There is a wide range of gastrointestinal illnesses in children. Many are rare but these too often first present to the GP so you must be able to recognise them. Do not forget gynaecological pain in girls, testicular pain in boys and child abuse.

Consider the child’s age: many conditions are age related. Check the growth and look at the growth chart. Poor growth is always significant.

Abdominal Pain

History

• Establish if this is the first episode of pain or if there have been recurrent attacks, if so, over what period of time?
  
• Ask about the site of the pain, its frequency, quality and timing (e.g. SOCRATES). How does pain affect the child? Are they reluctant to move? Do they appear ill?
  
• Is there vomiting? Bilious vomiting with abdominal pain is always abnormal and should be considered a malrotation until proved otherwise.
  
• Ask about constipation or diarrhoea. Ask parents to describe the stools. Blood may indicate Henoch–Schönlein purpura, intussusception (associated with bouts of severe pain, drawing up of the legs and pallor), inflammatory bowel disease or gastroenteritis.
  
• Is there fever? This may be present with appendicitis or indicate non-gastrointestinal cause of the pain. Ask about urinary symptoms and other signs of systemic infection.
  
• Is there weight loss? If the pain is recurrent ask about interference with activities or school or psychological factors.
  
• Explore the past medical history, including any previous surgery.
  
• Take a family and social history.

Management of Acute Abdominal Pain

This depends on the cause. All should have a urinary dipstick. The majority will have self-limiting abdominal pain with no abnormal finding. If there is doubt or signs of a serious cause admit.

Children with an acute abdomen can deteriorate rapidly. If you suspect an organic cause for the pain refer urgently.

Management of Recurrent Abdominal Pain

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