Chronic Abdominal Pain in Children

Chronic abdominal pain (CAP) is one of the most common recurrent complaints in pediatrics, with most cases classified as functional abdominal pain disorders (FAPDs). Despite its prevalence, diagnosis and management remain difficult because symptoms often overlap with organic gastrointestinal diseases, and family anxiety may drive repeated investigations. The principal challenge is distinguishing functional from organic causes. Alarm features such as weight loss, gastrointestinal bleeding, nocturnal pain, persistent vomiting, and family history of inflammatory bowel disease help identify children needing further evaluation, but these markers are not entirely reliable. Excessive investigations may reinforce illness behavior, delay intervention, and increase healthcare burden. A focused diagnostic approach is recommended: baseline studies such as complete blood count, inflammatory markers, celiac serology, and fecal calprotectin when inflammatory bowel disease is suspected. Imaging and endoscopy should be reserved for children with concerning features or abnormal initial results. Application of Rome IV criteria supports a positive diagnosis of FAPD and reduces uncertainty. Management is centered on a biopsychosocial model. Education, reassurance, and normalization of school attendance and daily routines are foundational. Cognitive-behavioral therapy (CBT) and gut-directed hypnotherapy are the most consistently effective interventions, with multiple randomized trials demonstrating improvements in pain frequency and quality of life. Addressing constipation is essential, as it is both common and treatable. Dietary strategies, such as lactose restriction or short-term low-FODMAP trials under dietitian guidance, may help selected patients but are not recommended universally. Pharmacologic options, including antispasmodics or low-dose antidepressants, are generally reserved for refractory cases in specialist care, as evidence for routine use remains limited. Conclusion: The management of CAP in children requires balancing the need to rule out significant pathology with the risks of over-investigation. Pediatricians should adopt a streamlined diagnostic pathway and prioritize evidence-based psychosocial interventions. Early, confident diagnosis and initiation of non-pharmacologic therapy improve outcomes and reduce chronicity.