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.

Functional abdominal pain can be managed, and often goes away on its own.

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 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
  • Be 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
The doctor will ask 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 doctor will run some tests to rule out causes of abdominal pain. These tests may include:

  • Blood, stool, and urine tests to look for infection and testing of stool for blood
  • Imaging tests, such as x-ray or ultrasound, to look for abnormalities, such as constipation, structural defects, or tumors
In order to narrow down a definite cause, your child’s doctor may prescribe acid reducers, laxatives, or antidiarrheal medications. These medications are generally used for a short amount of time to determine if they reduce or eliminate symptoms.

It may also be suggested that your child make dietary changes, such as eliminating dairy products, or increasing intake of fruits, vegetables, and whole grains.

Ultimately, a diagnosis can be made based on normal test results, absence of any disorders, and regularity of abdominal pain.

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 Academy of Pediatrics

American College of Gastroenterology

CANADIAN RESOURCES:
Canadian Paediatric Society

The Canadian Association of Gastroenterology

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 24, 2013.

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 October 1, 2013. Accessed October 24, 2013.

Recurrent abdominal pain in children. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 9, 2011. Accessed October 24, 2013.

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.

Last Reviewed November 2013



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