What are the symptoms of recurrent abdominal pain in children?
Recurrent abdominal pain (RAP) is recurring pain in the tummy which has continued, on and off, for three months or more.
In RAP that is not caused by a physical condition, the pain is usually around the belly button. There is often a headache. Feeling sick (nausea) and even being sick (vomiting) are fairly common. However, your child is well between attacks and is otherwise healthy - growing well and, generally eating and drinking normally. There are no 'alarm symptoms' (see below).
The patterns of RAP that doctors describe, and which are NOT associated with a physical condition are: irritable bowel syndrome (IBS, the most common), functional abdominal pain, functional abdominal syndrome, functional dyspepsia and abdominal migraine.
What is childhood IBS like?
This occurs when your child has abdominal pain which can be made better by going to the toilet (for a poo), or pain which is associated with needing to poo more often or with the poo being different. IBS is diagnosed if your child has abdominal pain or discomfort and a change in bowel habit.
Other symptoms of IBS in children may include diarrhoea (often several times a day, often with a 'rush' to go), constipation (hard, dry stools; infrequent bowel movements or straining to have a bowel movement, passing mucus, and feeling bloated). Symptoms may occur after eating.
What is functional abdominal pain like?
The tummy pain is typically around the belly button. Your doctor finds no signs or symptoms that point to a physical condition causing your child's pain. They are well between episodes and are not losing weight. They may be quite anxious about the pain and about the effect that it is having. Most children experiencing RAP will have functional abdominal pain.
What is functional abdominal pain syndrome like?
This occurs when your child has functional abdominal pain but also has symptoms affecting other parts of their body at the same time, such as headache, pain in the arms or legs, or difficulty sleeping.
What is functional dyspepsia like?
This occurs when the pain is high in the tummy - above the belly button - and not made better by going to the toilet (for a poo). There may be symptoms of indigestion, such as belching and pain after eating.
What is abdominal migraine like?
Your child has recurrent sudden episodes of pain around the belly button which last for over an hour, and which interfere with normal activities. During attacks your child is off their food, may have nausea or vomiting, and may also have headache, turn pale and be intolerant of light. Between episodes your child is perfectly well.
What symptoms of recurrent abdominal pain suggest a physical cause?
Tummy pain due to physical causes can occur anywhere in the abdomen, including around the belly button. However, it is most often in the lower abdomen, either just above the pubic bone or in the bottom right or left corners, or in the upper right corner just under the ribs. Most physical causes do not run in families (exceptions to this are inflammatory bowel disorders such as Crohn's disease and ulcerative colitis, and coeliac disease).
Signs which suggest a physical cause
- Constipation (which may coexist with RAP)
- Repeated or persistent sickness (vomiting).
- Chronic or severe diarrhoea.
- Unexplained high temperature (fever).
- Blood in the stools, or black stools.
- Waking at night - due to pain - to have a bowel movement, or diarrhoea at night.
- Losing weight.
- Joint pains
- Symptoms which are worsening over time.
If one or more of these symptoms are present, this does not mean that your child is seriously ill, or that you should be alarmed. They are sometimes called 'alarm' symptoms because they set off an alarm in the mind of a doctor, reminding them to consider other physical causes for the pain.
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