2 Abdominal Pain in Children
TABLE 2-1 Causes of Acute Abdominal Pain in Children
Gastrointestinal causes | |
Genitourinary causes | |
Drugs and toxins | |
Pulmonary causes | |
Metabolic disorders | |
Liver, spleen, and biliary tract disorders | |
Hematologic disorders | |
Miscellaneous |
From Leung AK, Sigalet DL: Acute abdominal pain in children. Am Fam Physician 67:2321-2326, 2003.
Nature of Patient
Presentation and causes of abdominal pain vary according to three age groups, as follows:
TABLE 2-2 Differential Diagnosis of Acute Abdominal Pain by Predominant Age
Birth to 1 year | |
2 to 5 years | |
6 to 11 years | |
12 to 18 years |
From Leung AK, Sigalet DL: Acute abdominal pain in children. Am Fam Physician 67:2321-2326, 2003.
Nature of Pain
In addition to observing the severity, duration, and location of abdominal pain, the examiner must note whether the onset is gradual or sudden. A gradual onset of cramping pain often suggests an intestinal cause, such as appendicitis, whereas a sudden onset of constant noncramping pain suggests torsion of a viscus, intussusception, or perforation. The pain of appendicitis classically precedes the development of vomiting and anorexia, begins gradually as a crampy epigastric or periumbilical pain, and progresses to a constant pain in the right lower quadrant (RLQ). In young children this pain may be mild, discontinuous, or both. Because of frequent atypical presentations and a decreased incidence in young children, this diagnosis is often missed.