Abdominal Pain in Children History

Author – Kar Chang Natalie Ko  Editor Dr James Mackintosh

Last updated 06/01/24

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Primary care, emergency departments, and secondary care encounter paediatric abdominal pain frequently as a presenting symptom. Abdominal pain in children can stem from various causes, ranging from harmless to significant and potentially altering one’s life. 


Balancing history taking from both the child and parent is crucial, along with adapting the language to the child’s developmental stage. While parents provide valuable information, it is essential to engage directly with the child and consider their perspective. Adapting the language used ensures effective communication, using age-appropriate terms and explanations. 

Presenting Complaint


Left lower quadrant (LLQ) e.g. constipation, Inflammatory bowel disease (IBD), ectopic pregnancy 

Right lower quadrant (RLQ) e.g. appendicitis, mesenteric adenitis, gastroenteritis, ectopic pregnancy  

Central e.g. abdominal migraine, constipation, appendicitis (later migrates to the RIF), Crohn’s  

Testicular pain e.g. testicular torsion, epididymal-orchitis, hydroceles 

Suprapubic/ pelvic/ lower abdominal pain e.g. Urinary tract infection (UTI), ovarian torsion, pelvic inflammatory disease (PID) 

Flank e.g. pyelonephritis 


Radiates from umbilicus to RIF e.g. appendicitis  

Radiates through to the back e.g. pancreatitis 

Radiating to shoulder tip e.g. ectopic pregnancy ( and other pelvic pathology) 

Loin to groin e.g. pyelonephritis, renal calculi


Colicky e.g. constipation, gastroenteritis, Henoch Schonlein Purpura (HSP), PID, obstruction 

Burning (dyspepsia) e.g. reflux  

Sharp stabbing e.g. appendicitis 

MLA Tip 💡

Colicky pain is pain that comes and goes in abrupt waves. It is caused by muscular contractions of a hollow tube.


Severe e.g. intussusception, ovarian torsion


Comes and goes e.g. mesenteric adenitis 

Sudden e.g. ovarian/ testicular torsion, intussusception, volvulus, incarcerated hernia  

Over hours (may suggest inflammatory or infective cause) e.g. appendicitis, gastroenteritis


Continuous or discrete episodes?

Has the pain changed over time?

How long does the pain last for?



Gastrointestinal: appendicitis, obstruction, flare of IBD incarcerated hernia 

Pancreatic: acute pancreatitis 

Genitourinary: UTI, testicular torsion 

Gynaecological: ectopic pregnancy, PID, ovarian torsion/cyst 

Others: DKA 


Chronic (over weeks to months) 

Gastrointestinal: IBD, Coeliac, Irritable Bowel Syndrome (IBS), Chronic constipation 

Gynaecological: ovarian cyst (s), chronic pelvic pain, endometriosis 

Other (medical causes): hypercalcaemia 



e.g. abdominal migraines (well between episodes), IBS (often corresponds to stressful life events), functional abdominal pain 

Associated Symptoms

Gastrointestinal symptoms 

Fever (suggest an infective cause) e.g. gastroenteritis 

Vomiting e.g. bowel obstruction/volvulus (bilious i.e. dark green), pyloric stenosis (projectile) 

Change in bowel habit (Bristol Stool Chart) e.g. IBD/HUS (bloody diarrhoea), constipation (straining + hard stools), intussusception (red currant jelly stools),  

Eating and drinking  

Jaundice e.g. breastfeed related, hypothyroidism, rhesus factor disease 

Pallor e.g. GI bleed, malnutrition 

Urological symptoms 

Dysuria, Flank pain, Urinary frequency, Haematuria e.g. UTI/pyelonephritis/nephrotic syndrome, sexually transmitted diseases ( STI) 

Gynaecological symptoms  

Vaginal discharge, Pelvic pain, Dyspareunia e.g. PID 

Other symptoms:  

Shortness of breath, Chest pain, Cough e.g. pneumonia  

Weight loss, Polyuria, Polydipsia e.g. Diabetic Ketoacidosis (DKA)

Aggravating Factors

Worse before opening bowels e.g. gastroenteritis 

Worse with movements e.g. appendicitis (walking, jumping/ bumps during a car journey) 

Worsen by laying down e.g. Gastro-oesophageal reflux (dyspepsia) 

Worsen by eating gluten e.g. coeliac disease 


– Last menstrual period/ sexually active e.g. ectopic pregnancy, PID  

– Ask about coryzal symptoms over the preceding two weeks e.g. mesenteric adenitis 


There is a large amount of overlap between different causes of abdominal pain in children. Key features of common differentials are summarised in the table below:

