Differential Diagnosis for Pediatric Epigastric Pain
Single Most Likely Diagnosis
- Viral Gastroenteritis: This is the most common cause of epigastric pain in children, often accompanied by nausea, vomiting, and diarrhea. The diagnosis is usually clinical, based on symptoms and epidemiological context.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Common in infants and children, presenting with epigastric pain, regurgitation, and sometimes difficulty feeding or refusal to feed.
- Peptic Ulcer Disease: Though less common in children than in adults, peptic ulcers can cause epigastric pain, especially if related to Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
- Functional Dyspepsia: A common cause of chronic or recurrent epigastric pain in children, often related to stress, eating habits, or other non-organic factors.
Do Not Miss Diagnoses
- Appendicitis: Although appendicitis typically presents with right lower quadrant pain, it can initially cause epigastric pain, especially in early stages or in younger children. Missing this diagnosis can lead to perforation and severe complications.
- Pyloric Stenosis: A condition that causes severe vomiting and can lead to dehydration and electrolyte imbalances. It typically presents in infants with projectile vomiting after feeding.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause severe abdominal pain, vomiting, and bloody stools. It's a medical emergency that requires prompt diagnosis and treatment.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic abdominal pain, including epigastric pain, along with diarrhea, weight loss, and other systemic symptoms.
- Pancreatitis: Acute or chronic inflammation of the pancreas, which can cause severe epigastric pain radiating to the back, nausea, and vomiting. It's rare in children but can be associated with gallstones, trauma, or genetic conditions.
- Hepatic or Biliary Disease: Conditions affecting the liver or biliary system, such as hepatitis or choledochal cysts, can cause epigastric pain, jaundice, and other symptoms related to liver dysfunction.