Historical feature | Potential significance |
Alarm symptoms | |
Involuntary weight loss, difficulty swallowing or painful swallowing, significant vomiting*, chronic severe diarrhea¶, unexplained fever, urinary symptomsΔ, back pain, blood in stool | Increase likelihood of organic etiology |
Pain | |
Pain triggers (eg, foods, activities, stressors, etc) | May identify areas for intervention Prandial or postprandial – Gastroesophageal, pancreatobiliary, functional, carbohydrate intolerance, allergies |
Onset and course of pain | May suggest an organic disorder or category of organic disorders (eg, pain related to lactase deficiency occurs approximately 2 hours after eating, whereas acid-peptic disease is exacerbated by eating) May suggest a stress-related pain trigger (eg, pain that occurs during academic examinations) |
Timing of pain |
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Location and radiation of pain | May suggest an etiology Location
Radiation
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Quality of pain | Burning – Acid-peptic disease Crampy – Gastroenteritis, biliary obstruction, IBS Aching – Referred |
Impact of pain | Provides information about how the pain affects the child and family |
What is the child's and family's response to the pain? | May identify reinforcing factors (eg, attention) |
Aggravating and relieving factors | |
Aggravating or relieving factors, including medications and dietary factors (eg, cow's milk) | Relief with eating or acid suppression – Acid-peptic disorders, Helicobacter pylori Relief with avoidance of fat – Cholelithiasis, chronic pancreatitis, IBS Relief with avoidance of cow's milk – Lactose intolerance |
Associated symptoms | |
Associated symptoms (eg, rash, joint pain, anorexia, nausea, bloating, diarrhea, hoarseness, chronic cough) | May suggest a specific etiology (eg, IBD, GERD, IBS) |
Past history | |
History of trauma or past surgeries | May predispose to organic conditions (eg, splenic infarct, adhesions) |
Family history | |
Gastrointestinal disease (eg, IBD, celiac disease, IBS, constipation) | May suggest an particular organic or functional condition |
Migraine headaches | May be associated with abdominal migraine |
Habits | |
Dietary history, including fiber intake and juice consumption | Low-fiber intake may be associated with constipation Excessive juice consumption may be associated with carbohydrate malabsorption |
Restrictive eating behavior/desire to lose weight; purging behavior/self-induced vomiting; excessive exercise | May suggest an eating disorder |
Stool habits; ask specifically about stool frequency and size as well as soiling of undergarments (the child and parents may not recognize constipation) | Constipation (functional or organic) may cause abdominal pain; chronic diarrhea suggests organic disease |
Review of systems | |
Dates of 3 last menstrual periods, relationship of pain with menses | May suggest gynecologic cause of abdominal pain |
History of sexual activity and contraception | Sexually transmitted infections and pregnancy (or ectopic pregnancy) may cause abdominal pain |
Psychosocial history | |
Disruption of normal activities by the pain (eg, sleep, school attendance, sports, social interactions) | Provides information about how the pain affects the child and family |
Any known stressors for the child and adolescent (eg, school problems, divorce, emotional trauma, loss)? Is there a temporal relationship between the stressor and symptoms? | Stress can affect pain perception (organic or functional) |
HEEADSSS assessment (for adolescents) | May identify triggers, stressors, areas for intervention, or provide information about how the pain affects the adolescent and family |
GERD: gastroesophageal reflux disease; HEEADSSS: Home, Education/employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety; IBD: inflammatory bowel disease; IBS: irritable bowel syndrome; LLQ: left lower quadrant; RLQ: right lower quadrant; RUQ: right upper quadrant.
* Significant vomiting – Bilious, protracted, or otherwise worrisome.
¶ Chronic severe diarrhea – ≥3 loose or watery stools per day for ≥2 weeks.
Δ Urinary symptoms – Change in bladder function, dysuria, hematuria, flank pain.Do you want to add Medilib to your home screen?