Functional Abdominal Pain in Children


  • Yudith Setiati Ermaya Faculty of Medicine Padjadjaran University, Dr. Hasan Sadikin General Hospital Bandung



functional abdominal pain, pediatric disorder, rome IV criteria


Background: Functional abdominal pain (FAP), often affecting girls and those with mental health issues, is a prevalent pediatric disorder characterized by persistent symptoms without a clear identifiable organic pathology. The Rome IV Criteria classify it into subtypes, which have distinct symptoms and required tailored management approaches.

Discussion: Subtypes classified by the Rome IV Criteria include irritable bowel syndrome (IBS), functional dyspepsia, abdominal migraine, and FAP - not otherwise specified (NOS). The pathophysiology involves gut hypersensitivity, hyperalgesia, genetic predispositions, and psychosocial triggers. Diagnosis relies on medical history, physical examination, the presence of alarm signs, and the characteristic of pain. Treatment strategies encompass dietary modifications, psychological interventions, pharmacology treatment including proton pump inhibitors, prokinetics, and antidepressants like amitriptyline.

Conclusion: Recognizing the specific subtypes, as defined by the Rome IV Criteria, allows healthcare professionals to implement individualized care strategies for optimal outcomes.


Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional Disorders: Children and Adolescents. Gastroenterology. 2016;S0016-5085(16):00181-5. DOI:

Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PLoS One. 2015;10(5):e0126982. DOI:

McClellan N, Ahlawat R. Functional Abdominal Pain in Children [Internet]. Florida: StatPearls Publishing; 2024 Jan. [cited 2024 March 21]. Available from:

Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016;150(6):1257-61. DOI:

Ermaya YS, Kadim M. Funcional abdominal pain disorder: Modify from Rome IV diagnostic workflow of FAPDs. Paper presented at: PKB XII IDAI North Sumatra; 2022 Jul 30-31; Medan, Indonesia.

Saps M, Nichols-Vinueza DX, Rosen JM, Velasco-Benítez CA. Prevalence of functional gastrointestinal disorders in Colombian school children. J Pediatr. 2014;164(3):542-5.e1. DOI:

Defrees DN, Bailey J. Irritable Bowel Syndrome: Epidemiology, Pathophysiology, Diagnosis, and Treatment. Prim Care. 2017;44(4):655-71. DOI:

Di Lorenzo C, Youssef NN, Sigurdsson L, Scharff L, Griffiths J, Wald A. Visceral hyperalgesia in children with functional abdominal pain. J Pediatr. 2001;139(6):838-43. DOI:

Van Ginkel R, Voskuijl WP, Benninga MA, Taminiau JA, Boeckxstaens GE. Alterations in rectal sensitivity and motility in childhood irritable bowel syndrome. Gastroenterology. 2001;120(1):31-8. DOI:

Iovino P, Tremolaterra F, Boccia G, Miele E, Ruju FM, Staiano A. Irritable bowel syndrome in childhood: visceral hypersensitivity and psychosocial aspects. Neurogastroenterol Motil. 2009;21(9):940-e74. DOI:

Gulewitsch MD, Enck P, Schwille-Kiuntke J, Weimer K, Schlarb AA. Rome III criteria in parents' hands: pain-related functional gastrointestinal disorders in community children and associations with somatic complaints and mental health. Eur J Gastroenterol Hepatol. 2013;25(10):1223-9. DOI:

Waters AM, Schilpzand E, Bell C, Walker LS, Baber K. Functional gastrointestinal symptoms in children with anxiety disorders. J Abnorm Child Psychol. 2013;41(1):151-63. DOI:

Bonilla S, Saps M. Early life events predispose the onset of childhood functional gastrointestinal disorders. Rev Gastroenterol Mex. 2013;78(2):82-91. DOI:

Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-4. DOI:

Hancock A. IBS in Children: A Guide for Parents and Caregivers [Internet]. Australia: Mindset Health; 2021 June. [cited 2024 March 21]. Available from:

Henderson P, Casey A, Lawrence SJ, Kennedy NA, Kingstone K, Rogers P, et al. The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease. Am J Gastroenterol. 2012;107(6):941-9. DOI:

MES FG, Eliakim R, Fedorak R, Gangl A, Garisch J, Kaufmann P. Probiotics and prebiotics [Internet]. 1st ed. United States: World Gastroenterology Organisation; 2017 Feb. [cited 2024 March 21]. Availabe from:

Huang W, Jiang SM, Jia L, You LQ, Huang YX, Gong YM, Wang GQ. Effect of amitriptyline on gastrointestinal function and brain-gut peptides: a double-blind trial. World J Gastroenterol. 2013;19(26):4214-20. DOI:

Horvath A, Dziechciarz P, Szajewska H. Systematic review of randomized controlled trials: fiber supplements for abdominal pain-related functional gastrointestinal disorders in childhood. Ann Nutr Metab. 2012;61(2):95-101. DOI:

Rutten JM, Reitsma JB, Vlieger AM, Benninga MA. Gut-directed hypnotherapy for functional abdominal pain or irritable bowel syndrome in children: a systematic review. Arch Dis Child. 2013;98(4):252-7. DOI:

