It is important to establish the nature, duration and location of any abdominal pain. Central, peri-umbilical pain with no radiation is less likely to be pathological than pain that is localised or radiates. Associated bowel disturbance or urinary symptoms should be elicited. A family history of inflammatory bowel disease or renal disease is important to note.
You should establish the impact of pain on daily functioning and a pain diary can be helpful in this. Any exacerbating or relieving factors should also be documented. This should include an assessment of any socio-emotional stressors affecting the child or young person.
In pubertal girls, it is important to discuss their menstrual cycle – whether this is related to the pain, its regularity and heaviness of bleeding. A history of sexual activity should be taken, in an appropriately confidential way. Pregnancy should be ruled out using urine βHCG. Any allegation or suspicion of child sexual abuse should be taken seriously and concerns should be raised through safeguarding processes.
A recent height and weight should be plotted in the Red Book, or appropriate age-specific centile chart.
Abdominal examination should be performed. Inspection of external genitalia is also important, considering torsion of testes as an important differential in boys.
Some children can present with respiratory pathology complaining of upper abdominal pain, so it is important to have also performed a respiratory systems examination, auscultating carefully at the lung bases.
If there are symptoms of urinary tract infection (suprapubic pain, dysuria, fever, frequency), a urine dipstick should also be performed.