Abdominal Pain in Children
This is one of the leading causes of out patient consultations in the pediatric age group – a topic well discussed by a pediatric gastroenterologist, Dr Karen Sophia C. Mercado, during the Philippine Pediatric Society Annual Convention.
Dr. Mercado stated that recurrent abdominal pain is not a single entity but a symptom complex with both organic and functional etiologies (Martin R, et al, 2001; Campo, JV et al, 2021). It is functional disorder/s if there is a variable combination of symptoms without any readily identifiable or strong suspicion of an organic condition. Once a child is brought to the clinic for a recurrent abdominal pain, the physician will identify first whether this is functional or organic.
It is classified as organic if associated with the presence of alarm symptoms or signs. The following are the red flags or alarm symptoms:
– weight loss
– chronic severe diarrhea
– pain that awakens the child from sleep
– night diarrhea
– persistent vomiting
– unexplained fever
– dysphagia
– delayed puberty
Whereas, the red flags or alarm signs are the following:
– GI blood loss
– abdominal tenderness
– presence of mass
– tenderness
– perianal abnormalities
– arthritis
The common conditions that are regarded as functional abdominal pain are the following:
– Functional dyspepsia
– Irritable bowel syndrome
– Abdominal Migraine
– Functional abdominal pain not otherwise specified
– Functional Constipation
This Functional abdominal pain (FAP) disorder could also mimic Somatization. What is this Somatization all about? This is the expression of mental phenomena as physical symptoms. The patient seeks medical evaluation and treatment rather than psychiatric care. This could be classified as:
1. Somatic symptoms and related disorders
2. Factitious disorders
3. Malingering (which is not a psychiatric disorder).
On the other hand, the common organic causes of abdominal pain are the following:
– inflammatory bowel disease (Crohn’s Disease)
– Acid Peptic Disease/ GERD
– Choledochal Cyst
– ovarian mass
– UTI
The talk of Dr Karen Mercado showed that recurrent abdominal pain in children is something to be given utmost attention since this could be a symptom of a greater medical problem. And that, recurrent abdominal pain in children is truly the pediatrician’s chronic headache.