Differential Features
Gastroenteritis (0-18y/o)
Diarrhoea (usually stops within 2 weeks), Vomiting (usually stops within 3 days), Crampy abdominal pain, Fever, headache, aching limbs
Constipation (0-18 y/o)
Less than 3 stools a week, Straining and painful passages of hard stools (rabbit dropping), altered perception of the urge to defecate
Inflammatory Bowel Disease (12-18 y/o)
Both: Diarrhoea, family history of IBD or autoimmune conditions. Crohn’s disease: non-bloody diarrhoea, weight loss, perineal disease e.g. skin tags or ulcersUlcerative colitis: bloody diarrhoea, tenesmus
Intestinal Obstruction(3 months to 6 years/ 6-11 years in the context of previous surgery)
Diffuse, central abdominal pain, bilious vomiting, absolute obstruction with abdominal distension
Intussusception (2-5 y/o)
Intermittent, severe, colicky abdominal pain (progressive), infant will exhibit a distinct pattern of knee flexion and pallor during a paroxysm, red-currant jelly stool
Appendicitis (2-18 y/o)
Appendicitis: periumbilical abdominal pain radiating to the right iliac fossa, pain worsens on movements e.g. jumping, bumps during a car journey)*Mesenteric adenitis can present similarly: usually associated with URTI
Acute Pancreatitis(0-18 y/o)
Severe epigastric pain radiating through to the back, vomiting, abdominal tenderness, systemically unwell
Necrotising Enterocolitis (3-12 days after birth)
Generally unwell, intolerance to feeds, bilious vomit, bloody stools, distended/ tender abdomen
Cow’s Milk Allergy (first few months of life and before six months)
Diarrhoea and vomiting, bloating, urticaria rash/ eczema, cough/wheeze, angioedema, irritable, crying
Ectopic Pregnancy (reproductive years)
Constant lower abdominal pain +/- pelvic tenderness, vaginal bleeding, history of recent amenorrhoea, shoulder tip pain (peritonitis), dizziness or syncope (blood loss)
Ovarian torsion(reproductive years)
Sudden onset of constant severe unilateral pelvic pain that gets progressively worse, vomiting and distress
Pelvic Inflammatory Disease(reproductive years)
Lower abdominal pain, vaginal/ cervical discharge, pyrexia, deep dyspareunia, intermenstrual/ postcoital bleeding
Urinary Tract Infection(0-11 years)
Abdominal/ suprapubic pain, urgency, frequency, dysuria, pyrexia, haematuriaInfants: irritable and crying, poor feeding, vomiting, fevers
Diabetic Ketoacidosis(2-18 y/o)
Weight loss, polyuria, polydipsia, Acetone-smelling breath, nausea and vomiting, dehydration, Kussmaul respiration

Red Flags

It is crucial to show that you are taking into account the possibility of severe causes of abdominal pain in children by asking pertinent red flag questions to assess them. 


  • Bilious/ Persistent vomiting e.g. Bowel obstruction 
  • Bloody stool e.g. Necrotising Enterocolitis, Cow’s milk protein allergy 
  • Abdominal tenderness e.g. Peritonitis (perforation?) 
  • Distended abdomen e.g. bowel obstruction (if associated with absolute constipation) 
  • Weight loss or faltering growth e.g. Cow’s milk intolerance, IBD, Coeliac disease 
  • Not keeping down any feed e.g. pyloric stenosis or intestinal obstruction 


When conducting a patient history, it is necessary to inquire about past medical history, medications & immunisations, allergies, prenatal/birth/neonatal history, growth history, family history and social history. In the case of a paediatric abdominal pain history, you can showcase your knowledge of different causes by explicitly probing into the following aspects: 

Past Medical History

Abdominal surgery (when, why) e.g. can increase the risk of bowel obstruction secondary to adhesions 

Chronic conditions such as IBD, IBS, and constipation (how well controlled, treatments, complications including hospital admissions) 

Birth History

Prematurity is a risk factor for certain conditions e.g. Necrotising Enterocolitis, Biliary Atresia  

Family History

Coeliac disease, IBD, and Hirschsprung Disease often run in families.

These conditions are also associated with a family history of autoimmune conditions.

Social History

Low fibre diet, poor fluid intake e.g. constipation 

Anyone else at home with the same symptoms e.g. infective cause such as gastroenteritis  


While examining the patient, it is important to bear in mind your potential diagnoses and observe for indications that support or contradict them.

Conducting a thorough assessment of a child experiencing abdominal pain necessitates checking vital signs, conducting an abdominal examination, and performing a genital/rectal examination as a minimum requirement.

Additionally, it may be beneficial to consider other straightforward assessments and investigations, such as a nutritional assessment and urinalysis. 

  1. BMJ, Assessment of abdominal pain in children – https://bestpractice.bmj.com/topics/en-gb/787
  2. Patient Info, Acute abdominal pain in Children – https://patient.info/doctor/acute-abdominal-pain-in-children
  3. GP Notebook, Abdominal pain in children – https://gpnotebook.com/pages/gastroenterology/abdominal-pain-in-children 
  4. Mind the Bleep – Abdominal Pain in Children – https://mindthebleep.com/abdominal-pain-in-children/ 

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