Differential Diagnosis for a 7-year-old with Gastric Pain

Single Most Likely Diagnosis

• Functional Dyspepsia: This is a common condition in children characterized by recurrent abdominal pain, particularly in the upper abdomen, without any identifiable cause. The absence of other symptoms like diarrhea, abnormal stools, nausea, or vomiting supports this diagnosis.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): Although the child does not have nausea or vomiting, GERD can cause gastric pain, especially after eating or at night. It's a common condition in children that can lead to discomfort.
• Constipation: Even though there's no mention of abnormal stools, constipation can cause significant abdominal pain. Children might not always recognize or report constipation symptoms accurately.
• Stress or Anxiety-related Abdominal Pain: Psychological factors can manifest as physical symptoms, including abdominal pain, in children. Given the age and the absence of other gastrointestinal symptoms, this is a plausible consideration.

Do Not Miss Diagnoses

• Appendicitis: Although less common in this age group and typically presenting with more severe symptoms, appendicitis can initially manifest with vague abdominal pain. It's crucial to consider this diagnosis due to its potential severity and need for urgent surgical intervention.
• Peptic Ulcer Disease: Though rare in children, peptic ulcers can cause severe gastric pain and can be a complication of NSAID use or Helicobacter pylori infection.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can present with abdominal pain, among other symptoms. While diarrhea and abnormal stools are common, they might not always be present initially.

Rare Diagnoses

• Gastric Volvulus: A rare condition where the stomach abnormally twists, which can cause severe abdominal pain and vomiting, though vomiting is not present in this case.
• Intussusception: More common in younger children, this condition involves the intestine telescoping into itself, causing abdominal pain, which can be intermittent. It's less likely in a 7-year-old without other symptoms like currant jelly stool.
• Hernias: Though not typically causing isolated gastric pain, hernias can cause abdominal discomfort and are worth considering, especially if the pain is localized to a specific area.