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 IV.

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

Functional dyspepsia
Must include one or more of the following bothersome symptoms at least 4 times a month for at least 2 months:

  1. An uncomfortable fullness after eating
  2. Feeling full after eating a small portion
  3. Pain or a burning sensation at the top of the abdomen, not associated with a bowel movement
  4. After appropriate evaluation, the symptoms cannot be explained by another medical condition

Irritable bowel syndrome
Must include all of these features for at least 2 months:

  1. Abdominal pain at least 4 days a month associated with one or more of these features:
    1. Related to bowel movements
    2. A change in bowel movement frequency
    3. A change in bowel movement form (appearance)
  2. In children with abdominal pain and constipation, the pain does not disappear when the constipation gets better.
  3. After appropriate evaluation the symptoms cannot be explained by another medical condition.

Abdominal migraine
Must include all of these features occurring at least twice:

  1. Paroxysmal episodes of intense, acute pain around the bellybutton or all over the abdomen lasting 1 hour or more
  2. Episodes are separated by weeks to months
  3. Repeated pattern and symptoms in the individual patient
  4. The 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
    6. Pallor
  5. After appropriate evaluation the symptoms cannot be explained by another medical condition.

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.

Functional abdominal pain – not otherwise specified
Must include all these features at least four times a month for at least 2 months before diagnosis:

  1. Episodic or continuous abdominal pain that does not occur exclusively during specific events like eating, having a bowel movement, exercise, or menses
  2. Insufficient criteria for other functional disorders, such as functional dyspepsia, IBS, and abdominal migraine
  3. After appropriate evaluation the pain cannot be fully explained by another medical condition

Functional constipation
Must include 2 or more criteria for a month with insufficient criteria for IBS:

  1. Two or fewer bowel movements per week
  2. Stool retention, purposeful attempts to avoid passing stool
  3. Hard or painful bowel movements
  4. A large mass of stool in the rectum
  5. Large stools that may obstruct the toilet
  6. At least 1 episode of stool incontinence per week in a child with developmental age of at least 4 years

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.

Did This Article Help You?
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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