ABSTRACT
Although abdominal pain is a common complaint in childhood accounting for a large percentage of health-care visits (10-30%) for children aged 4 to 16 years, there is confusion surrounding definitions related to chronic so-called ‘‘nonorganic’’ abdominal pain in childhood (1-4). An early definition was developed from the seminal work of Apley who defined recurrent abdominal pain (RAP) as intermittent abdominal pain in children between the ages of 4 and 16 years that persists more than three months and affects normal activity (1). This definition has withstood the test of time to denote a population of children that often are brought to medical attention. Recent as well as older data demonstrate that 10% to 25% of children 4 to 16 years of age meet the criteria for RAP, with younger children (4-6 years of age) accounting for the greater percentages (1-6). Recently, these criteria have been defined further by von Baeyer and Walker: (i) the pain occurs at least once each month, in at least three consecutive months, and within the last year and (ii) episodes have been severe enough to cause the child to stay at home, terminate or avoid play, take medication for pain, or rate the pain as moderate or severe (3/10 on a scale of pain intensity) (7). Although this definition appears to work well to define a particular population of children with chronic nonorganic abdominal pain, clinically it has been recognized that as in adults, there probably exist identifiable clinical subtypes of children with chronic nonorganic abdominal pain.
