When Tummy Troubles Strike: Tips for Diagnosing Paediatric Abdominal Pain in Primary Care

Abdominal pain is a common yet challenging presentation in paediatric primary care. While many cases are benign, some may indicate serious underlying conditions. Accurate differential diagnosis is crucial to avoid misdiagnosis, over-investigation, or unnecessary referrals. This blog highlights practical tips to help UK primary care professionals navigate the complexities of paediatric abdominal pain.

Understanding the Challenge

Children often struggle to articulate their symptoms, making it difficult to localise pain or determine its severity. Furthermore, the differential diagnosis for paediatric abdominal pain is broad, ranging from benign conditions like constipation to life-threatening emergencies such as intussusception or appendicitis.

As a primary care professional, early identification of red flags is vital in determining whether a child needs reassurance, outpatient management, or urgent specialist referral.

Common Causes of Paediatric Abdominal Pain

  1. Gastrointestinal (GI) Conditions
    • Acute Gastroenteritis: Often viral, presenting with vomiting, diarrhoea, and mild abdominal cramping.
    • Constipation: A common cause characterised by infrequent bowel movements and hard stools.
  2. Surgical Emergencies
    • Appendicitis: Presents with periumbilical pain shifting to the right lower quadrant, often accompanied by nausea and fever.
    • Intussusception: Causes intermittent, severe pain with “currant jelly” stools and a palpable abdominal mass.
  3. Infections Beyond the GI Tract
    • Urinary Tract Infection (UTI): May present as diffuse abdominal pain or suprapubic tenderness in young children.
    • Pharyngitis: Referred pain to the abdomen due to mesenteric adenitis, especially in younger children.
  4. Other Causes
    • Functional abdominal pain syndromes such as irritable bowel syndrome (IBS).
    • Gynaecological causes in adolescent females, such as ovarian torsion or pelvic inflammatory disease.

Tips for Effective Diagnosis in Primary Care

  1. Structured History Taking
  • Symptom Onset and Duration: Acute pain may suggest appendicitis, while chronic pain might indicate IBS or constipation.
  • Associated Symptoms: Vomiting, fever, diarrhoea, dysuria, or rash can narrow down the differential diagnosis.
  • Impact on Activities: Assess how pain affects eating, sleeping, and daily activities.
  1. Physical Examination
  • Perform a thorough abdominal examination, noting tenderness, guarding, or masses.
  • Check for systemic signs, such as fever or jaundice.
  • Look beyond the abdomen: Inspect the throat, ears, chest and genitals for referred pain sources.
  1. Identifying Red Flags including:
  • Persistent or worsening pain.
  • Haematemesis or rectal bleeding.
  • Weight loss or failure to thrive.
  • Signs of peritonitis, such as rigidity or rebound tenderness.
  1. Use of Point-of-Care Tools

Point-of-care ultrasound (POCUS), where available, can aid in identifying appendicitis or intussusception early.

  1. Shared Decision-Making

Involve parents in discussions about symptoms, potential diagnoses, and management plans. Clear communication fosters trust and adherence to treatment.

The Role of Continuing Education

Keeping your knowledge and skills up to date is vital in handling complex presentations like paediatric abdominal pain.

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Takeaway Message

Diagnosing paediatric abdominal pain requires a careful balance of clinical acumen, patient-centred care, and awareness of red flags. By following a structured approach to history-taking, examination, and leveraging continuing education opportunities, primary care professionals can significantly improve outcomes for their youngest patients.

References

  1. Behrman, R.E., Kliegman, R.M., & Jenson, H.B. (2021). Nelson Textbook of Paediatrics. 21st ed. Elsevier.
  2. NICE (2022). Acute Abdominal Pain in Children: Assessment and Management. Available at: https://www.nice.org.uk