Assessment of chronic or recurrent abdominal pain in children

Specialty: Children's medicine
Age group: Children

Direct to an emergency department

• Acute, severe or uncontrollable abdominal pain
• Severe diarrhoea with dehydration or when the child is systemically unwell
• Suspected hernia with symptoms suggestive of strangulation or incarceration
• Suspected shock or sepsis
• Symptoms suggestive of conditions such as bowel obstruction, ectopic pregnancy, ovarian torsion, testicular torsion, appendicitis or peritonitis.

Criteria for referral to public hospital service

• Chronic abdominal pain (longer than 8 weeks) unrelated to constipation (without refractory symptoms)
• Chronic or recurrent (4 or more episodes within a month) abdominal pain with either
  • faltering growth (weight loss greater than 2 weight centiles)
  • iron deficiency anaemia (haemoglobin less than 90 grams per litre)
  • iron deficiency that is unexplained or persists despite correction of potential causative factors
  • transglutaminase-IgA (tTG-IgA) greater than 10 times the upper limit of normal with concurrent normal total IgA level
  • abnormal liver function test with aspartate transaminase (AST) or alanine aminotransferase (ALT) greater than or equal to 5 times the upper level of the normal range, or two abnormal liver function test results performed at least 3 months apart with AST or ALT 2-5 times the upper level of the normal range
  • persistent bloody diarrhoea for longer than 2 weeks, where infection has been excluded
  • absence from school, social activities or work, or parental concern.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
• Onset, characteristics and duration of symptoms
• Growth charts, including current weight
• The functional or psychological impact on quality of life or activities of daily living including impact on sleep, school, study, or social activities
• Relevant past medical history (e.g. surgery, faltering growth, autoimmune disease)
• Relevant family history
• Details of previous management including the course of treatment(s) and outcome of treatment(s)
• Current and complete medication history (including non-prescription medicines, herbs and supplements)
• If the patient is pregnant.

Provide if available

• If available
  • abdominal ultrasound results (including date and details of the diagnostic imaging practice)
  • coeliac serology
  • C-reactive protein (CRP)
  • creatinine
  • erythrocyte sedimentation rate
  • faecal calprotectin
  • full blood examination
  • iron studies or serum ferritin
  • lipase test
  • liver function tests
  • urea and electrolytes results
  • stool microscopy, culture and sensitivity (MCS), polymerase chain reaction (PCR) and microscopic examination
  • urine microscopy, culture and sensitivity (MCS)
• If pregnant, results of human chorionic gonadotropin (hCG) confirming pregnancy
• Any other recent relevant imaging or investigation results (including date and details of the diagnostic imaging practice)
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child is neurodiverse
• If the child is gender diverse
• If the child has a disability
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If the child is a refugee, seeking asylum or has a bridging visa while waiting for an immigration outcome
• If the child is aged 14-18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

As testing for coeliac disease can be falsely negative in the absence of gluten consumption, when coeliac disease is suspected the child should continue consuming gluten until the diagnosis is confirmed.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Constipation without refractory symptoms or that has not had an adequate trial of treatment.