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Abdominal pain is a common complaint of children seeking medical care in the pediatric ED. Data from the U.S. National Center for Health Statistics indicate that, among all age groups, abdominal pain was the principal reason (6.8%) for visiting the ED and the second most frequent final diagnosis (4%).1 Acute abdominal pain is pain of <1 week’s duration. The assessment of acute abdominal pain in children can be challenging given the preverbal state of young children and varied number of diagnoses that present similarly. This chapter begins with a review of the ED evaluation and management of nontraumatic acute abdominal pain in infants and children, highlighting the most common diagnoses. The pathophysiology of abdominal pain is discussed in Chapter 74, Acute Abdominal Pain. Abdominal pain in adolescents and women related to gynecologic causes is discussed in more detail in Chapter 100, Abdominal and Pelvic Pain in the Nonpregnant Female.

The cause of abdominal pain varies by age group. Table 124-1 classifies emergent and nonemergent conditions by age group.

Table 124-1 Classification of Abdominal Pain by Age Group


The approach to the child with abdominal pain is divided into three age groups: neonates and young infants (0 to 3 months old), older infants and toddlers (3 months to 3 years old) and children (3 to 15 years old). Table 124-2 lists important history items to obtain in all age groups.

Table 124-2 Historical Items for Acute Abdominal Pain

Physical Examination

Assess the child’s general appearance, vital signs, and hydration. Any child who is in shock or critically ill needs immediate IV fluid resuscitation. Vital signs should be compared with age-based references. Vital signs are affected by fever, anxiety, and pain.

Observe the patient’s position of comfort to help distinguish between peritoneal and obstructive pain. Peritoneal pain tends to be exacerbated by motion, and children prefer relative stillness (for example, acute appendicitis). Obstructive pain is usually spasmodic ...

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