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Functional abdominal pain: what clinicians need to know
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  • Published on:
    Functional abdominal pain: what clinicians need to know

    Re Functional Abdominal Pain: what clinicians need to know

    In their article on the above subject, Andrews et al rightly emphasise that the majority of cases of recurrent abdominal pain in childhood are “functional” ie not associated with structural organic disease.
    In placing this large number of potentially differing problems under one large umbrella I feel the authors are ignoring important subdivisions, each requiring a different approach. In particular, they only mention abdominal migraine twice in the whole article, and then only in passing.
    The work of the late George Russell put abdominal migraine firmly on the map of UK paediatrics but it seems his message has been lost (1). With a prevalence of 4.1% of the population it seems likely that abdominal migraine is the commonest cause of children presenting with recurrent abdominal pain.
    Rather than being a diagnosis of exclusion, abdominal migraine can be regarded as a positive clinical diagnosis based on a clear history. In typical cases the pain is clearly episodic and can come on in any situation. The pain is diffuse and central, and there is associated nausea and even vomiting, often associated with facial pallor and dark rings under the eyes. There is often a past history of travel sickness and usually a positive family history of migraine.
    Parents seem to find being given a positive label and an explanation that makes sense to be maximally reassuring. Reassurance and explanation alo...

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    Conflict of Interest:
    None declared.
  • Published on:
    Functional Abdominal Pain
    • Joanne C Renshaw, Consultant Paediatrician-Community Child Health Poole Hospital NHS Foundation trust

    I read with interest the review on functional abdominal pain and link to anxiety. However, there is no mention of the potential aetiology for anxiety.
    In our school age paediatric neurodevelopmental clinic , children and young people with diagnoses of Autism Spectrum Disorder often present with escalating levels of anxiety in relation to school attendance that is reflected in a range of physical symptoms that may include abdominal pain, headaches and sleep disturbance . Indeed ,they have often been under the care of the acute paediatric service and prescribed a variety of medications. School attendance has often been affected and/or there have been concerns about learning and behaviour leading to referral to the Neurodevelopmental /Community Paediatric clinic
    Once reasonable adjustments and environmental modifications have been implemented to support the individual , anxiety diminishes and physical symptoms improve. This has been most noticeable during the recent lockdown with many young people with ASD flourishing without the incapacitating anxiety that is associated with the busy, complex, social environment of school.
    A detailed psycho - social and neurodevelopmental history and consideration of the possibility of Autism Spectrum Disorder is likely to be helpful for this group of children and young people.

    Conflict of Interest:
    None declared.