Lactose Recurrent with milk Lower abdomen None Cramping Distention, gaseousness, diarrhea intolerance products
Urolithiasis Acute, sudden Back Groin Severe, colicky pain Hematuria
Pyelonephritis Acute, sudden Back None Dull to sharp Fever, costochondral tenderness, dysuria, urinary frequency, emesis
Adapted from Andreoli TE, Carpenter CJ, Plum F, et al: Cecil Essentials of Medicine, Philadelphia, 1986, WB Saunders.
*Common.
even in the absence of warning signs. The initial evaluationrecommended in Table 126-7 is a sensible approach, avoidingunnecessary testing and providing ample sensitivity for mostserious underlying disorders. While waiting for laboratory andultrasound results, a 3-day trial of a lactose-free diet can evaluate for lactose intolerance. If tests are normal and no warningsigns are present, testing should be stopped. If there are warning signs, progression of symptoms, or laboratory abnormalities that suggest a specific diagnosis, additional investigation may be warranted.
Treatment of Recurrent Abdominal Pain
A child who is repeatedly kept home from school becauseof pain receives reinforcement in the form of being excusedfrom responsibilities and withdraws from full social functioning. This tends to both increase anxiety and prolong thecourse. To break the cycle of pain and disability, the childwith functional pain must be assisted in returning to normal activities immediately. Instead of being sent home fromschool with stomachaches, a child may be allowed to take ashort break from class until symptoms abate. The child and parents should be informed that pain is likely to be worse onthe day the child returns to school as anxiety worsens dysmotility and enhances pain perception. Medications may behelpful. Fiber supplements may help to manage symptoms ofIBS. Probiotics and peppermint oil can be beneficial in treating IBS. In difficult and persistent cases, cognitive behavioral
A. Diagnostic Criteria for Childhood Functional Abdominal Pain
Must include all of the following: 1.
2.
3.
No evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the subject’s symptoms.
B. Diagnostic Criteria for Childhood Functional Abdominal Pain Syndrome
Must include functional abdominal pain at least 25% of the time and 1 or more of the following: 1.
Some loss of daily functioning 2.
Additional somatic symptoms such as headache, limb pain, or difficulty sleeping
C. Diagnostic Criteria for Irritable Bowel Syndrome
Must include all of the following: 1. Abdominal discomfort (an uncomfortable sensation not described as pain) or pain associated with 2 or more of the following at least 25% of the time: a.
improved with defecation b.
onset associated with change in frequency of stool c.
onset associated with a change in form (appearance) of stool 2. No evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the subject’s symptoms.
D. Diagnostic Criteria for Abdominal Migraine
Must include all of the following: 1.
Paroxysmal episodes of intense, acute periumbilical pain that lasts for 1 hour or more.
2.
Intervening periods of usual health lasting weeks to months.
3.
The pain interferes with normal activities.
4.
The pain is associated with 2 or more of the following: a.
b.
c.
d.
e.
f.
5. No evidence of an inflammatory, anatomic, metabolic, or neoplastic process considered that explains the subject’s symptoms.
*Criteria fulfilled 2 or more times in the preceding 12 months.
E. Diagnostic Criteria for Cyclic Vomiting Syndrome
Must include all of the following: 1.
Two or more periods of intense nausea and unremitting vomiting or retching lasting hours to days.
2.
Return to usual state of health lasting weeks to months.