Chronic/recurrent abdominal pain

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Introduction

Chronic /recurrent abdominal pain is common, affecting up to 10% of all children.^1,2,3In the majority of cases, it gets better with time and without any specific treatment.^1,2,3

Features that suggest a more sinister cause include: pain consistently waking the child from sleep, weight loss, significant vomiting or diarrhoea, blood in stools. ^1,2,3,4

Pre-referral investigations

FBC, ESR, CRP, U&E’s, LFT, coeliac serology^1,2,3
Urine MC&S^1,2,3
Stool MC&S, virology, parasites/oocytes^1,2,3
Consider checking lipase and/or H Pylori urea breath test/ (NB positive serology does not indicate active infection)^1,2,3

Pre-referral management

Explain that in otherwise healthy children who have no concerning features noted on history, a normal clinical examination and normal baseline investigations, the outcome is generally excellent.^1,2,3Strongly encourage the continuation (or return) to normal daily activities (e.g. school attendance)^1,3

If there is any suggestion of constipation, treat with stool softener +/- stimulant^1,2

If there is any suggestion of oesophagitis (eg epigastric pain, pain associated with meals), treat with a proton pump inhibitor for 4 weeks.^1,2

If there are stressors/significant changes in family and /or school environment, discuss with parent/care re: liaising with school and review by clinical psychologist.

When to refer

If there are any features suggesting a more sinister cause of abdominal pain, or if symptoms persist after initial investigations and management.^3,4

How to refer

Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office.

References

American Academy of Pediatrics. Chronic Abdominal pain in Children Pediatrics Vol 115, 3 2005.
www.patient.co.uk/doctor/recurrent-abdominal-pain-in-children.February 2013
http://www.rch.org.au/kidsconect/prerefferral_guidelines/Chronic_abdominal_pain/ September 2012.
http://bestpractice.bmj.com/best-practice/monograph/767.html

Reviewer/team:	Department of General Paediatrics	Review date:	Jan 2021
		Next review date:	Jan 2024
Endorsed by:	Medical Advisory Committee (MAC)	Date:	Jan 2021

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