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RAP or recurrent abdominal pain was first described by Dr. Apley in 1975 in his book “The Child with Abdominal Pain.” Children with RAP has what physician call “functional” disorder of the gastrointestinal tract for which the exact cause can’t be found by conventional or standard testing. About 10% to 15% children are believed to have RAP. These children are usually between 4 to 16 years old with recurrent belly pain longer than three months whose normal activity is affected. The physical examination is frequently normal as well as blood, urine, stool test, and X-rays. The abdominal pain is typically around the navel with variable severity. In some children the pain episodes can cluster followed by painless long period. Other gastrointestinal symptoms are usually absent. The pain episode starts gradually and can last for less than an hour in 50% and less than three hours in 40%. Continuous pain is described in about 10% of children. Many children could not describe the character of the pain. When asked where is pain is located, they usually point around the navel. Rarely will they say that the pain travel to back, chest, hips, or shoulder. It is not related with meals or bowel movement. These children are rarely awakened at night because of belly pain. However, it could affect their ability to fall asleep. For those with severe attack, they will double over, grimace, cry, or clench and push their belly. Some commonly associated symptoms are: headache, dizziness, nausea, paleness, and tiredness which is seen in 50% to 70% of children with RAP. Fever is not present in children with RAP. Some of these children have family history of irritable bowel syndrome, peptic ulcer, previous appendectomy, or migraine headaches. There is no specific treatment of children with RAP. Reference: Pediatrics in Review, September 1997, page 310 Comment: The usual initial tests that most clinicians will order are: CBC, Urinalysis, and ESR. All of these will be normal in RAP. In my 31 years of practice, I have not seen a child with chronic belly pain for longer than three months that ultimately had a serious condition that needed surgery or medications. In my practice, the most common cause of chronic belly pain that need treatment is constipation. All children with belly pain should be seen by their clinician for evaluation. Leo Leonidas, MD, FAAP |
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