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    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.

    When to Use
    Why Use

    Patients presenting with symptoms suggestive of functional abdominal pain for at least 2 months. The diagnosis of functional abdominal pain should be made by clinical history, positive symptom criteria, physical examination, and minimal laboratory tests. Additional testing should only be done if clinically indicated.

    • Functional abdominal pain (FAP) refers to chronic or recurrent abdominal pain occurring in children and adolescents who do not meet criteria for other pain-predominant disorders of the gut brain interaction.

    • If the abdominal pain is associated with defecation, or altered bowel habits, consider a diagnosis of irritable bowel syndrome

    • If the abdominal pain is located in the upper abdomen and associated with meals, consider a diagnosis of functional dyspepsia (epigastric pain syndrome and/or postprandial distress syndrome).

    • If the patient has a positive Carnett’s sign, has point tenderness, or the pain is worsened by movement or activity, consider abdominal wall pain.

    • Pain attributed to FAP does not occur during physiologic events like eating or the menstrual cycle, but can be exacerbated by them.

    • Labeling FAP as a psychological problem (“It’s in your head”) is incorrect and can be counterproductive for treatment.

    • A negative upper endoscopy and colonoscopy are not needed to make the diagnosis in the pediatric population. 

    • Care should be taken not to overinterpret minor findings that may result from diagnostic testing (mild delay in gastric emptying, mild gastritis, etc) as these may not have clinical significance. Studies have shown that doing testing does not reassure parents. 

    • The pain in FAP is often severe and has an impact on a patient's daily functioning. Overlapping pain and autonomic symptoms are common and can further contribute to the disability.

    • Pain coping strategies have been shown to affect outcomes in pediatric patients with FAP. Catastrophizing is associated with a negative outcome but can be reduced effectively through cognitive behavioral therapy strategies. Similarly, parental coping and response to the child’s pain affect the patient's pain response.

    • Used to establish the diagnosis of functional abdominal pain in patients who present with abdominal pain and differential between other pain predominant functional disorders. 

    • Making a diagnosis will help avoid unnecessary testing and allows for targeted treatment more quickly. 

    • Can be used to discuss the diagnosis of functional abdominal pain with patients and initiate appropriate treatment.

    Must have the following:

    For ≥4 times per month for ≥2 months prior

    Diagnostic Result:

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    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