Abdominal Pain in Children Older than 3 Years of Age

Urinary tract infection

Tubo-ovarian pathologic conditions

Gastroenteritis, colitis

"Strep throat"

Pneumonia

Constipation

Gastroduodenitis with or without Helicobacter

pylori

Gallstones

In general, when older children are examined because of abdominal pain, those with peritoneal findings are referred for an operation to exclude appendicitis or other serious intra- abdominal conditions. No tests are usually necessary.

Children with fairly specific pain but questionable peritoneal findings are admitted to a hospital for observation of evolution of symptoms. If findings on physical examination are suggestive of a disease, roentgenography and ultrasonography may be helpful.

Inflammatory bowel disease or infectious terminal ileitis may be detected. Signs and symptoms of chronic disease usually suggest Crohn's disease or ulcerative colitis, and roentgenography helps to confirm the diagnosis. Infectious terminal ileitis is almost always associated with a fairly brisk diarrhea or crampy abdominal pain and bloody stools.

Localized abdominal pain with no peritoneal findings may represent early onset of appendicitis, but more likely, patients with this finding have a nonsurgical condition that can be expected to resolve within 24 to 48 hours. Although no testing is warranted, telephone follow-up or a repeated examination should be done the next day. If the patient's history is suggestive of a disorder, urinalysis, throat cultures, or a chest examination can be performed. Lateralized upper abdominal complaints imply gastritis, peptic ulcer disease, gallstones, or hepatitis. In an older adolescent, a thorough elicitation of the history and findings on physical examination can aid in the diagnosis of gallstones or hepatitis, whereas new technology raises intriguing questions about the presence of peptic ulcer disease. The association of Helicobacter pylori and gastroduodenal conditions can now be confirmed by a serial increase in IgG antibodies to the bacteria. Although the presence of H. pylori neither confirms nor excludes ulcer disease, the increase in antibodies strongly correlates with infection, which can be treated.? Upper endoscopy may still be necessary for some patients with persistent symptoms

Recurrent abdominal pain as defined by Apley is "three or more episodes severe enough to affect the child's activities, occurring over a period longer than 3 months." Usually, findings on all studies are normal. Although numerous "organic" causes are possible, 90 to 95% of patients have idiopathic pain that gradually resolves over time. The management of this situation has been eloquently bemoaned as the "loneliness of the long-distance physician" who must try to diagnose pain that is "defiant of description."

There is no fail-safe way to stop your child having abdominal pain, but keeping an eye on what they eat will help. Monitor their consumption and limit the amount of snack foods, fizzy sodas and sweets they eat, as children often do not know when to stop. Keeping a food diary will help pinpoint any foods that cause problems, as children will not always remember. Young children sometimes eat non-food items (e.g., coins); usually these will pass through their digestive system without trouble. Ingestion of medicines and poisons are much more worrisome; these products must be kept in lockable cupboards away from children. Keep a close watch on any signs your child is stressed or worried and see if these have any correlation to their abdominal pain.