Abdominal pain is a prominent feature in the life of the average child, with 12-month period prevalence rates varying from 20% in a population sample (40) to 44% in a general practice cohort (41). In up to one-fifth of affected children, episodes are recurrent and interspersed by symptom-free periods, and this is termed RAP (41). In the majority of children, the abdominal pain is vague and typically situated in the periumbilical area. Physical examination is strikingly normal and laboratory investigations unremarkable. Because an organic diagnosis is made in less than 10% of cases, this has led to the long-held belief that most childhood abdominal pain is functional in origin (42).
RAP is defined by at least three discrete episodes of pain over a period of at least three months. Physical examination reveals no abnormality and laboratory investigations are unremarkable. Studies dating back to the 1950s (43) have reported that 10% of children aged 5 to 14 years suffered from RAP. Subsequent published prevalence rates have varied from 9% to nearly 25% (41,44,45). Whether there is a sex difference in the prevalence rates is disputed, but it is generally acknowledged that as children get older, incidence rates are higher in girls than in boys. In the late adolescent years, there is a sharp decline in incidence.
In many ways, the burden of illness is similar to unexplained abdominal pain in adults. Only 30% of emergency hospital visits for abdominal pain result in a definitive diagnosis (46), and in up to one-third of emergency appendectomies performed for abdominal pain, the appendix is normal (47). The financial impact of abdominal pain is overshadowed by the effects on the child. Many school days are lost through recurrent clinic visits or hospitalizations, which, in addition to the disruption of social activities, may be detrimental to the child's well-being and development.
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