Abdominal pain is a common yet infuriatingly nonspecific symptom in children presenting to GPs. Having a well-practised, thoughtful approach to diagnosis and investigation helps differentiate potentially serious conditions from the benign.
- Managing paediatric abdominal pain in general practice begins with a well-considered, confident diagnosis.
- Having an established approach to diagnosis allows a targeted evaluation within the short amount of time available during a consultation.
- Dangerous conditions should first be ruled out by screening for red flags.
- Investigations should be tailored towards confirming or ruling out diagnoses.
- GPs should not hesitate to seek another opinion; well-considered referrals and first-line investigations will facilitate prompt triaging.
Abdominal pain accounts for up to 5% of childhood consultations in family practice.1 GPs have the unenviable task of sorting through symptoms ranging from the sublime to the ridiculous to reach a diagnosis and ensure patients receive timely, appropriate care. Most difficulties arise when patients present for the first time, early in the evolution of disease.
In up to 90% of abdominal pain presentations, GPs suspect a nonorganic cause.1 However, it is often challenging to discriminate between organic and functional abdominal pain with confidence. It may be heartening to know that this problem is not exclusive to the family physician; subspecialty practitioners are often faced with similar feelings of consternation. Are symptoms being exaggerated? What if I miss a dangerous condition? Is there such a thing as overinvestigation?
It is helpful to have a well-considered strategy when dealing with abdominal pain. This article outlines a suggested approach to the diagnosis and investigation of abdominal pain in children.
Are there red flag signs and symptoms?
Red flags are signposts for dangerous conditions not to be missed (Box 1). Presence of red flags should trigger further history taking and examination along the respective diagnostic pathways. This helps the physician determine the tempo for escalation, if required.