Clinical Assessment of Pediatric Abdominal Pain

" Age of the patient.

" Characteristics of the pain. Location, quality, intensity, timing.

" Associated symptoms

" Physical findings

Clinical Assessment of Abdominal

Historical Clues

- Acute, inconsolable crying vs chronic, periodic crying.

- Formula change, reflux, medications, DPT, ulcerative colitis, Crohns disease, Crohn disease

Physical Examination

- Inflammation, trauma, obstruction

Laboratory Tests

- CBC, urinalysis, urine culture

Differential Diagnosis of Abdominal Pain, Intense Crying in Infants

" Inflammatory Disorders

- Otitis media, stomatitis, osteomyelitis

" Obstructive Disorders

- Testicular torsion, hernia, intussusception, glaucoma

" Physical Injury

- Eye injury, hair tourniquet, fracture, spider bite

- Trauma

Recurrent Abdominal

Recurrent abdominal pain (RAP) consists of abdominal pain of unknown etiology that occurs at least once per month for 3 consecutive months, severe enough to interfere with routine functioning, separated by asymptomatic periods.

It tends to occur in children 5 to 12 years of age; girls are affected more than boys.

Pain is periumbilical and ill-described.

Clusters occur in the morning or the evening.

Nausea may occur, but vomiting is infrequent.

Pallor is often associated with the pain.

The children are academically successful and emotionally sensitive.

Affected children are usually healthy appearing.

Clinical Evaluation of Recurrent Abdominal Pain

The history should assess the character of the pain and associated symptoms.

Review of Systems Assess diet, sleep patterns, bowel habits, and the context in which the pain occurs. A record of dietary intake and a diary of pain should be kept. "Nonsomatic" forces such as family function and school performance should be explored.

Laboratory tests usually are minimal unless directed by history or findings on physical examination (eg, inflammatory conditions, urinary tract infection, parasitic infection, carbohydrate intolerance).