Assessment of abdominal pain in children

• Summary 3
• Overview 4
• Aetiology 4
• Emergencies 13
• Urgent considerations 13
• Red flags 15
• Diagnosis 17
• Step-by-step diagnostic approach 17
• Differential diagnosis overview 24
• Differential diagnosis 26
• Diagnostic guidelines 63
• Evidence scores 64
• References 65
• Images 70
• Disclaimer 90

Summary

◊ Paediatric abdominal pain is often a diagnostic dilemma. It is a common problem and, although the vast majority of these episodes are benign and self-limiting, persistent abdominal pain may signify an underlying pathology requiring urgent intervention. Timely assessment and intervention are critical in preventing untoward sequelae in children presenting with abdominal pain. Because of the spectrum of aetiologies that manifest as abdominal pain, the differential remains broad and diagnosis can be challenging. In most cases, a thorough history and physical examination can narrow the broad differential. However, depending on the age of the child, additional investigations may be required to delineate diseases that present with similar symptoms. Furthermore, even with the assistance of parents or guardians, a comprehensive history is often difficult to obtain, and diagnosis therefore relies heavily on the clinical acumen of the practitioner.

◊ Reducing exposure to environmental allergens (e.g., dander, dust mites, and tobacco smoke) is an important measure for patients sensitive to these items, and can often be recommended empirically based on the patient’s history.