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Organic causes of pediatric abdominal pain common in primary care

PHILADELPHIA — Between 2% and 4% of all pediatric outpatient visits reference abdominal pain, with 3% to 8% having organic causes that create symptoms for more than  3 months like Heliobacter pylori, according to recent presentation at the annual meeting of the American Association of Nurse Practitioners.

“Pediatric abdominal pain is very common,” Sophia L. Thomas, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, said in the presentation. “It’s something that everybody sees in their practice just about every day.

To better understand common presentations of abdominal pain in pediatric patients within an outpatient setting, as well as how to treat these patients, Thomas discussed the history and the various symptoms of conditions such as constipation, appendicitis, colic and H. pylori infection.

Although appendicitis and colic are major concerns for parents of young children and neonates, Thomas claims that more commonly, constipation may be the root of symptom presentation. She encourages providers to use a Bristol Stool Scale, a history of dietary patterns and frequency of toilet use to determine whether or not constipation may be a contributing factor.

According to Thomas, H. pylori, an infection that causes gastric inflammation, largely affects minority children of black, Hispanic, Asian and Native American descent and those of low socioeconomic status. Families who have a high number of people living within one house are also more prone to contracting the infection. Thomas said that the most common manifestation in children is antral gastritis.

The presenter stressed that a thorough review of symptoms should be conducted, with expanded screening if the child has a sore throat, breathlessness, chest pain, coughing, or skin rashes, among many symptoms. Several of these symptoms, which may be signs of infectious diseases such as streptococcal pharyngitis (strep throat) or mononucleosis, can cause gastrointestinal conditions.

“I always tell parents that come in with their child who has abdominal pain and constipation, if they come back in with abdominal pain in the future, don’t automatically assume it’s constipation again,” Thomas said. “It could be [from other causes like] appendicitis. Even though this child has a history [of one gastrointestinal symptom], go back through the history to make sure you’re not missing anything.” – by Katherine Bortz 

Reference:

Thomas SL, et al. “Sorting Out Pediatric Abdominal Pain”. Presented at: American Association of Nurse Practitioners National Conference; Jun. 20-25, 2017; Philadelphia.