What will the doctor want to know?
The doctor will often make the diagnosis of recurrent abdominal pain (RAP) based on the questions they ask you and your child, and on the examination they make of your child. They will want to know:
Questions about the pain
- Where the pain is.
- What it feels like - how severe it is and what sort of sensation is felt.
- When it began, how often it comes and how long it lasts for.
- Whether it is getting gradually worse, is variable, or is always the same.
- Whether it makes your child feel that they need to go to the toilet and, if so, whether going to the toilet helps.
- Whether it is affecting daily activities - school, or fun things, or both.
Questions about your child
- They will ask about your child's recent and general weight gain.
- They will ask about your child's diet and whether you have noticed any particular reactions to certain foods such as bread (gluten) or milk (lactose).
- They will ask what their bowels are usually like and whether their stools are any different at the moment (you may need to have a look before you see the doctor, although you do not usually need to bring a sample at the first appointment).
- They will ask whether they have any urinary or genital symptoms such as pain on passing urine, or itching or discharge in the genital area.
- They will want to know about any recent illnesses. Many common childhood conditions can cause enlargement of the immune (lymphatic) glands in the tummy, which can lead to episodes of recurrent tummy pain. This is very common in younger children.
- In older girls your doctor will want to know about periods - if they have begun, or you are expecting them soon because other signs of puberty have appeared.
- They will want to know about any recent foreign travel and immunisations.
- They will ask about your child's previous medical history and family history, including the health of siblings. They will be interested in any physical bowel disorders and in any RAP or IBS in other family members.
Your doctor will check your child's height and weight and will examine your child's tummy, to see how tender it is and where it is sore.
How will my child's recurrent abdominal pain be investigated?
Most children with recurrent abdominal pain (RAP) do not need investigations, because their symptoms and examination findings point so strongly to one of the common patterns of RAP. However, because coeliac disease and giardia infection are both common possibilities which are easily ruled out (and which mimic IBS), these basic tests are commonly offered:
- Blood tests: these can look for conditions such as coeliac disease and inflammatory bowel disorders, for anaemia and for general inflammation. In the UK doctors generally test anyone with repeated abdominal pain for coeliac disease, as it is fairly common. If your doctor did not mention it, it may mean your child has been tested before - but ask them.
- Urine tests: to rule out infection.
- Stool examination: to rule out giardia and other infections and to look for blood.
If your child is upset at the thought of a blood test then ask the doctor how necessary this is. If the doctor feels that coeliac disease is very unlikely in your child's case, and everything else suggests to the doctor that there is no physical cause for the pain, then a blood test is very unlikely to be helpful.
However, if your doctor feels that your child's signs or symptoms suggest a physical cause for the pain, further investigations will be needed. These may include:
- Imaging tests: such as X-rays or ultrasound. These are not usually suggested without clear reason.
- Abdominal ultrasound: this is used if the doctor suspects that any of the abdominal organs feel abnormal.
- Computerised tomography (CT) and magnetic resonance imaging (MRI) scans: these are not generally done, unless something abnormal has been found on other tests.
- Colonoscopy: a colonoscopy or a sigmoidoscopy is reserved for children in whom inflammatory bowel disease is suspected. These tests are usually performed by a specialist.
- Gastroscopy: gastroscopy is reserved for children in whom ulcers or other conditions of the stomach or small intestine are suspected.
How will the doctor make the diagnosis?
In most cases of recurrent abdominal pain (RAP) the diagnosis is made by your GP after taking a clear history and examination and checking carefully for 'alarm' signs and for anything that suggests a physical cause, such as constipation or lactose intolerance. Your GP may do some tests to exclude coeliac disease. If lactose intolerance is suspected they may also suggest a food diary and some trials to see if excluding milk is helpful.
Your doctor is likely to want to review your child, after an interval has passed, to see whether things are settling down and to make sure that things aren't changing and that your child - even if they still have some symptoms of RAP - is feeling better.
How can I be sure my child doesn't have a rare but serious condition?
Your doctor will investigate your child to rule out all causes that seem possible, based on the symptoms and examination.
If everything tests as normal, and your child is not getting worse and is well between attacks, it is extremely likely that your child has no physical illness causing their pain. Further testing for rare conditions that don't 'fit' the picture is thought to be a bad thing, as this is likely to make your child more anxious, which is likely to make the pain worse.
Serious conditions generally show themselves quickly because they get worse and because they show alarm signs. However, if your child is diagnosed with RAP and then new symptoms develop, you should return to your doctor and ask for another review.
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