Acute Abdominal Pain in Children: Evaluation and Management

Acute abdominal pain in children is a common presentation in clinic and emergency department settings and accounts for up to 10% of childhood emergency department visits. ¹ Most causes of acute abdominal pain are self-limited. ¹ The most common etiologies that indicate referral for surgery in children younger than 12 months are incarcerated inguinal hernia and intussusception; in those older than 1 year, the most common cause for surgery is acute appendicitis. ¹ The most common nonsurgical causes of abdominal pain include upper respiratory tract infection with or without otitis media or sinusitis (23.7%), gastroenteritis (15.4%), uncertain etiology (15.4%), constipation (9.4%), and urinary tract infection (8%). ¹ Cases of pancreatitis are increasing due to gallstones caused by obesity. ²

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	Comments
Ultrasonography is the preferred initial imaging modality for children with acute abdominal pain. 1,6,7,8,17,20–24	C	Systematic reviews of randomized controlled trials with diagnostic accuracy outcomes
Do not routinely perform radiography for the evaluation of abdominal pain in children. 3,10,14,21,22,32	A	Multiple randomized controlled trials and society guidelines that show no benefit and increased diagnostic error
Use a clinically validated scoring system (eg, the Pediatric Appendicitis Score) for the evaluation of children at high risk of appendicitis in the emergency setting. 7,8,13,23,24,36	C	Expert opinion

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

HISTORY

Narrowing the differential diagnosis can be done by using the age and symptoms of the patient. Table 1 shows the differential diagnosis of acute abdominal pain in children by age. ^1,3 Table 2 ^1,3,4 and Table 3 ^1,3,5 outline the clinical features of common causes of acute abdominal pain in infants and toddlers and school-aged children and adolescents, respectively. Because of the visceral nature of many etiologies of acute abdominal pain, the pain is often generalized on initial presentation. Children younger than 5 years may struggle to localize pain; therefore, obtaining a comprehensive history is important. ⁶ Although history alone is rarely sufficient to determine the source of the pain, it is critical in determining which cases are high risk and require urgent evaluation...