Non-organic abdo pain Flashcards
define non-organic abdo pain
complex interplay of multiple factors including childs mental state, temperament and environment
-there is no definitive test for psychosomatic illness
-investigations will only exclude organic disease
how do children with non-organic abdo pain present depending on age
younger children - express in simple terms- vauge aches
adolescence - around early puberty
-can describe more specific syx, chest pains, headaches, limb pain
-can be accompaniseed by fatigue and nausea
-before puberty pain is equally expressed, after puberty more common in girls
describe recurrent non organic abdo pain
very common in early to middle childhood
-characterised by at least three episodes of abdo pain over 3 months, which affects activites of daily living
-pain does not have physiological complications but children are more likely to be anxious and depressed
assessing children with non-organic abdo pain 5
Children who present with pain are in distress regardless of whether that pain is organic or non-organic in origin. Therefore, all children with painful symptoms should be treated with respect, their ‘sickness’ should be acknowledged and the reality of their pain accepted.
-interview both child and parent
-take pain hisotry
-examine thoroughly
-explore social history and impact of pain
distinguishing non-organic and organic abdo pain
recurrent abdominal pain is usually felt as a vague, periumbilical pain; if it is discrete and located away from the umbilicus, it is more likely to be organic in origin
assess when pain occurs, if associated with an acitivty, more likely to be psychosomatic, ie going to school
features which make pain more likely to be organic 6
Pain which is unifocal (especially in a younger child)
Pain with anatomically appropriate radiation
Pain which wakes the child from sleep
Pain which is accompanied by loss of appetite or weight
Pain which persists through pleasurable activity
Pain accompanied by vomiting
investigating non-organic pain 3
can be reassuring for child and parent
only do if wont cause child harm
use it as a positive ifinvestigation is clear
management of non-organic pain 4
reassure that nothing is wrong
‘sad feelings can make you sick’
be sympatethic
if a more serious underlying psychological cause- can be referred to specalist
-keep pain diary to understand symptoms
what should a pain diary include 4
(1) What were the circumstances just prior to the commencement of the pain?
(2) How long did the pain last?
(3) What was the severity of the pain?
(4) How did the child react to the pain?
