Functional Abdominal Pain—Child
Functional abdominal pain is pain that occurs with normal activity in the intestine. The pain recurs on a regular basis somewhere in the abdominal area. It is not caused by a specific disorder or condition that can be detected in testing, but it does interfere with activities and school attendance.
Food and gas put pressure on the walls of the intestine causing the intestines to stretch. Normally this pressure is not noticeable, but people with functional abdominal pain appear to be hypersensitive to this stretch and pressure. This hypersensitivity may be caused by a change in the nerves that transmit information from the intestines to the brain.
Functional pain may also be connected to crossed pathways in the brain. Emotional events create new nerve pathways in the brain. Sometimes these new pathways interact with areas of the brain that sense pain with the intestines. This could make a connection between emotional stress and functional abdominal pain.
Parasitic infection may also cause functional abdominal pain in a small percentage of children.
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Factors associated with functional abdominal pain may be psychological, physical, or a combination of both.
Psychological factors include:
- Difficulties with stress management
- Passive or dependent personality
- History of being bullied
- Parent with a history gastrointestinal problems
Physical factors may include:
- Previous gastrointestinal infection
- Repeated abdominal injury
Symptoms vary widely among children. Pain can be intermittent, steady, or chronic. It may appear suddenly or slowly increase over time.
Functional abdominal pain may be:
- Located near the belly button
indigestion, such as a burning sensation under the breastbone that is not associated with eating
- A feeling of fullness after a few bites of food
- Upper abdominal pain that may or not be associated with nausea or vomiting
- Associated with bowel movements, but not always relieved by bowel movements
You will be asked about your child’s symptoms and medical history. A physical exam will be done. The doctor may suspect functional abdominal pain based on the type and pattern of pain. It will be helpful for the doctor to know how it has affected your child’s quality of life with missed activities and school.
Your doctor may try removing certain foods from the diet. This may also help find another cause for the symptoms.
Your child's bodily fluids and waste products may be tested. This can be done with:
- Blood tests
- Urine tests
- Stool tests
Imaging tests to look for abnormalities can be done with:
In most cases, abdominal pain goes away with time and understanding. The goal of treatment is to identify and address triggers for abdominal pain, and return your child to normal activity.
Part of the treatment plan may include keeping a journal of:
- Frequency and duration of abdominal pain
- Circumstances that may have triggered the abdominal pain
- Amount of activities and school days missed
Your child’s doctor may also recommend:
Emotions and stress can trigger abdominal pain or make it worse. Therapy will help you and your child with stress management. This is done with different relaxation techniques.
Behavioral therapy centers on changing behaviors to help control your child’s symptoms. This can happen by avoiding triggers or coping with the pain with distraction techniques.
Medications may be used to treat physical symptoms that occur with the abdominal pain. In most cases, medications are only prescribed for a short time until pain can be resolved by therapy. These may include:
- Acid reduction treatments
- Intestinal muscle relaxers
- Bulk laxatives or antidiarrheals
There are no current guidelines to prevent functional abdominal pain because the cause is not clear.
American College of Gastroenterology
American Academy of Pediatrics
The Canadian Association of Gastroenterology
Canadian Paediatric Society
American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain. Chronic abdominal pain in children. Pediatrics. 2005;115(3):812-815.
Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD008013.
Chiou E, Nurko S. Functional abdominal pain and irritable bowel syndrome in children and adolescents. Therapy. 2011;8(3):315-331.
Chiou E, Nurko S. Management of functional abdominal pain and irritable bowel syndrome in children and adolescents. Expert Rev Gastroenterol Hepatol. 2010;4(3):293-304.
Functional abdominal pain in children American College of Gastroenterology website. Available at: http://patients.gi.org/topics/functional-abdominal-pain-in-children. Updated December 2012. Accessed November 10, 2015.
Functional abdominal pain in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115824/Functional-abdominal-pain-in-children. Updated September 15, 2016. Accessed October 3, 2016.
Functional abdominal pain syndrome. International Foundation for Functional Gastrointestinal Disorders website. Available at: http://www.iffgd.org/site/gi-disorders/functional-gi-disorders/functional-abdominal-pain-syndrome. Updated September 12, 2014. Accessed November 10, 2015.
12/17/2013 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115824/Functional-abdominal-pain-in-children: Gijsbers CF, Schweizer, et al. Protozoa as a cause of recurrent abdominal pain in children. J Pediatr Gastroenterol Nutr. 2013 Nov;57(5):603-6.