The diagnosis of RAP should be based on a thorough history, physical
examination, and review of symptoms. A psychosocial history is essential
to learn how the child and family cope with pain and to identify
school avoidance and reinforcers of pain. A history of fever, weight
loss, growth failure, rash, or other symptoms of systemic illness
should prompt further investigation of organic causes.13,14 Occurrence
of persistent pain or recurrent abdominal pain in a child younger
than 4 years of age is also of concern. A physical examination should
include a rectal examination with stool guaiac, evaluation for undescended
testes, hernias, and abdominal masses. Findings on history and physical
examination that suggest a possible underlying organic disorder
should serve as a guide to laboratory and diagnostic testing. In
general, extensive routine screening tests such as endoscopies,
barium studies, and other radiographic studies are of low yield,
particularly when there are no specific clinical suspicions from
history or physical examination. In addition to a careful history
and physical examination, baseline complete blood count, sedimentation
rate, and urinalysis are reasonable screening tests to help rule
out occult organic disease. A family history of inflammatory bowel
disease in a child with chronic abdominal pain warrants further
laboratory and possibly diagnostic testing. In children who experience
chronic persistent abdominal pain, rather than the more characteristic
episodic pain of RAP, laparoscopy identified treatable conditions
in a high percentage of cases.15,16