Chronic and recurrent abdominal pain: SAQ

This girl presents the classic picture of a functional abdominal pain disorder: recurrent central pain over months, clustering with school-related stress and easing on holidays, with a well child, normal growth, and a normal examination. The absence of alarm features and preserved growth allow a positive diagnosis rather than an open-ended search for organic disease. ^[1]

Question 1 (10 marks)

Describe how you would assess this child to decide whether her pain is functional or organic, and outline the investigations you would arrange. ^[2]

Take a structured history that characterises the pain by site, timing, radiation, and its relationship to meals and defecation, and then actively screen for alarm features: weight loss or growth faltering, gastrointestinal bleeding, pain that wakes her from sleep, dysphagia, fever, joint or mouth symptoms, and a family history of coeliac disease, inflammatory bowel disease, or peptic ulcer. Give equal weight to the psychosocial history, asking about school attendance, sleep, mood, anxiety, life events, and how the family responds to the pain. Examine her fully, plot growth, assess pubertal stage, and inspect the abdomen and perianal area. A well child with normal growth, a normal examination, and no alarm features has a functional disorder by positive diagnosis. ^[2]

Investigation should be targeted rather than exhaustive, because over-testing reinforces illness behaviour and rarely changes the diagnosis. A reasonable first-line screen includes a full blood count, C-reactive protein and erythrocyte sedimentation rate, coeliac serology with total immunoglobulin A, and a urinalysis, with faecal calprotectin if inflammatory bowel disease is a concern and stool studies if the history suggests infection. Second-line tests such as ultrasound, endoscopy, or colonoscopy are reserved for children with alarm features or an abnormal screen. Normal results in this well child support a confident functional diagnosis. ^[2]