Pediatric Abdominal Pain Causes

Aka: Pediatric Abdominal Pain Causes, Abdominal Pain Causes in Children

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II. Causes: All Ages (common or important)

  1. Surgical conditions
    1. Appendicitis
    2. Bowel Obstruction
    3. Gallbladder disease (Biliary Colic, Cholecystitis)
    4. Abdominal Trauma
  2. Other high risk conditions
    1. Child Abuse
    2. Hemolytic Uremic Syndrome
    3. Pancreatitis
    4. Sickle Cell Crisis
    5. Pyelonephritis (or Urinary Tract Infection)
    6. Diabetic Ketoacidosis
    7. Henoch-Schonlein-Purpura (HSP)
  3. Functional or self limited
    1. Constipation
    2. Dietary indiscretion
    3. Gastroenteritis
    4. Mesenteric Lymphadenitis
    5. Upper Respiratory Infection

III. Causes: Neonatal or Infant (<1 year)

  1. Also see Infant, toddler and preschool causes below
  2. Surgical or serious conditions
    1. Intestinal Malrotation or Midgut Volvulus
    2. Necrotizing Enterocolitis
    3. Hirschprung's Enterocolitis
    4. Testicular Torsion (especially in Undescended Testicle)
    5. Incarcerated Hernia
    6. Pyloric Stenosis (Vomiting)
  3. Functional, self-limited or easily managed
    1. Infantile Colic
    2. Milk Protein Allergy
    3. Pediatric Gastroesophageal Reflux

IV. Causes: Infant, toddler and preschool (age 1 to 5 years old)

  1. Miscellaneous Important causes
    1. Intussusception
    2. Intestinal Malrotation or Midgut Volvulus
    3. Pyelonephritis (or Urinary Tract Infection)
    4. Lead Poisoning
    5. Foreign Body Ingestion
    6. Meckel Diverticulum
    7. Diabetic Ketoacidosis
  2. Bowel Obstruction
    1. Pyloric Stenosis
    2. Incarcerated Hernia
    3. Internal Hernia
    4. Omphalomesenteric band
    5. Hirschprung's Disease
  3. Non-accidental Trauma (or Battered Infant)
    1. Duodenal Hematoma (classic presentation)
    2. Jejunum perforation
    3. Duodenal transection
  4. Functional or self-limited
    1. Gastroenteritis
    2. Constipation

V. Causes: School-Aged Child (ages 5 to 11 years old)

  1. Miscellaneous serious causes
    1. Intussusception or Volvulus (children under age 6)
    2. Abdominal Trauma
    3. Sickle Cell Crisis
    4. Henoch-Schonlein Purpura
    5. Appendicitis
    6. Pyelonephritis or Urinary Tract Infection
    7. Pneumonia
    8. Acute Pancreatitis
    9. Lead Poisoning
    10. Diabetic Ketoacidosis
    11. Inflammatory Bowel Disease
    12. Testicular Torsion or Ovarian Torsion
  2. Hernia
    1. Inguinal Hernia occurs in 5% of pediatric patients
    2. Ovary Herniate
  3. Bowel Obstruction
    1. Prior abdominal surgery
    2. Abdominal masses (e.g. Wilm's Tumor in toddlers, Neuroblastoma)
  4. Gall Bladder disorder
    1. TPN Cholestasis
    2. Sickle Cell Anemia
    3. Morbid Childhood Obesity
  5. Benign or self-limited causes (or easily treated)
    1. See Functional Abdominal Pain in Children
    2. Mesenteric Lymphadenitis (difficult to distinguish from Acute Appendicitis)
    3. Gastroenteritis
    4. Pharyngitis (e.g. Strep Throat)
    5. Constipation
    6. Lactose Intolerance
    7. Helicobacter Pylori
    8. Abdominal Migraine
    9. Mononucleosis

VI. Causes: Adolescent (age 12 to 18 years)

  1. Surgical and serious causes
    1. Appendicitis
    2. Testicular Torsion
    3. See Gallbladder disease above
  2. Gynecologic cause
    1. Pregnancy (or Ectopic Pregnancy)
    2. Mittelschmerz
    3. Dysmenorrhea
    4. Pelvic Inflammatory Disease (or Tubo-Ovarian Abscess)
    5. Ovarian Torsion
    6. Imperforate Hymen
  3. Miscellaneous important causes
    1. Drug and Alcohol use
    2. Sexual abuse
    3. Neoplasm
    4. Inflammatory Bowel Disease
    5. Nephrolithiasis
    6. Pyelonephritis or Urinary Tract Infection
    7. Sexually Transmitted Infection
  4. Benign or self limited conditions
    1. See Functional Abdominal Pain in Children
    2. Gastroenteritis
    3. Constipation
    4. Mononucleosis
    5. Abdominal Migraine
    6. Irritable Bowel Syndrome

VII. References

  1. Herbert (2012) EM:RAP - C3 Project 2(3):1
  2. Buel (2024) Am Fam Physician 110(6): 621-31 [PubMed]
  3. Hijaz (2017) Pediatr Health Med Ther 8:83-91 +PMID: 29388612 [PubMed]
  4. Leung (2003) Am Fam Physician 67(11):2321-6 [PubMed]

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