Describe the pain and the bowel pattern
Children may find it hard to explain where pain is or how it feels. Record when it occurs, how long it lasts, and whether meals or passing stool change it. Information about constipation, diarrhoea, vomiting, urinary symptoms and growth helps direct the assessment. In adolescents, menstrual symptoms may also be relevant.
- Note stool frequency, consistency and any painful bowel movements.
- Record missed lessons, interrupted sleep or reduced eating.
- Bring previous results, medicines and any dietary restrictions.
Possible causes are considered individually
Constipation, infection, reflux and some food-related problems can cause abdominal symptoms. Depending on the history, clinicians may also consider coeliac disease, inflammatory bowel disease or urinary problems. A child does not need testing for every possibility. The purpose is to identify which explanations fit their symptoms and examination.
What does functional abdominal pain mean?
Some children have a disorder of gut–brain interaction, such as irritable bowel syndrome, where pain can occur without visible damage to the digestive tract. The pain is real. Stress may influence symptoms, and pain itself may increase worry. This does not mean the child is inventing symptoms or that all unexplained pain has a psychological cause.
Functional pain can be diagnosed from a fitting clinical pattern and appropriate assessment; it does not require every possible test to be negative. New symptoms should still be reviewed.
When pain needs urgent assessment
Seek urgent care for severe or worsening pain, green vomit, blood in vomit or stool, marked drowsiness, or inability to keep fluids down. A child who looks very unwell or will not move because of pain should be assessed promptly.
Tell the clinician about weight loss, slowed growth, unexplained fever, persistent vomiting, ongoing diarrhoea or diarrhoea at night. These features need timely assessment and may lead to paediatric or gastrointestinal referral; do not assume they are caused by stress.
Which tests are useful?
History, growth measurements and examination come first. Blood, urine or stool tests may be selected to investigate a specific possibility. Scans and endoscopy are not automatically needed for recurring pain. Ask what a proposed test could change in the plan. A normal result should be explained in context rather than used to dismiss ongoing pain.
Treatment and practical support
Treatment follows the clinical explanation, including constipation treatment when relevant. For functional pain, a plan may combine information about the condition, suitable diet advice, psychological approaches such as cognitive behavioural therapy and selected medicines. Do not begin restrictive diets or supplements without discussing the child’s nutritional needs with an appropriate clinician.
Set practical goals: eating regularly, returning to activities and managing a school day. Agree access to a toilet, rest when needed and a review plan. Supporting participation does not mean ignoring the child’s pain.
Common questions
My child’s tests were normal. Is the pain imaginary?
No. Normal tests do not make pain less real. Ask what the clinical explanation is, what support may help and which changes should trigger another review.
Is stomach pain before school always anxiety?
No. Timing can be useful but does not establish the cause. Bowel habits, meals, health and school experiences all deserve consideration.
Does recurring abdominal pain require EEG?
It is not part of the usual assessment of recurring abdominal pain. Any neurological investigation needs a separate, clinically justified question; digestive and paediatric assessment remain important.
