Functional abdominal pain refers to recurrent abdominal pain and is one of the most common childhood and adolescent complaints. The vast majority of children and adolescents with recurrent abdominal pain have "functional" or "non-organic" pain, meaning that the pain is not caused by physical abnormalities. Patients usually fall into one of two categories:

1. Functional abdominal pain or functional abdominal pain syndrome – pain without other symptoms
2. Irritable bowel syndrome (IBS) – abdominal pain with abnormal bowel movements (diarrhea, constipation or both).

Causes

Most pediatric GI specialists believe that the pain is caused by abnormal contractions in the intestines and overly sensitive nerves in the GI tract. The perception of pain is thought to involve input from both the nerves in the GI tract and the processing of these signals from the brain. As a result, psychological stress, anxiety or depression may provoke pain episodes but they may also occur without an obvious cause.

Symptoms

Children with functional abdominal pain usually have pain that is located at or around the belly button and have no other warning signals to suggest a more serious cause. Some warning signals in children with recurrent abdominal pain that usually require additional testing include:

• weight loss
• vomiting
• waking up at night because of pain or to have a bowel movement
• multiple episodes of diarrhea a day
• blood in stool
• recurrent fevers higher than 100 degrees

Exams and Tests

Although often not necessary for most children with recurrent abdominal pain, testing may include a urinalysis, complete blood count (CBC), erythrocyte sedimentation rate (ESR - a marker for inflammation), stool cultures (for parasites and bacteria), and/or a stool test for blood. Further testing, if required, may include an x-ray, upper GI, abdominal (and/or pelvic) ultrasound or CT scan, or endoscopy.

Treatment

• Reassurance and education – Simply explaining to a child that their pain is not caused by a serious medical problem often results in improvement by easing worry.
• Dietary modifications – Adequate fiber in the diet is important, as well as the avoidance of foods that can irritate the gastrointestinal tract (caffeine, chocolate, spicy foods and seasonings). Also limit intake of tomato-based products (spaghetti sauce, pizza sauce, ketchup), gas-producing vegetables (cabbage, cauliflower, broccoli, beans, etc), and high-fat, greasy and fried foods.
• Stress reduction – Stressors at home and school may contribute to pain.
• Medications – Anti-spasmodics, which help decrease abnormal contractions in the GI tract, may be prescribed to prevent pain or relieve pain once it has occurred.

Points to Remember

• Functional abdominal pain is true pain and can be quite severe.
• Functional abdominal pain is treatable and causes no long-term health problems.

For More Information

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition - NASPGHAN.org