Recurrent abdominal pain (RAP) is one of the most common reasons children are referred to a paediatric gastroenterologist. It is broadly defined as three or more episodes of abdominal pain over at least 3 months that are severe enough to affect daily activities.

It affects an estimated 10–15% of school-age children and can significantly disrupt attendance at school, participation in sport, and overall quality of life.

Organic vs Functional Causes

A key distinction in evaluating recurrent abdominal pain is between organic (structural or biochemical) and functional (no identifiable structural or biochemical cause) conditions.

Common organic causes include:

Coeliac disease

Constipation (often overlooked)

Inflammatory bowel disease (Crohn's or colitis)

Peptic ulcer disease (Helicobacter pylori)

Urinary tract infections or kidney conditions

Ovarian cysts (in adolescent girls)

Functional causes (the majority) include:

Functional abdominal pain disorder

Irritable bowel syndrome (IBS) — associated with altered bowel habits

Functional dyspepsia — upper abdominal pain related to eating

Importantly, functional pain is real pain — it is not "made up" or simply a psychological problem. It reflects altered gut-brain communication and can be just as disabling as organic pain.

Red Flags That Warrant Urgent Investigation

The following features suggest an organic cause and require prompt specialist assessment:

Blood in stool or dark/tarry stools

Unexplained weight loss or growth failure

Fever consistently associated with pain episodes

Diarrhoea that is nocturnal (waking the child from sleep)

Family history of IBD, coeliac disease, or peptic ulcer disease

Pain consistently waking the child from sleep

Jaundice, right upper quadrant pain (suggests liver or gallbladder)

Significant vomiting alongside pain

What to Expect at an Assessment

Dr Singh will take a thorough history of the pain — its location, character, timing, relationship to eating and bowel habits, and impact on daily life. A physical examination will follow.

Investigations are guided by the history and examination findings, but may include:

Blood tests (coeliac screen, inflammatory markers, liver function)

Urine test

Faecal calprotectin (a non-invasive marker of gut inflammation)

Abdominal ultrasound

Colonoscopy or gastroscopy if indicated

Treatment

For functional abdominal pain, treatment is multidisciplinary:

Dietary approaches: low-FODMAP diet, increasing fibre, regular eating patterns

Gut-directed therapies: antispasmodics, peppermint oil

Gut-brain therapies: cognitive behavioural therapy (CBT), hypnotherapy, and relaxation techniques have good evidence

Reassurance: explaining the gut-brain mechanism and normalising the experience reduces anxiety

For organic causes, treatment is targeted at the underlying condition.

The good news is that the majority of children with recurrent abdominal pain improve over time. A specialist assessment can provide clarity, reassurance, and a clear management plan for the whole family.

Last reviewed by Dr Harveen Singh FRACP, Paediatric Gastroenterologist & Hepatologist