🔍 Clinical Decision-Making: Abdominal Pain in Children
⚠️ Surgical Red Flags • Sudden excruciating pain • Bilious vomiting • Involuntary guarding, rebound tenderness • Rigid abdomen • Point or diffuse severe tenderness • Pain with movement/cough • Absent bowel sounds
🦠 Appendicitis • Periumbilical pain → migrates to RLQ (McBurney) within hours • Anorexia, nausea, low-grade fever • Emesis AFTER pain (if vomiting precedes pain, less likely) • WBC normal or elevated with left shift
🌀 Intussusception • Ages 3 months–6 years (peak 6-18 months) • Paroxysmal colicky pain with drawing up knees • Currant jelly stool (60%) • Ultrasound diagnosis; air enema reduction
🩺 Chronic/Recurrent Pain • Functional pain: age >5 years, periumbilical, normal exam, no organic signs • Constipation: most common cause of chronic pain • IBD: pain awakens from sleep, weight loss, perianal disease • Celiac disease: tissue transglutaminase (TTG) IgA
📌 Decision strategy: Identify surgical emergencies first (appendicitis, intussusception, volvulus). Emesis before pain → unlikely appendicitis. Pain that awakens child from sleep suggests organic cause. Functional pain has normal exam, no red flags.