Dogan G, Yavuz S, Aslantas H, Ozyurt BC, Kasirga E. Is low FODMAP diet effective in children with irritable bowel syndrome? North Clin Istanb. 2020;7(5):433-7. DOI:

Turco R, Salvatore S, Miele E, Romano C, Marseglia GL, Staiano A. Does a low FODMAPs diet reduce symptoms of functional abdominal pain disorders? A systematic review in adult and paediatric population, on behalf of Italian Society of Pediatrics. Ital J Pediatr. 2018;44(1):53. DOI:

Hills GAoB. Low FODMAP Diet [Internet]. Los Angeles, CA: Gastroenterology Associates of Beverly Hills; 2023 January 12. [cited 2024 March 21]. Available from:

Alammar N, Wang L, Saberi B, Nanavati J, Holtmann G, Shinohara RT, Mullin GE. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Complement Altern Med. 2019;19(1):21. DOI:

Cherry RN, Blanchard SS, Chogle A, Santucci NR, Mehta K, Russell AC. Herbal Approaches to Pediatric Functional Abdominal Pain. Children. 2022;9(8):1266 DOI:

Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr. 1996;129(2):220-6. DOI:

Miwa H, Ghoshal UC, Gonlachanvit S, Gwee KA, Ang TL, Chang FY, et al. Asian consensus report on functional dyspepsia. J Neurogastroenterol Motil. 2012;18(2):150-68. DOI:

Camilleri M, Stanghellini V. Current management strategies and emerging treatments for functional dyspepsia. Nat Rev Gastroenterol Hepatol. 2013;10(3):187-94. DOI:

Dehghani SM, Imanieh MH, Oboodi R, Haghighat M. The comparative study of the effectiveness of cimetidine, ranitidine, famotidine, and omeprazole in treatment of children with dyspepsia. ISRN Pediatr. 2011;2011:219287. DOI:

Rodriguez L, Diaz J, Nurko S. Safety and efficacy of cyproheptadine for treating dyspeptic symptoms in children. J Pediatr. 2013;163(1):261-7. DOI:

Azmy DJ, Qualia CM. Review of Abdominal Migraine in Children. Gastroenterol Hepatol (N Y). 2020;16(12):632-9

Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S. Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress. J Pediatr Gastroenterol Nutr. 2011;53(6):659-65. DOI:

Devanarayana NM, Rajindrajith S, Rathnamalala N, Samaraweera S, Benninga MA. Delayed gastric emptying rates and impaired antral motility in children fulfilling Rome III criteria for functional abdominal pain. Neurogastroenterol Motil. 2012;24(5):420-5, e207. DOI:

Zernikow B, Wager J, Hechler T, Hasan C, Rohr U, Dobe M, et al. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatrics. 2012;12(1):54. DOI:

Yacob D, Di Lorenzo C, Bridge JA, Rosenstein PF, Onorato M, Bravender T, Campo JV. Prevalence of pain-predominant functional gastrointestinal disorders and somatic symptoms in patients with anxiety or depressive disorders. J Pediatr. 2013;163(3):767-70. DOI:

Boey CC, Goh KL. The significance of life-events as contributing factors in childhood recurrent abdominal pain in an urban community in Malaysia. J Psychosom Res. 2001;51(4):559-62. DOI:

van Tilburg MA, Runyan DK, Zolotor AJ, Graham JC, Dubowitz H, Litrownik AJ, et al. Unexplained gastrointestinal symptoms after abuse in a prospective study of children at risk for abuse and neglect. Ann Fam Med. 2010;8(2):134-40. DOI:

Walker LS, Smith CA, Garber J, Claar RL. Testing a model of pain appraisal and coping in children with chronic abdominal pain. Health Psychol. 2005;24(4):364-74. DOI:

Saps M, Youssef N, Miranda A, Nurko S, Hyman P, Cocjin J, Di Lorenzo C. Multicenter, randomized, placebo-controlled trial of amitriptyline in children with functional gastrointestinal disorders. Gastroenterology. 2009;137(4):1261-9. DOI:

Bahar RJ, Collins BS, Steinmetz B, Ament ME. Double-blind placebo-controlled trial of amitriptyline for the treatment of irritable bowel syndrome in adolescents. J Pediatr. 2008;152(5):685-9. DOI:

Roohafza H, Pourmoghaddas Z, Saneian H, Gholamrezaei A. Citalopram for pediatric functional abdominal pain: a randomized, placebo-controlled trial. Neurogastroenterol Motil. 2014;26(11):1642-50. DOI:

Vlieger AM, Rutten JM, Govers AM, Frankenhuis C, Benninga MA. Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome. Am J Gastroenterol. 2012;107(4):627-31. DOI:

Levy RL, Langer SL, Walker LS, Romano JM, Christie DL, Youssef N, et al. Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. Am J Gastroenterol. 2010;105(4):946-56. DOI:



How to Cite

Functional Abdominal Pain in Children. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2024 May 31 [cited 2024 Jun. 23];3(2):35-51. Available from: