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Functional Abdominal Pain-Child

Definition

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.

Causes

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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Risk Factors

Factors associated with functional abdominal pain may be psychological, physical, or a combination of both.
Psychological factors include:
  • Difficulties with stress management
  • History of depression or anxiety
  • 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

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
  • Feel like 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

Diagnosis

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 child's bodily fluids and waste products may be tested. This can be done with:
  • Blood tests
  • Urine tests
  • Stool tests
Images may be taken of your child's bodily structures. This can be done with:

Treatment

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:

Therapy

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

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
  • Muscle relaxers
  • Bulk laxatives or antidiarrheals

Prevention

There are no current guidelines to prevent functional abdominal pain because cause is not clear.

RESOURCES

American College of Gastroenterology http://patients.gi.org

Healthy Children— American Academy of Pediatrics http://www.healthychildren.org

CANADIAN RESOURCES

The Canadian Association of Gastroenterology http://www.cag-acg.org

Canadian Paediatric Society http://www.cps.ca

References

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 October 31, 2014.

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 October 31, 2014.

Recurrent abdominal pain in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 7, 2014. Accessed October 31, 2014.

12/17/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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.

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