Outpatient Speciality Care Clinical Pathway for the Evaluation/Treatment of the Child with Chronic Abdominal Pain

≥ 1 Red Flag Present
More evaluation may
be required
Red Flags
  • Symptoms
  • Continued weight loss/growth deceleration
  • Bloody or significant diarrhea
  • Consistent right-sided abdominal pain/fullness
  • Frequent and/or nighttime vomiting
  • Difficult/painful swallowing
  • CVA tenderness, dysuria
  • Extra-intestinal manifestations:
    • Unexplained fever
    • Rash
    • Arthritis
    • Secondary amenorrhea
    • Oral ulcers
    • Delayed puberty
  • Nocturnal diarrhea
  • Physical Signs
  • Perirectal disease
  • Rashes
  • Other concerning physical findings
  • Laboratory Abnormalities
  • Anemia
  • Low albumin
  • Elevated calprotectin
  • Positive celiac panel
  • Elevated amylase and lipase
  • ESR and/or C-reactive protein
  • Family history
  • Inflammatory bowel disease
  • Celiac disease
  • Peptic ulcer disease
Treatment Table
  1st Line 2nd Line 3rd Line 4th Line 5th Line Testing
As indicated
Functional Dyspepsia
  • H2 blockers
  • Digestive enzymes
  • Proton pump inhibitors
  • Antihistamine
  • Antispasmodics
  • Tricyclic antidepressant
  • Ondansetron
  • Referral to Motility Center for possible use of Remeron/Buspar
   
IBS Constipation
  • Hydration
  • Fiber
  • Probiotics
  • Stool softeners/osmotic laxatives
  • Antispasmodics
  • Stimulant
  • Tricyclic antidepressant
  • Rectal therapy
  • Refer to Motility Center
 
  • Sitz Marker Study (off therapy, if possible)
IBS Diarrhea
  • Hydration
  • Fiber
  • Probiotics
  • Antispasmodics
  • Anti-diarrheal
  • Antibiotics
  • Tricyclic antidepressant
  • Anti-emetics and further dietary interventions
  • Refer to Motility Center
  • Breath test
IBS Mixed
  • Hydration
  • Fiber
  • Probiotic
  • Stool softeners/osmotic
  • laxatives
  • Antispasmodics
  • Anti-diarrheal
  • Stimulant
    (Based on predominant symptom)
  • Antibiotics
  • Tricyclic antidepressant
  • Refer to Motility Center
  • Breath test
  • Sitz Marker Study
IBS Pain
  • Hydration
  • Fiber
  • Probiotics
  • Antispasmodics
  • Peppermint Oil
  • Tricyclic antidepressant
  • Pregabalin/Gabapentin
  • Refer to Motility Center
 
Abdominal migraine
  • Hydration
  • CoEnzyme Q
  • Levocarnitine
  • Amitriptyline
  • Cyproheptadine
  • Refer to Motility Center
     
Functional Abdominal Pain NOS
  • Hydration
  • Symptom-based treatment
  • Refer to Motility Center
       
Posted: August 2015
Updated: November 2017, December 2017, July 2020
Authors: K. Baber, PHD; P. Bierly, P. CRNP; T. Boyle, MD; K. Fiorino, MD; P. Kapavarapu, MD; A. Nepa RD, A. Moore, PharmD; S. Mayer-Brown, PHD; K. Rodriguez, PHD; N. Stanley, BSN, RN; M. Szabo, PHD; C. Thomas, MS, RD, LDN