Recurrent Abdominal Pain or RAP is like Rap music! Very difficult to understand! You and your doctor may indulge in endless investigations without coming to any diagnosis. Mrs. Neeta Mehta came to my clinic with the following problem: "My eight-year-old son Apoorv keeps complaining of Stomach aches. He has undergone checkups and medication several times. He still talks about Stomach Discomfort and Uneasiness. What can be done about it?" I am reproducing my answer in the form of this article. I am sure it will be of help to many parents, who have at some point of time faced this not so uncommon riddle. Recurrent Abdominal Pain or RAP is like Rap music! Very difficult to understand! You and your doctor may indulge in endless investigations without coming to any diagnosis. However, a basic 'stool and urine' routine and microscopic examination along with Ultrasonography (USG) of abdomen should always be carried out in all children having RAP. If your child has pain in the abdomen, but otherwise looks well, you can be almost sure that the problem is not serious. See the doctor, if you have cause to be anxious. Some important causes of abdominal pain in children are: Psychological Factors, Medical Causes and Surgical Conditions. Psychological Factors School going children often complain of recurrent abdominal pain, generally located around the navel. In most cases, the pain is not severe and the child forgets all about it, if he/ she is involved in doing something interesting. It rarely wakes the child from sleep and the child is perfectly all right in between the attacks, which may last for a few moments or longer, but rarely for more than half an hour. Usually such children are quite intelligent. Emotional trauma due to any reason may be the cause of abdominal pain in such children. Is the child being bullied in school? Is the child afraid of a new teacher? Are the examinations causing much anxiety? Is the child upset because of a quarrel between the parents? It is not always easy to probe the mind of a child. If the symptoms persist, take the advice of a doctor, who may even refer the child to a family counselor, psychologist or a psychiatrist. Don't upset the child by remarks like, "You are just acting" or "Do not try to fool us". Such children do get pain, but the symptom is probably related more with the mind rather than the body - possibly a subconscious way of attracting parents' attention for more body contact. Hence, the treatment lies in understanding the child and helping the child overcome the emotional problem, if any. Medical Causes Although various worm infestations can cause abdominal pain, a tendency to presume that they are the predominant cause in most cases is wrong. Roundworms, threadworms, hookworms and whipworms can be eradicated by administering Albendazole or Mebendazole. Care must be taken to treat the entire family, if worms are found in the stool of any member. For treating Tapeworms, Niclosamide and Praziquantel are used. Giardiasis and Amebiasis may be suspected in children with persistent or recurrent pain in the abdomen. A stool examination of a fresh sample is asked for to confirm the diagnosis. A course of Metronidazole will solve the problem in most cases. In some cases, ameba may invade the liver and cause Hepatic Amebiasis. This leads to abdominal discomfort and pain of varying degrees. If treated inadequately, it may lead to liver abscess. A full course of Metronidazole or Tinidazole must be administered to cure this condition. Secnidazole and Ornidazole can also be tried. In some difficult cases, a long course of Chloroquine may be given. Bacillary Dysentery is another important cause of griping pain in the abdomen along with passage of blood or mucus in the stool, which may not necessarily be loose. This condition can be treated by the use of a wide variety of antibiotics. Surgical Conditions Appendicitis, Intestinal Obstruction, Intussusceptions, Strangulated Hernia, Torsion of Testes, all begin with abdominal pain before other signs and symptoms appear. Pain increases in intensity rapidly and if surgical intervention is not done in time, condition may become life threatening. Other common surgical condition that can cause spasmodic pain in the abdomen is stone in the urinary tract. Onset of pain, when stone is present, is sudden. Pain is often located in the back and extends towards the groin. A dull ache persists, with outbursts of shooting unbearable pain. This may be associated with passage of blood in the urine. Ultrasonography can usually clinch the diagnosis. Cystoscopy, Laser or conventional surgery may be required for removing the stone depending upon its site and size.