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    Rome IV Diagnostic Criteria for Child Aerophagia

    Official Rome IV criteria for the diagnosis of child aerophagia.


    Use in a child or adolescent with symptoms suggestive of aerophagia, such as excessive air swallowing, abdominal distension which increases throughout the day, repetitive belching or increased flatus of at least 2 months duration.

    When to Use
    Why Use

    Children and adolescents presenting with symptoms suggestive of aerophagia for at least 2 months. The diagnosis of aerophagia should be made by clinical history, positive symptom criteria, physical examination, and minimal diagnostic testing as clinically indicated.

    • Aerophagia refers to excessive and repetitive air swallowing (often visible or audible), resulting in progressive abdominal distension, which in turn can lead to belching, flatus, and abdominal pain. Children who are unable to belch may have more severe pain as a result of the distension.

    • Children typically wake up with a flat abdomen and the distension increases as the day progresses. 

    • Patients with aerophagia can present with supragastric belching. 

    • Aerophagia is more common in children with intellectual disabilities but also occurs in otherwise healthy children and adolescents.

    • In aerophagia, significant distension of the stomach in the absence of any signs of bowel obstruction can be seen on abdominal radiograph, but this finding is non-specific.The esophageal “air sign” on chest radiograph has been noted in the majority of children with aerophagia, but its specificity is unknown.

    • Anxiety is a common cause of excessive air swallowing.

    • In babies, sucking on an empty bottle or prolonged sucking on a pacifier can result in excessive air swallowing, whereas in older children, it may result from chewing gum or drinking rapidly.

    • Used to establish the diagnosis of aerophagia in children and adolescents who present with excessive swallowing of air and abdominal distension, belching and/or flatus after appropriate evaluation. 

    • Can be used to discuss the diagnosis of aerophagia with patients and initiate treatment.

    • Making a diagnosis will help minimize unnecessary diagnostic evaluations and allow early treatment.

    Must have the following:

    For ≥2 months prior

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH