I was bothered by Dr. Perri Klass' article on abdominal pain in children in the 11/23/10 New York Times. Dr. Klass is a well respected Harvard pediatrician, as well as an author. However, I believe her conclusion that so many cases of abdominal pain in kids are functional is overstated. In my fifty years of practicing pediatrics and seeing kids from all walks of life, I believe making the diagnosis of functional pain and prescribing sedatives or counseling is not a wise aprproach unless some other problems are considered.
One of the most important problems Dr. Klass failed to discuss is allergy. Many children get stomach aches because they are allergic to specific foods. This is not celiac disease; this is allergy. There may be a family history of allergy and a child may have other signs of the so-called allergic diathesis, such as eczema, hayfever or asthma. A pediatric allergist can often make the correct diagnosis. A doctor friend developed severe headaches and stomach aches and every possible test was done except for allergy tests. Finally, my doctor friend solved the problem by realizing that chocolate was the cause of her headaches and stomach aches.
The other significant omission in the article is urinary infections or problems with the urinary system. Congenital abnormalities of the kidney, bladder, ureters, and urethra are often not considered and urinary infection can be a significant cause of abdominal pain. A urinalysis and urine culture should always be done, as well as a study of the urinary system. I have solved many kids' stomach aches with this approach. There is often a history of urinary malformations and problems in a family.