From the Guidelines
The most common etiologies of abdominal pain in pediatric patients include gastroenteritis, constipation, functional abdominal pain, urinary tract infections, and appendicitis, with appendicitis being a critical diagnosis due to its potential need for surgical intervention 1.
Common Causes of Abdominal Pain
The differential diagnosis for acute abdominal pain in children is broad and includes infectious, inflammatory, musculoskeletal, traumatic, gynecologic, and other etiologies. Some of the common causes of abdominal pain in children are:
- Gastroenteritis, which typically presents with diarrhea, vomiting, and cramping pain due to viral or bacterial infections.
- Constipation, causing recurrent, often lower abdominal discomfort that may improve after bowel movements, and can be managed with increased fluid intake, dietary fiber, and occasionally polyethylene glycol (Miralax) at a dose of 0.5-1.5 g/kg/day.
- Functional abdominal pain, including irritable bowel syndrome, occurs without identifiable organic cause and often correlates with stress or anxiety.
- Urinary tract infections present with pain often accompanied by urinary symptoms and fever, requiring antibiotic treatment based on urine culture results.
- Appendicitis, which typically begins as periumbilical pain that migrates to the right lower quadrant, accompanied by fever, vomiting, and anorexia, requiring prompt medical attention as it may need surgical intervention.
Less Common but Serious Causes
Less common but serious causes of abdominal pain in children include:
- Intussusception
- Inflammatory bowel disease
- Pancreatitis Parents should seek immediate medical attention if abdominal pain is severe, persistent, accompanied by high fever, bilious vomiting, bloody stool, or if the child appears very ill, as these may indicate conditions requiring urgent intervention 1.
Diagnosis and Management
The diagnosis of acute appendicitis often presents a challenge, as the classic presenting symptoms are not always elicited and are only moderately reproducible between clinicians 1. Imaging plays a crucial role in narrowing the differential diagnosis and directing management, with laparoscopic appendectomy being the most effective surgical treatment for appendicitis 1. Non-operative management of uncomplicated appendicitis is also being explored, with imaging helping to identify candidates for non-operative management 1.
From the Research
Etiologies of Abdominal Pain in Pediatric Patients
The most common etiologies of abdominal pain in pediatric patients can be categorized into surgical and non-surgical causes.
- Surgical causes include:
- Appendicitis, which is the most common surgical cause of abdominal pain in children 2, 3, 4
- Intussusception, which is a rare but life-threatening condition that requires immediate medical attention 5, 3
- Volvulus, which is a condition where the intestine twists around itself, cutting off blood flow 4
- Testicular torsion, which is a condition where the testicle twists, cutting off blood flow 3, 4
- Ovarian torsion, which is a condition where the ovary twists, cutting off blood flow 3, 4
- Non-surgical causes include:
- Gastroenteritis, which is the most common medical cause of abdominal pain in children 2, 3, 6, 4
- Constipation, which is a common cause of abdominal pain in children 5, 3, 6, 4
- Functional abdominal pain, which is a condition where the abdominal pain is not caused by any underlying disease or condition 6
- Urinary tract infection, which can cause abdominal pain in children 4
- Respiratory infections, which can cause abdominal pain in children 3
Age-Related Etiologies
The etiologies of abdominal pain in pediatric patients vary by age.
- In infants and toddlers, clinicians should consider congenital anomalies, malrotation, hernias, Meckel diverticulum, and intussusception 3
- In school-aged children, constipation and infectious causes of pain, such as gastroenteritis and colitis, are more common 3
- In female adolescents, clinicians should consider pelvic inflammatory disease, pregnancy, ruptured ovarian cysts, and ovarian torsion 3