Amina is a student of class V. Since last 6 month she is having frequent attacks of abdominal pain. Her pain is around umbilicus and not associated with fever, vomiting or diarrhoea. Pain occurs during school time and while her private tutors come. Aminas parents became very anxious and paid visit to several doctors with the same problem. This is a typical presentation of recurrent abdominal pain.
Recurrent abdominal pain in children is relatively a common problem. About 10% of the school going children face this problem and girls are more affected then males. Male female ratio is 4:3. It is rare before 5 years of age and most common in 8-10 years of age.
The child complaints of recurrent abdominal pain, colicky in nature, site and intensity is variable though it is more common around umbilicus. There are two major causes of recurrent abdominal pain a) Organic causes; and b) Functional.
Fortunately 90% of the causes are functional. Though mostly functional but organic causes must be excluded and to do that detail history, physical examination and sometime related laboratory examination are very important. If the pain is away from the umbilicus, it is more likely of organic origin. Examinations are necessary to exclude appendicitis and renal causes. Functional pains are psychological such as school refusal, irrational fear, disliking of teacher, friends and some times to avoid home work etc.
Management of such psychosomatic abdominal pain includes reassurance to parents, occasional use of paracetamol, psychotherapy and anti anxiety drugs. By late adolescents all patients become okay.
Dr M Karim Khan
Source: The Daily Star, June 27, 2009