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Abdominal Pain and Recurrent or Functional Abdominal Pain (RAP or FAP)

What is abdominal pain?

Abdominal pain, or stomachache, affects many children. There are many possible causes of abdominal pain. It can be a sign of infection, constipation, or a serious medical condition. The pain may also be unrelated to a medical problem, and simply be your child’s way of expressing feelings of stress or anxiety (which does not mean that it doesn’t truly hurt!). Abdominal pain results in many doctor and ER visits, as well as many missed days of school.

What is recurrent abdominal pain (RAP) or functional abdominal pain (FAP)?

If your health care provider has ruled out serious conditions, yet the abdominal pain is severe enough to limit your child’s activity, and occurs at least once a month in a period of at least three months, your child may have recurrent abdominal pain or functional abdominal pain. Functional abdominal pain (FAP) typically affects kids ages 4-12, and is quite common, affecting up to 15% of children [1]. While the exact cause is not known, the reason for your child’s pain may be related to diet, anxiety, depression, increased sensitivity or immaturity of the nervous system. FAP can be associated with anxiety, depression, headache, vomiting, pale skin, not participating in regular activities, and missing school. Kids with FAP are at greater risk of having anxiety as young adults [2].

What is abdominal pain like for my child?

Abdominal pain has many different characteristics. The pain may be acute (starting suddenly) or chronic (present for a period of weeks or months). It may be dull, sharp or crampy. Each type of pain and its location in the belly provides clues about the specific cause. That’s why it’s important to “know your child’s pain” as it can help in making a diagnosis. Write down the things that make your child’s pain worse or better, how long it lasts, other problems at the time of pain (vomiting, diarrhea). Keep a pain diary and bring it to your appointment. This will help your child’s health care provider figure out what’s going on.

When should I take my child to the doctor for a stomachache?

It is very important to know when to seek medical advice. Although most childhood abdominal pain has no known cause and is not dangerous, there are causes of pain that may be life threatening and require immediate medical attention. Some alarm signs and symptoms that should trigger your child’s health care provider to order more tests include (but are not limited to) [3] :girl holding stomache

How can I help my child with the pain?

While your child is getting checked out, talk with your health care provider about safe and effective ways to ease pain. There are times when watching for worsening pain is important and your health care provider may not feel pain medication is the safest option. In this case, distraction techniques such as guided imagery may help your child cope. You could also try progressive relaxation or self-hypnosis.

What diet and medication treatments are available for the pain of functional abdominal pain (FAP)?

There has been limited scientific study of treatment for recurrent abdominal pain. One review of treatments [4] found the following:

How can I find out more about behavioral and alternative treatments for FAP?

One study [5] found that cognitive-behavioral therapy (CBT) helped kids with FAP to become pain-free more quickly than without CBT. There was no evidence for any negative side effects of this treatment. In the study, the CBT involved explaining FAP and how the pain would be managed, training parents, and training kids in self-management over the course of a number of training sessions.

There is good evidence to support using behavioral interventions (for example: distraction, relaxation, coping skills, and biofeedback) in reducing or eliminating FAP [4]. Treatment including biofeedback (along with adding fiber to the diet) has been shown to be more effective than adding fiber alone [6]. Enteric-coated peppermint oil

While this study found that fiber and biofeedback was as effective as fiber/biofeedback/cognitive-behavioral/parental support, it may be that for some families, parental support could help [7]. Sometimes worried parents can make the situation worse (not on purpose, of course) by reinforcing their child’s pain behavior. In this case, if the parents get the support they need in the stressful situation of dealing with their child’s suffering with FAP, it can help the overall situation for the child.

Teaching kids self-hypnosis [8] or guided imagery [8a] show great promise as treatments for recurrent abdominal pain. Research on these treatments is ongoing.

How do we choose a treatment plan?

It works best to choose treatments based on the type of FAP your child has [4]. Your doctor should also take into account any other factors that are involved. For example, if your child is anxious about school, the anxiety may be a factor—in addition to their stomachaches—in poor attendance at school. In that case, their individualized treatment plan would need to include addressing school anxiety [6]. girl in pain

Your doctor can help figure out what approaches would work best for your child. You should always feel free to get a second opinion, if it would make you more comfortable.

Where can I find more information and related topics?

Related topics on YourChild:


Written and compiled by Kyla Boyse, RN.  Reviewed by faculty and staff at the University of Michigan.

Updated November 2012


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