How is functional abdominal pain diagnosed?
The doctor will gather information to help make the diagnosis. This will include:
- a detailed history regarding the location of abdominal pain,
- the frequency and the duration of a typical episode, and
- association of pain with physical activity or emotional stress.
Many children with functional abdominal pain have a family history of gastrointestinal problems. You should expect the physician to ask about a family history of abdominal pain or other medical conditions. The doctor may ask about your child’s activities, social life, and school functioning.
The physical examination is also an important tool in evaluating abdominal pain. The child’s weight, height, and percentile on the growth chart help a physician to determine if the child's growth and development are within the normal range. Children who are underweight or short or have fallen below their usual growth curve are more likely to have another disorder as a cause for their abdominal pain. The physician will examine the child's abdomen with light and deep pressure. A visual examination of the anus and a digital (finger) exam of the rectum are important to determine if there is constipation or blood in the stool.
The diagnosis of functional abdominal pain is often based on the report of symptoms and a normal physical examination. Testing should be limited if the history is typical for functional abdominal pain and the physical examination is normal. Laboratory tests are sometimes recommended if the doctor suspects another condition as the cause of abdominal pain.
The initial screening tests may include some blood and stool tests. In specific cases further testing may be required. This further testing may include x-ray, ultrasound, or CT scan of the abdomen, or endoscopies.
Normal laboratory workup in a patient with symptoms consistent with the diagnosis of functional abdominal pain should be considered as a reaffirmation of the diagnosis of functional abdominal pain. Normal test results do not indicate the need to pursue further testing as those will likely continue to be normal. Parents are encouraged to discuss the indication of testing and results with the physician.
How can parents prepare for the doctor appointment?
A pain diary is useful in helping identify patterns and other significant factors of child’s pain. If possible, obtain a pain diary before the first consultation and bring it to the appointment. This could help your doctor’s assessment.
At the end of each day, talk to your child or family members and record information about the day’s pain, including:
- Severity of pain (1 to 10 with 10 being the worst pain)
- Time of pain
- Location of pain (around belly button, above or below belly button, left or right)
- Duration of pain (minutes, hours, all day)
- Whether the pain restricted the daily activities
- Possible triggers (food, activities, stressors, other)
- Remedies tried, and if the pain improved with that
A pain diary should not result in too much focusing on the pain or other body functions. If documentation of these events increases your child’s worries, obtain as much information as possible without excessive involvement of the child. Although this information could be useful, documenting every event should not be the focus of the child’s life or attention.