This is the current release of the guideline.

All clinical reports from the American Academy of Pediatrics (AAP) automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Recommendations

1. The term "recurrent abdominal pain" as currently used clinically and in the literature should be retired. Functional abdominal pain is the most common cause of chronic abdominal pain. It is a specific diagnosis that needs to be distinguished from anatomic, infectious, inflammatory, or metabolic causes of abdominal pain. Functional abdominal pain may be categorized as one or a combination of: functional dyspepsia, irritable bowel syndrome, abdominal migraine, or functional abdominal pain syndrome (see table below titled "Recommended Clinical Definitions of Long-Lasting Intermittent or Constant Abdominal Pain in Children").
2. Functional abdominal pain generally can be diagnosed correctly by the primary care clinician in children 4 to 18 years of age with chronic abdominal pain when there are no alarm symptoms or signs, the physical examination is normal, and the stool sample tests are negative for occult blood, without the requirement of additional diagnostic evaluation.
3. The presence of alarm symptoms or signs, including but not limited to involuntary weight loss, deceleration of linear growth, gastrointestinal blood loss, significant vomiting, chronic severe diarrhea, persistent right upper or right lower quadrant pain, unexplained fever, family history of inflammatory bowel disease, or abnormal or unexplained physical findings, is generally an indication to pursue diagnostic testing for specific anatomic, infectious, inflammatory, or metabolic etiologies on the basis of specific symptoms in an individual case. Significant vomiting includes bilious emesis, protracted vomiting, cyclical vomiting, or a pattern worrisome to the physician. Alarm signs on abdominal examination include localized tenderness in the right upper or right lower quadrants, a localized fullness or mass effect, hepatomegaly, splenomegaly, costovertebral angle tenderness, tenderness over the spine, and perianal abnormalities.
4. Testing may also be performed to reassure the patient, parent, and physician of the absence of organic disease, particularly if the pain significantly diminishes the quality of life of the patient.
5. The child with functional abdominal pain is best evaluated and treated in the context of a biopsychosocial model of care. Although psychological factors do not help the clinician distinguish between organic (disease-based) and functional pain, it is important to address these factors in the diagnostic evaluation and management of these children.
6. Education of the family is an important part of treatment of the child with functional abdominal pain. It is often helpful to summarize the child's symptoms and explain in simple language that although the pain is real, there is most likely no underlying serious or chronic disease. It may be helpful to explain that chronic abdominal pain is a common symptom in children and adolescents, yet few have a disease. Functional abdominal pain can be likened to a headache, a functional disorder experienced at some time by most adults, which very rarely is associated with serious disease. It is important to provide clear and age-appropriate examples of conditions associated with hyperalgesia, such as a healing scar, and manifestations of the interaction between brain and gut, such as the diarrhea or vomiting children may experience during stressful situations (e.g., before school examinations or important sports competitions).
7. It is recommended that reasonable treatment goals be established, with the main aim being the return to normal function rather than the complete disappearance of pain. Return to school can be encouraged by identifying and addressing obstacles to school attendance.
8. Medications for functional abdominal pain are best prescribed judiciously as part of a multifaceted, individualized approach to relieve symptoms and disability. It is reasonable to consider the time-limited use of medications that might help to decrease the frequency or severity of symptoms. Treatment might include acid-reduction therapy for pain associated with dyspepsia; antispasmodic agents, smooth muscle relaxants, or low doses of psychotropic agents for pain or nonstimulating laxatives or antidiarrheals for pain associated with altered bowel pattern.
9. Additional research is needed to fill the large gaps of knowledge on chronic abdominal pain in children.

None provided

Of the 83 studies for which methodology was reviewed, 46 were case control, 20 were cohort cross section, 10 were cohort follow-up, and 7 were randomized controlled trials (RCTs).

Not applicable: The guideline was not adapted from another source.

2005 Mar

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Subcommittee on Chronic Abdominal Pain

Subcommittee on Chronic Abdominal Pain: Carlo Di Lorenzo, MD, Co-chairperson; Richard B. Colletti, MD, Co-chairperson; Harold P. Lehmann, MD, PhD; John T. Boyle, MD; William T. Gerson, MD; Jeffrey S. Hyams, MD; Robert H. Squires, Jr, MD; Lynn S. Walker, PhD

Staff: Pamela T. Kanda, MPH

Not stated

This is the current release of the guideline.

All clinical reports from the American Academy of Pediatrics (AAP) automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

None available

This NGC summary was completed by ECRI on March 23, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.