Alarm findings for chronic abdominal pain in children - UpToDate 28.12.

23, 21:34

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Alarm findings in the evaluation of children with chronic abdominal pain

Potential significance

Historical findings

Involuntary weight loss Malabsorption (IBD, celiac disease, pancreatitis),

malignancy

Difficulty swallowing (dysphagia) or painful Eosinophilic esophagitis, pill esophagitis,

swallowing (odynophagia) infectious esophagitis, achalasia

Significant vomiting (bilious, protracted, Acid-peptic disease, cyclic vomiting syndrome,

projectile, or otherwise worrisome) eosinophilic gastroenteritis, bowel obstruction,
hepatobiliary disease, metabolic (eg, DKA,
adrenal crisis), cholecystitis, intracranial lesion

Chronic severe diarrhea (≥3 loose or watery Enteric infection (parasitic, bacterial, viral), IBD,
stools per day for more than 2 weeks) or immune deficiency, celiac disease, food protein-
nocturnal diarrhea induced enteropathy

Unexplained fever Infectious or inflammatory process; familial

Mediterranean fever

Urinary symptoms (change in bladder Recurrent urinary tract infection; nephrolithiasis

function, dysuria, hematuria, flank pain)

Back pain Referred pain (eg, chronic pancreatitis)

Family history of IBD, celiac disease, peptic IBD, celiac disease, peptic ulcer disease
ulcer disease

Bloody diarrhea IBD

Melena (black, tarry stools) Acid peptic disease, Meckel diverticulum

Skin changes (rash, eczema, hives) IBD, celiac disease, food allergy

Examination findings

Deceleration in linear growth (eg, height gain IBD, celiac disease

<5 cm/year in a prepubertal child) and/or

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Alarm findings for chronic abdominal pain in children - UpToDate 28.12.23, 21:34

delayed puberty

Oral aphthous ulcerations IBD

Localized right upper quadrant tenderness Hepatobiliary disease (eg, gallstones,

cholecystitis, extrahepatic bile duct [choledochal
cyst])

Localized right lower quadrant pain Ovarian cyst or mass, chronic appendicitis

Left lower quadrant pain Constipation, ovarian cyst or mass, ulcerative

colitis

Suprapubic tenderness Urinary tract infection

Hepatomegaly Chronic hepatitis, hepatobiliary disease, storage

disease (eg, Gaucher disease)

Splenomegaly Hemolytic disease, splenic infarct, splenic

abscess, storage disease

Costovertebral angle tenderness Pyelonephritis

Perianal abnormalities (eg, skin tags, fissures, IBD

fistulae)

Guaiac-positive stool Enteric infection, IBD, juvenile polyps, acid-peptic

disease, foreign body, vasculitis (eg, polyarteritis
nodosa); proximal small bowel disease (Crohn
disease, Helicobacter pylori, peptic disease, celiac
disease)

IBD: inflammatory bowel disease; DKA: diabetic ketoacidosis.

References:
1. American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain. Chronic abdominal pain in children.
Pediatrics 2005; 115:812.
2. Chiou E, Nurko S. Functional abdominal pain and irritable bowel syndrome in children and adolescents. Therapy 2011;
8:315.
3. Noe JD, Li BU. Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing. Pediatr Ann 2009;
38:259.
4. Hyams JS, Di Lorenzo C, Saps M, et al. Childhood functional gastrointestinal disorders: Child/adolescent. Gastroenterology
2016; 150:1456.

Graphic 90721 Version 8.0

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