Differential Diagnosis for a 7-year-old with Abdominal Pain after Meals
Single most likely diagnosis
- Functional abdominal pain: This is the most common cause of recurrent abdominal pain in children, often related to meals, and can be exacerbated by stress or anxiety. The generalized epigastric pain without other symptoms like diarrhea or vomiting supports this diagnosis.
Other Likely diagnoses
- Gastroesophageal reflux disease (GERD): Symptoms can include abdominal pain, especially after eating, and can be exacerbated by lying down or eating certain foods. The epigastric location of the pain is consistent with GERD.
- Constipation: Although the mother did not report diarrhea or vomiting, constipation can cause abdominal pain, especially if the child is straining during bowel movements or has a bowel movement after meals.
- Lactose intolerance or other food intolerances: These can cause abdominal pain after eating, especially if the child consumes lactose or other problematic foods regularly.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the pain is currently generalized and in the epigastric area, appendicitis can present with variable symptoms, including abdominal pain that may initially be diffuse or around the navel before localizing to the right lower quadrant.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause severe abdominal pain, vomiting, and bloody stools. Early diagnosis is crucial.
- Pyloric stenosis: Typically presents in infants but can occur in older children, causing projectile vomiting after meals due to gastric outlet obstruction.
Rare diagnoses
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain, diarrhea, and other symptoms. While less common in children, they should be considered if other symptoms are present or if the pain persists.
- Pancreatitis: Acute or chronic inflammation of the pancreas, which can cause severe abdominal pain, often radiating to the back, and may be associated with vomiting or fever.
- Hepatic or biliary disease: Conditions affecting the liver or bile ducts, such as hepatitis or choledochal cysts, can cause abdominal pain, jaundice, and other symptoms.