Patients with [disease name] usually appear [general appearance].
• Physical examination may be remarkable for:

• [finding 1]
• [finding 2]
• [finding 3]
• [finding 4]
• [finding 5]
• [finding 6]

Laboratory Findings

• There are no specific laboratory findings associated with [disease name].

• A [positive/negative] [test name] is diagnostic of [disease name].
• An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
• Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

• [Disease name] may also be diagnosed using [diagnostic study name].
• Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].