An approach to functional abdominal pain in children and adolescents

Abstract

BACKGROUNDMost chronic abdominal pain in children and adolescents is functional, lacking objective evidence for organic pathology. Approximately 15% of schoolchildren experience weekly episodes of abdominal pain and 8% consult a doctor.

Primary care of children: the unique role of GPs

“…But of course, serious conditions in children, such as childhood cancer, are rare and Brett et al point out that most cases of abdominal pain in children have no underlying organic pathology. 12 This highlights the challenge of diagnostic uncertainty in balancing the risks of over-investigation and referral against the possible delay in a serious diagnosis.…”

Testing the Feasibility of DARWeb

“…4 FAP can negatively impact the quality of life of both children and their families, 5,6 and it is often associated with other pain and mental health problems. [7][8][9][10][11] It can also persist for years and be associated with other pain problems and psychological disorders in later life. 4,[12][13][14] Effective interventions could help to improve the quality of life of children with FAP and their families and reduce its consequences later in life.…”

“…[23][24][25][26] Third, related specifically to FAP, there are diagnostic problems that make access to effective interventions difficult. 7 Children usually undergo numerous time-consuming investigations to exclude organic causes, 27 and meanwhile they may not be receiving adequate treatment. In addition, not all families consult a doctor about FAP.…”

Diagnosing somatisation in adults in the first consultation: moving beyond diagnosis by exclusion

“…3 Many doctors find assessment and management difficult, using investigations to exclude disease before they feel sufficiently confident to explore the possibility of stress-related illness. 5 This approach of 'diagnosis by exclusion' frequently wastes time and money. It can also lead to 'somatic fixation': an overemphasis on physical symptoms and investigations while avoiding personal and psychological issues.…”

“…6 Somatisation can often be a positive diagnosis, rather than by exclusion. 5 Diagnosis at the first consultation is possible by asking specific questions to identify common patterns of somatising illness. These questions can be readily incorporated within the standard biomedical enquiry and examination.…”