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Functional Abdominal Pain—Child

(Centrally mediated abdominal pain syndrome, CAPS, Visceral hypersensitivity)

Definition

Functional abdominal pain is defined as either:

  • Pain one or more times a week for 2 months
  • Continuous pain for 2 months

It commonly interferes with activities and school attendance.

Causes    TOP

Food and gas put pressure on the walls of the intestine causing the intestines to stretch. Normally this pressure is not noticeable, but people with functional abdominal pain appear to be hypersensitive to this stretch and pressure. This hypersensitivity may be caused by a change in the nerves that transmit information from the intestines to the brain.

Functional pain may also be associated with abnormalities in bowel motility.

Functional pain may also be connected to crossed pathways in the brain. Emotional events create new nerve pathways. Sometimes these new pathways interact with areas of the brain that sense pain with the intestines. This could make a connection between emotional stress and functional abdominal pain.

Parasitic infections may also cause functional abdominal pain in a small percentage of children.

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Risk Factors    TOP

Factors associated with functional abdominal pain may be psychological, physical, or a combination of both.

Psychological factors include:

  • History of physical, sexual, or emotional abuse
  • Stressful life events plus difficulties with stress management
  • History of depression or anxiety
  • Passive or dependent personality
  • History of being bullied
  • Parent with a history gastrointestinal problems

Physical factors may include:

  • Previous gastrointestinal infection
  • Repeated abdominal injury

Symptoms    TOP

Symptoms vary widely among children. Pain can be intermittent or steady, and may be chronic. It may appear suddenly or slowly increase over time.

Other symptoms may include:

  • Pain located near the belly button or anywhere in the abdominal area.
  • A burning sensation under the breastbone that is not associated with eating
  • A feeling of fullness after a few bites of food
  • Pain following bowel movements

Diagnosis    TOP

You will be asked about your child’s symptoms and medical history. A physical exam will be done. The doctor may suspect functional abdominal pain based on the type and pattern of pain. It will be helpful for the doctor to know how it has affected your child’s quality of life with missed activities and school.

Your child's stool will be tested for blood.

If there are other symptoms, the doctor may:

  • Try removing certain foods from the diet to see if symptoms improve.
  • Do breath testing to look for certain disorders such as lactose intolerance.
  • Test bodily fluids with blood and urine tests.
  • Look for abnormalities with x-rays or an ultrasound.

Treatment    TOP

In most cases, abdominal pain goes away with time and understanding. The goal of treatment is to identify and address triggers for abdominal pain, and return your child to normal activity.

Part of the treatment plan may include keeping a journal of:

  • Frequency and duration of abdominal pain
  • Circumstances that may have triggered the abdominal pain
  • Amount of activities and school days missed

Your child’s doctor may also recommend:

Therapy

Emotions and stress can trigger abdominal pain or make it worse. Therapy will help you and your child with stress management. This is done with different relaxation techniques.

Behavioral therapy centers on changing behaviors to help control your child’s symptoms. This can happen by avoiding triggers or coping with the pain with distraction techniques.

Medications

Medications may be used to treat physical symptoms that occur with the abdominal pain. In most cases, medications are only prescribed for a short time until pain can be resolved by therapy. These may include:

  • Acid reduction treatments
  • Intestinal muscle relaxers
  • Bulk laxatives or antidiarrheals
  • Probiotics
  • Antidepressants

Prevention    TOP

There are no current guidelines to prevent functional abdominal pain because the cause is not clear.

RESOURCES:

American College of Gastroenterology
http://patients.gi.org
Healthy Children— American Academy of Pediatrics
https://www.healthychildren.org

CANADIAN RESOURCES:

Canadian Association of Gastroenterology
https://www.cag-acg.org
Caring For Kids—Canadian Paediatric Society
https://www.caringforkids.cps.ca

References:

Chiou E, Nurko S. Functional abdominal pain and irritable bowel syndrome in children and adolescents. Therapy. 2011;8(3):315-331.
Functional abdominal pain in children. American College of Gastroenterology website. Available at:
...(Click grey area to select URL)
Updated December 2012. Accessed December 21, 2017.
Functional abdominal pain in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated September 15, 2016. Accessed December 21, 2017.
Functional abdominal pain syndrome. International Foundation for Functional Gastrointestinal Disorders website. Available at: https://www.iffgd.org/lower-gi-disorders/functional-abdominal-pain-syndrome.html. Updated August 22, 2017. Accessed December 21, 2017.
Gijsbers CF, Schweizer, Büller HA. Protozoa as a cause of recurrent abdominal pain in children. J Pediatr Gastroenterol Nutr. 2013;57(5):603-606.
Last reviewed December 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 12/21/2017

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