Recurrent Abdominal Pain
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: R10.4 DESCRIPTION Recurrent abdominal pain for which no cause can be found occurring at least monthly for 3 consecutive months with severity that interferes with routine function of the child. DIAGNOSTIC CRITERIA Clinical Peri-umbilical pain associated with belching, bloating with negative fin
General and supportive measures
ICD-10 code: R10.4
DESCRIPTION
Recurrent abdominal pain for which no cause can be found occurring at least monthly for 3 consecutive months with severity that interferes with routine function of the child.
DIAGNOSTIC CRITERIA
Clinical
- Peri-umbilical pain associated with belching, bloating with negative findings on clinical evaluation and no response to acid-blocking medication OR pain below the umbilicus accompanied by abdominal cramps, bloating and distension and with an altered bowel pattern that are consistent with Irritable Bowel Syndrome in adults.
- Either of the above syndromes with the exclusion of organic disease with appropriate investigation.
- Avoid excessive investigation where the diagnosis is strongly suspected in the presence of a normal clinical evaluation.
- Exclude the following:
- Urinary tract infections, urinary tract anomalies, renal disease.
- GIT infection, infestation or inflammation.
- Chronic abdominal conditions such as tumours or infections, e.g. TB abdomen.
- Gall bladder disease.
- Pancreatic disease.
GENERAL AND SUPPORTIVE MEASURES
- Manage psychological stressors, anxiety or depression, where present, appropriately.
- Reassure child and family.
- Counselling to avoid the reinforcement of the symptoms with secondary gain.
- Adequate dietary fibre in children with irritable bowel syndrome-type condition.
MEDICINE TREATMENT
Manage constipation, where present. See: Constipation/faecal loading.
Manage comorbid anxiety or depression appropriately. See: Depression in Childhood and Adolescence and Anxiety disorders.
REFERRAL
- Failure to respond to management.
- For appropriate psychiatric/psychological management, if not locally available.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 2: Alimentary Tract, 2.7 Recurrent Abdominal Pain