Recurrent abdominal pain
Recurrent abdominal pain is a common problem affecting around 10% of school-age children. Boys and girls are affected to a similar extent, and there is no clear social class link. Abdominal pain associated with pallor, anorexia, nausea or vomiting may be caused by abdominal migraine, even in the absence of headaches. The abdomen is examined to exclude localised tenderness, guarding or constipation. It is also worth examining the eardrums, chest and genitalia. Investigations should be kept to a minimum, as an endless search for possible causes reinforces in the mind of the child and their parents that there must be a serious cause that no one can pinpoint. Tests that are appropriate in primary care include a full blood count, erythrocyte sedimentation rate, urinary microscopy and urinary culture. Other problems may coexist with recurrent abdominal pain. School refusal is potentially one of the most serious, and should be addressed as soon as possible.