Chronic and recurrent abdominal pain: Case

This boy shows the classic features of a functional abdominal pain disorder: recurrent central pain over months, tightly linked to school mornings and relieved at weekends, in a well child with steady growth and a normal examination. The absence of alarm features and preserved growth allow a positive diagnosis, while his anxiety, the school avoidance, and the recent family bereavement are the psychosocial drivers that management must address. [1]

Clinical findings

The pattern is strongly functional. Periumbilical pain that clusters with school stress and eases on holidays reflects the brain-gut mechanism, and the normal growth and examination make significant organic disease unlikely. The grandfather's bowel cancer is a source of family fear rather than a genuine red flag, because adult sporadic colorectal cancer does not confer meaningful childhood risk, though it must be acknowledged and addressed sensitively. The differential still includes coeliac disease and, if the pattern were to change, inflammatory bowel disease. [2]

Investigations and diagnosis

Investigation should be targeted. A reasonable first-line screen here includes a full blood count, C-reactive protein and erythrocyte sedimentation rate, coeliac serology with total immunoglobulin A, and a urinalysis, with faecal calprotectin added given the family's cancer anxiety and to confidently exclude gut inflammation. Extensive imaging and endoscopy are not indicated in a well child without alarm features. With a normal screen, the diagnosis is a functional abdominal pain disorder, made positively rather than by exhaustive exclusion, and communicated as a definite diagnosis. [2]

Management and outcome

Management begins with a positive diagnosis and a clear biopsychosocial explanation: the pain is real, the gut-brain connection has become oversensitive, serious disease has been excluded, and the goal is to return to normal function. A graded return to school is central, supported by liaison with the school and a plan for managing pain during the day rather than sending him home. Lifestyle measures, good sleep, and attention to his anxiety complete the base of the plan. [3]

Because anxiety and school avoidance are prominent, referral for cognitive behavioural therapy is appropriate, as it has strong evidence and treats the brain-gut mechanism directly while building coping skills. Pharmacology is not indicated at this stage. With early positive diagnosis, family engagement, and psychological support, the outlook is good, and most such children improve within months. Function-focused follow-up with clear safety-netting is arranged, with a low threshold to reassess should new alarm features or a changed pain pattern appear. [3]