Introduction

This guideline relates to abdominal pain in paediatric patients. For more information on how to assess and manage abdominal pain, please see: Clinical Practice Guidelines: Abdominal pain - acute or Clinical Practice Guidelines: Abdominal pain - chronic.

Unless referred by a paediatrician, paediatric patients with chronic abdominal pain will most likely be seen by General Medicine in the first instance. 

When to refer

• Patients aged 0-16 years
• Abdominal pain > 8 weeks without concerning features
• Abdominal pain (any time frame) with any of the following concerning features to be seen by a paediatrician in the first instance:
  • Faltering growth (weight loss > 2 weight centiles)
  • Iron deficiency anaemia (Hb <90)
• Abdominal pain (any time frame) with any of the following concerning features to be seen by a gastroenterologist:
  • Elevated inflammatory markers if infection excluded (stool MCS or PCR negative)
  • Tissue transglutaminase IgA (TTG IgA) > 10 x upper limit normal (ULN)
  • Associated, persistent bloody diarrhoea >2 weeks with infection excluded

If any of the following are present or suspected, please direct the patient to the Emergency Department (no referral required):

• Acute, severe abdominal pain for surgical review:
  • Peritonitis, infarction or obstruction (e.g., rigid abdomen, guarding, pain out of proportion to clinical signs)
  • Suspected bowel obstruction (e.g., bilious vomiting, significant distention, lack of passage of flatus)
  • Suspected ectopic pregnancy, ovarian torsion or testicular torsion
  • Suspected appendicitis
  • Acute inflammatory condition with systemic signs of sepsis requiring intravenous antibiotics, urosepsis, gynaecological sepsis, cholecystitis
  • Abdominal pain associated with acutely irreducible hernia
• Shock or sepsis

Services available closer to home

Other hospitals with public paediatric general medicine/gastroenterology services include:

• Austin Hospital
• Box Hill Hospital (Eastern Health)
• Monash Medical Centre
• The Northern Hospital
• Sunshine Hospital (Western Health)

Referral criteria/required information

• Detailed history and assessment, including duration of symptoms  
• Growth charts, including current weight
• Blood tests:
  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR)
  • Full blood count (FBC)
  • Iron studies
  • Liver function test (LFT)
  • Lipase
  • Coeliac serology: TTG IgA, total IgA (where possible) with or without anti-endomysial antibody (EMA)
  • Deaminated anti gliadin
• Stool MCS, PCR and microscopy
• Any previous investigations e.g., x-ray, ultrasound, endoscopy

How to refer

RCH Specialist Clinics Referral.pdf

Please complete the above and submit via:

• Fax (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED admitting officer or Gastroenterology Outpatient Consult Fellow on (03) 9345 5522. If after hours, ask for Gastroenterology fellow on call

Information for families

Kids Health Info : Abdominal pain

Resources and links

• Clinical Practice Guidelines : Abdominal pain - acute
• Clinical Practice Guidelines : Abdominal pain - chronic
• Kids Health Info : Abdominal pain

Acknowledgements

The development of this guideline was coordinated by the Department of Gastroenterology (A/Prof. George Alex). Guideline reviewed in July 2025.