Functional Abdominal Pain in Children

FAP refers to recurrent tummy pain in children that is not caused by any disease process. Pain that is caused by a disease process is called organic pain rather than functional pain.

Organic causes of pain in the abdomen include:

• infection, such as:
  • urinary tract infection
  • gastroenteritis
  • pneumonia
• inflammatory bowel disease, such as Crohn's disease and Ulcerative colitis
• tumors
• appendicitis
• intussusception
• celiac disease

For an overview of what causes tummy pain in children, click here.

On the other hand, FAP (functional pain in the abdomen) in children includes the following:

• functional dyspepsia - functional pain or discomfort in the upper abdomen
• irritable bowel syndrome - functional pain with alteration in bowel habit
• abdominal migraine - functional tummy pain with the features of migraine - (pallor, nausea, vomiting and a family history of migraine headaches)

Who gets functional abdominal pain?

Functional pain in the abdomen is seen in children from the age of 3 to 4 years. There is no serious underlying cause and few investigations are required.

Is the pain real?

Yes. The pain is real. It just isn't caused by any disease process. Headaches are very real, as you will be aware, but there is no disease process causing them - just some people are prone to them. The same is true of functional pain in the abdomen.

What are the features of functional pain in the abdomen?

Functional tummy pain is non-specific pain that is not associated with any alarming symptoms or signs. The following signs and symptoms would be considered alarming and so a search for another cause of pain should be sought:

• weight loss (involuntary)
• deceleration of height
• blood loss from the gut - so blood in the stool (you may not be able to see the blood and a special test may be required)
• significant vomiting
• bile stained vomiting
• protracted vomiting
• cyclical vomiting
• chronic severe diarrhea
• persistent pain on the right side (either upper or lower abdomen)
• unexplained fever
• family history of inflammatory bowel disease
• other abnormal or unexplained physical findings

How is functional abdominal pain diagnosed?

Your doctor will take a history of the pain and associated features and do a physical examination. Some baseline investigations may be performed, such as a stool test looking for occult blood, a blood count, kidney and liver function, inflammatory markers (ESR and CRP). These tests will not diagnose functional tummy pain but will reassure if they are normal.

How is functional pain in the abdomen treated?

There is no specific treatment that will work all the time. Sometimes, all that can be achieved is ensuring your child's life is affected as little as possible due to the pain.

For functional dyspepsia, anti-acid medication may be tried.

For irritable bowel syndrome, agents that affect bowel habit may be tried. If your child is constipated, you can read more by .

For abdominal migraine, pizotifen might be tried. This has been shown in one small study to reduce the frequency of painful episodes and reduce the severity of pain when the child gets it. You might also want to look for trigger factors - read more..

There have been studies looking at dietary changes, such as fiber supplements and lactose-free diets, but these have not shown conclusive benefits.

One study looking at probiotics, did show that Lactobacillus rhamnosus (Lactobacillus GG) when given to children with functional pain in the abdomen, did reduce frequency of the pain and more children were thought to have successful treatment of their tummy pain compared to those taking a dummy medication (placebo).

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