Version May 2024
| 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 |
| Onset and course of pain | May suggest an organic disorder or category of organic disorders (eg, pain related to lactase deficiency occurs approximately two 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 | Nighttime and/or early morning – Abdominal migraine Nighttime – GERD |
| Location and radiation of pain | May suggest an etiology Location
|
| Quality of pain | Burning – Acid-peptic disease Crampy – Gastroenteritis, biliary obstruction, IBS Aching – Referred |
| Severity 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 three 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, or 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 |
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