MDCalc

Rome IV Diagnostic Criteria for Child Functional Abdominal Pain

Official Rome IV criteria for the diagnosis of child functional abdominal pain.

Use in a child or adolescent with symptoms suggestive of functional abdominal pain such as episodic recurrent or chronic abdominal pain for at least 2 months.  

Patients with any of the following alarm features must be evaluated clinically for other diagnoses even though functional abdominal pain may be present:

  • Family history of inflammatory bowel disease, celiac disease, or peptic ulcer disease.

  • Persistent right upper or right lower quadrant pain.

  • Dysphagia.

  • Odynophagia.

  • Persistent vomiting.

  • Gastrointestinal blood loss.

  • Nocturnal diarrhea.

  • Arthritis.

  • Perirectal disease.

  • Involuntary weight loss.

  • Deceleration of linear growth.

  • Delayed puberty.

  • Unexplained fever.

Must have the following:

For ≥4 times per month for ≥2 months prior

Diagnostic Result

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Advice

If diagnosis not met (negative):

Current symptoms are unlikely to be caused by Functional Abdominal Pain. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above. 

If meets diagnosis (positive):

Likely diagnosis of Functional Abdominal Pain. Consider initiating treatment.

Management

  • Education about the diagnosis of Functional Abdominal Pain (FAP) as a disorder of the gut-brain interaction.

  • Providing reassurance and setting expectations.

  • FAP should be evaluated and treated in the context of the biopsychosocial model. 

  • Dietary changes (e.g. low FODMAP diet, avoiding lactose or fructose, soluble fiber).

  • Probiotics.

  • Herbal treatments (e.g. peppermint oil, Iberogast).

  • Anti-spasmodics (e.g. hyoscyamine, dicyclomine).

  • Psychological therapies to address psychosocial dysfunction and stressors as well as psychological comorbidities (e.g. cognitive behavioral therapy, hypnotherapy, learning of coping strategies).

  • Neuromodulators (e.g. tricyclic antidepressants, serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, gabapentin).

  • Acupuncture, complementary alternative medications.

  • Neurostimulator (e.g. IB-Stim).

  • A multidisciplinary treatment approach should be taken and is especially important in severe cases. 

  • Severely disabled patients may require more intensive rehabilitation in the form of a day or inpatient program.  

Some of the pharmacologic interventions have not been studied in children and/or adolescents and can only be used off-label.

The choice of therapy is outside the scope of this calculator and will depend on clinical context.

Critical Actions

This calculator should only be used in pediatric patients who do not have signs or symptoms suggestive of a structural, metabolic or systemic cause of their symptoms based on clinical history, physical exam, and initial work-up.

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