How should the diagnosis of functional abdominal pain be addressed in the emergency department (ED)?
The diagnosis of functional abdominal pain is usually evident following the completion of the history and physical examination. Failure to mention this diagnosis early or obtaining unnecessary studies to appease an anxious family may only result in the parents feeling that “the right” diagnostic test has yet to be performed. The parents and child should be reassured that stress-related abdominal pain is real pain and not due to the child’s “faking it.” They should be encouraged to continue their normal activities (e.g., school attendance) and seek psychological services. Finally, the emergency physician should provide careful instructions on the symptoms that should prompt an immediate return to the ED and should encourage follow-up with the child’s primary care provider.
- 1. Children may not have “classic” features of appendicitis or intussusception.
- 2. CBC is not specific for appendicitis.
- 3. Analgesia should not be withheld from a child with abdominal pain of unknown cause simply for fear of delaying diagnosis or causing misdiagnosis.
- 4. Children are at particularly high risk of ruptured appendix, with the youngest children possessing the highest risk.