Causes of Acute Abdominal Pain in children
|Infancy (< 2 years of age)||Preschool Age (2-5 years of age)||School Age (> 5 years of age)||Adolescent|
|Colic (age < 3 mo), GERD, acute gastroenteritis, “viral syndromes”||Acute gastroenteritis, UTI, trauma, appendicitis, pneumonia, asthma, sickling syndromes, “viral syndromes,” constipation||Acute gastroenteritis, trauma, appendicitis, UTI, functional abdominal pain, sickling syndromes, constipation, “viral syndromes”||Acute gastroenteritis, gastritis, colitis, GERD, trauma, constipation, appendicitis, pelvic inflammatory disease, UTI, pneumonia, asthma, “viral syndromes,” dysmenorrhea, epididymitis, lactose intolerance, sickling syndromes, mittelschmerz|
|Trauma (possible child abuse), intussusception, incarcerated hernia, sickling syndromes, milk protein allergy||Meckel’s diverticulum, Henoch-Schönlein purpura, toxin, cystic fibrosis, intussusception, nephrotic syndrome||Pneumonia, asthma, cystic fibrosis, inflammatory bowel disease, peptic ulcer disease, cholecystitis, pancreatic disease, diabetes mellitus, collagen vascular disease, testicular torsion||Ectopic pregnancy, testicular torsion, ovarian torsion, renal calculi, peptic ulcer disease, hepatitis, cholecystitis or pancreatic disease, meconium-ileus (cystic fibrosis), collagen vascular disease, inflammatory bowel disease, toxin|
|Very Uncommon or Rare|
|Appendicitis, volvulus, tumors (e.g., Wilms’ tumor), toxin (heavy metal, lead), malabsorptive syndromes||Incarcerated hernia, neoplasm, hemolytic uremic syndrome, rheumatic fever, myocarditis, pericarditis, hepatitis, inflammatory bowel disease, choledochal cyst, hemolytic anemia, diabetes mellitus, porphyria||Rheumatic fever, toxin, renal calculi, tumor, ovarian torsion, meconium-ileus (cystic fibrosis), intussusception||Rheumatic fever, tumor, abdominal abscess|
GERD, gastroesophageal reflux disease; UTI, urinary tract infection.
The history and physical examination are the essential components of the evaluation, with judicious use of ancillary testing serving to confirm diagnosis.
Elicit the nature of the pain if possible, such as its onset, quality, severity, location, and duration, as well as the presence of any associated symptoms.
The differential diagnosis of abdominal pain in children is extensive. The age of the patient and the most likely diagnoses in that age group can be used in concert with the history and physical examination to narrow the differential and guide further diagnostic testing.
Neuman MI: Pain—Abdomen. In Fleisher GR, Ludwig S, Henretig FM (eds): Textbook of Pediatric Emergency Medicine, 6th ed. Philadelphia, Lippincott Williams & Wilkins, 2010, p 422.