Functional Abdominal Pain in Children

Functional abdominal pain, also known as intractable abdominal pain, is persistent stomach pain that does not resolve with usual therapeutic treatment. The pain may be constant or may come and go.

Approximately 10 to 15 percent of school-age children have functional abdominal pain at some point. It can be accompanied by diarrhea, constipation, or both. It may be related to irritable bowel syndrome (IBS).

A child with functional abdominal pain may also suffer from multiple, interrelated problems, such as:

• Heightened sensitivity to light, sound, or diet
• Fatigue or sleep disorders
• Anxiety and depression
• Headaches
• Nausea
• Joint pain

Functional abdominal pain is not life threatening, but it can interfere with school and other activities.

Children with functional abdominal pain may experience diarrhea, constipation, or both. Often the pain occurs around a child's belly button, though it can also migrate to other areas of the stomach. The pain may come on suddenly or it may get more severe over time.

Other symptoms include:

• Indigestion
• Abdominal pain with bowel movements
• Feeling full after eating a small amount of food
• Nausea
• Vomiting

Researchers do not know for sure what causes functional abdominal pain. It can stem from a variety of conditions, such as a food allergy, infection, or condition like Crohn's disease that requires long-term care and monitoring. In most cases, functional abdominal pain is not caused by a serious medical condition.

Sometimes, anxiety, depression, or trauma may make a child more susceptible to functional abdominal pain and other GI issues.

Functional abdominal pain can be difficult to diagnose because it is not a symptom of another condition — the pain itself is the condition. Diagnosis typically includes a systematic evaluation of the child to understand what triggers the pain.

Most children with functional abdominal pain do not require medical testing, but when necessary, tests may include:

• Blood, urine, and stool tests
• Abdominal X-ray
• Abdominal ultrasound
• Endoscopy/colonoscopy: Involves the use of a thin, lighted tube placed through the nose or mouth into the esophagus to "see" inside the esophagus
• CT scan

If doctors diagnose an underlying cause, treatment will involve managing the specific condition.

In many cases, doctors are unable to identify a specific cause for functional abdominal pain. In such cases, they focus on support and education to enable the child to have the best possible quality of life. Treatment may address pain triggers, for instance, and how to control them. If the child is suffering from multiple overlapping problems, like heightened sensitivity to light, insomnia, and anxiety, clinicians may take an interdisciplinary approach to alleviating the symptoms.

The treatment plan may include one or several of the following:

• Pain control
• Physical therapy
• Nutrition advice and dietary changes
• Identification and treatment of specific pain triggers
• Cognitive behavioral treatments
• Treatment of associated symptoms and problems
• Reintegration into school and other activities

Our Functional Abdominal Pain Program is part of our Motility and Functional Gastrointestinal Disorders Center, one of the only medicine-based gastrointestinal (GI) motility centers in the United States.

Our integrated team of GI doctors, pain specialists, psychologists, nutritionists, and social workers bring a broad perspective to understanding GI issues and can address overlapping physical and psychological conditions that often accompany functional abdominal pain.