For info log on to www.healthlibrary.com. Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar Abdominal Pain in children occurs commonly. Sometimes it is nothing to do worry about but sometimes it can be life threatening. To identify and treat early is necessary in all children.

1. Abdominal pain in children
Prof. (Dr. Ms.)Sushmita Bhatnagar
B.J.Wadia Hospital for children
Bombay hospital
Joint Secretary - Association of Medical
Consultants

2. Abdominal pain
ACUTE
CHRONIC
Abdominal pain is one of the most common reason
for which parents take the child to a doctor.

6. Surgical causes of abdominal pain
• Intestinal obstruction
• Perforation of bowel
• Infections - Gall bladder, appendix, meckel's diverticulum,
• Constipation - due to Hirschsprung's disease
• Volvulus
• Intussusception
• Kidney stones
• Chronic Pancreatitis
• Tumors/cysts
• Hernia
• Trauma

7. What is significant pain?
ANY PAIN WHICH INTERRUPTS ACTIVITY
OF CHILD AND DISTURBS SLEEP
RED FLAGS
1. Weight loss
2. Failure to thrive
3. Fever with pain
4. Severe diarrhoea/vomiting or both
5. Family history
6. Severe right lower abdominal pain

8. Abdominal pain: evidence-based
data
Abdominal pain: appendicitis or not?

9. Abdominal pain: evidence-based
data
• Appendicitis
– Incidence
• 11/10,000 population per year
• Highest in males 10-14 years (27/10,000)
• Highest in females 15-19 years (20/10,000)
• Male:female ratio: 1.4:1
• Life time risk:
– Males: 8.6%; Females: 6.7%
• Perforation: 18% ; highest in < 5 and >65 y.o.

10. Appendicitis: evidence-based data
• Signs and symptoms
– Neonates:
• Abdominal distension
• Vomiting
• Fever
• Hypothermia
• Respiratory distress

11. Appendicitis: evidence-based data
• Signs and symptoms
– 3 years and under
• Diffuse abdominal pain
• Fever
• Vomiting
• Diarrhea
• Abdominal distension
• Diffuse abdominal tenderness

12. Appendicitis: evidence-based data
• Signs and symptoms
– Older children
• Abdominal pain
• Vomiting
• Fever
• Anorexia
• Pain with movement or cough
• Localized RLQ tenderness
• Diffuse/rebound tenderness

13. Abdominal pain: evidence-based
data
• Radiologic studies
– Ultrasound
• Appendiceal diameter or >6 mm
• Target sign with 5 concentric layers
• Distension or obstruction of the lumen
• High echogenicity around the appendix
• Pericecal or perivesical fluid
• Appendix wall > 2 mm
• Absence of appendiceal peristalsis
– Can confirm but not exclude appendicitis

14. Abdominal Pain: Evidence-based
Data
• Radiologic studies
– CT scan
• Enlarged appendiceal diameter (> 6 mm)
• Appendiceal wall thickening (> 1 mm)
• Periappendiceal inflammatory changes
including fat streaks, phlegmon, fluid collection,
and/or extraluminal gas
• Other findings: appendicalith, abscess,
arrowhead sign, or cecal bar
– Sensitivity 87 – 100 %, Specificity 89 – 98%

15. Treatment of appendicitis
• Conservative management
–Antibiotics
–IV hydration
• Surgery
– Laparoscopic
– Open

16. Treatment of appendicitis
• Conservative management
– IV and oral antibiotics
• Cefotaxime + (ofloxacin +tinidazole)
• Ciprofloxacin and metronidazole + (ciprofloxacin +
tinidazole)
– Advantages
• Less pain
• Shorter recovery time
• Avoid complications of surgery
and anesthesia

18. Functional abdominal Pain (FAP)
Real pain; not faking or malingering
Why does it occur
abnormal bowel reactivity to physiologic stimuli
(meal, gut distention, hormonal), noxious stressful
stimuli (inflammatory procees), psychological
stressful stimuli (parental seperation, anxiety)
Leading to the development of visceral
hyperalgesia
Symptoms of chronic or recurrent abdominal
pain in children where there is no identifiable
structural, inflammatory, infectious, neoplastic or
metabolic cause.
FAP is a POSITIVE diagnosis and not a failure to the
true cause of the pain

19. Chronic Abdominal Pain in children
One of the most common complaints in children and
adolescents
13% of Middle School aged; 17% of High School aged
children experience weekly abdominal pain (Hyams JS et al
J Pediatr. 1996)
Functional Abdominal Pain was found in 15% of school
aged children (Youssef NN. Clinical Pediatrics 2007)
10-15% of school age children seek help

20. 10-15% more have symptoms but never seek medical
attention
10% have an organic cause
Females>males
Higher in > 10 years old
Prevalence increases during school, not vacations

21. Drug Action Indication Risk
Peppermint
Oil
? Smooth Muscle
Relaxation
IBS None
Fiber
Stool
Bulking
Constipation
Predominant
Bowel obstruction
Lactose Free
Diet / Lactaid
Eliminates
Lactose
Lactase
Deficiency
None
Probiotics
Replacement of
“Toxic Bacteria”
S/P Antibiotics /
Enteritis
Systemic
Translocation

22. Drug Action Indication Risk
PEG Stool Softner Constipation
Dehydration /
Bowel Obstruction
H2 Blocker
Histamine
Antagonist
Dyspepsia
Tachyphalaxis after
2 weeks
PPI
Inhibits Acid
Production
Dyspepsia /
PUD
?
Osteopenia/Bacteri
al Overgrowth/
Gastronoma
Serotonin 2A
Antagonist
Serotonin
Blockade
Abdominal
Migraine /
Anxiety
Drowsiness,
Dizziness
Anti - Tricyclics Anti - Depressant Depression
Dependancy /
Suicide / Arrythmias

23. Drug Action Indication
Mylicon Anti - Flatulance
Excessive/Discomfort/ Gas
Pains
Bentyl
Anti - Spasmodic
(AS)
Spasms / Cramping
Levsin AS, Sedation Spasms / Cramping
Donnatol
AS, Sedation Spasms / Cramping
Drotaverine AS Spasms/ Cramping

24. Thank you!