A bellyache (belly or tummy pain) occurs in the abdomen. The abdomen is the area located below the chest and above the hips.

The Rome Criteria are lists of symptoms and criteria generally agreed upon by experts to diagnosis a functional gastrointestinal disorder. They are updated every 10 years or so. The latest criteria are referred to as Rome III.

Rome III diagnostic criteria for pediatric functional disorders associated with bellyaches:

Functional dyspepsia
Must fulfill all 3 criteria at least once a week for at least 2 months before diagnosis:

  1. persistent or recurrent pain or discomfort (like nausea) centered in the upper abdomen,
  2. not relieved by defecation or associated with diarrhea or constipation, and
  3. no evidence of inflammation or anatomic abnormalities that explains the symptoms.

Irritable bowel syndrome
Must include both criteria at least once a week for at least 2 months:

  1. abdominal discomfort or pain associated with 2 or more of these features at least 25% of the time:
  2. improved with defecation,
  3. onset associated with a change in frequency of stool,
  4. onset associated with a change in form (appearance) of stool
  5. there are no structural or metabolic abnormalities to explain the symptoms.

Other features support the diagnosis of irritable bowel syndrome:

  1. more than 3 bowel movements per day, or fewer than 3 bowel movements per week
  2. lumpy/hard or loose/watery stools
  3. straining, urgency, or a feeling of incomplete evacuation of stool
  4. passage of mucus in the stools
  5. bloating or feeling abdominal distention

Abdominal migraine
Must include all of these features two or more times in the preceding 12 months:

  1. paroxysmal episodes of abrupt onset, intense abdominal pain lasting 1 hour to several days
  2. intervening periods of usual health lasting weeks to months,
  3. the pain interferes with activities
  4. abdominal pain is associated with two or more of these features:
    1. headache,
    2. sensitivity of the eyes to light,
    3. vomiting,
    4. loss of appetite,
    5. nausea, or
    6. pallor.
  5. no evidence for inflammation, anatomic abnormalities, or metabolic disease to explain the symptoms.

Childhood functional abdominal pain
Must include all these features at least once a week for at least 2 months before diagnosis:

  1. episodic or continuous abdominal pain,
  2. insufficient criteria for other functional disorders, and
  3. no evidence for inflammation, anatomic abnormalities, or metabolic disease to explain the symptoms.

Childhood functional abdominal pain syndrome
Must include childhood functional abdominal pain at least 25% of the time for at least two months, and 1 or more of these criteria:

  1. Loss of daily functioning, and
  2. Additional symptoms such as headache, limb pain, or difficulty sleeping.

Functional constipation
Must include 2 or more criteria for a month in children up to 4 years old, or for 2 months in children 4 years or older:

  1. two or fewer bowel movements per week,
  2. stool retention, purposeful attempts to avoid passing stool,
  3. hard or painful bowel movements,
  4. presence of a large mass of stool in the rectum,
  5. large diameter stools that may obstruct the toilet,
  6. at least 1 episode of stool incontinence per week after the acquisition of toileting skills.

Accompanying symptoms may include irritability, abdominal cramps, and decreased appetite. These symptoms disappear immediately following passage of a large stool.

A condition called functional fecal retention – the voluntary withholding of stool – is the most common problem in children that come to see a pediatric gastroenterologist.

Learn More about Functional Fecal Retention

General Information
If your child meets the criteria for a functional gastrointestinal disorder, your physician may choose to do some tests to confirm the absence of disease, such as upper endoscopy for dyspepsia, or blood tests for celiac disease or inflammatory bowel disease.

Many children have bellyaches that do not meet the criteria for a functional gastrointestinal disorder, often because the symptoms are not as frequent, or have not been going on for as long as required for the symptom-based diagnosis.

Some children with functional abdominal pains get pale skin or blotchy skin, dizziness or faintness, or fatigue when they get a bellyache. These are signs of autonomic arousal, the chemical and hormone response of the body to the stress of a bellyache. Some children get headaches or body aches at the same time they get bellyaches.

If your child seems to have the symptoms that qualify as a functional gastrointestinal disorder, it is a good idea to learn more about these disorders by visiting your child’s physician. Communication is a key to effective management of functional gastrointestinal disorders.

No one knows your child as well as you do, but the physician knows about illness. Effective communication helps ensure that your child’s problems are understood and treated properly. The treatment goal with functional bellyaches is to relieve suffering.

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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.
Our original content is authored specifically for IFFGD readers, in response to your questions and concerns.
If you found this article helpful, please consider supporting IFFGD with a small tax-deductible donation.

Adapted from IFFGD Publication #809 by Paul Hyman, MD, Professor of Pediatrics; Chief, Division of Pediatric Gastroenterology, Children’s Hospital and Louisiana State University Center for Health Sciences, New Orleans, LA.

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