Recurrent Abdominal Pain in Children and Adolescents: Classification, Epidemiology, and Etiology/conceptual Models

The term recurrent abdominal pain (RAP) has been used and defined in various ways over time. Almost every paper or presentation on RAP, however, begins with a reference to Apley's criteria (Apley, 1975; Apley & Hale, 1973; Apley & Naish, 1958). According to Apley, RAP is characterized by three or more episodes of abdominal pain that occur over at least three months and are severe enough to interfere with activities, such as school attendance and performance, social activities, and participation in sports and extracurricular activities. Clinically, these episodes are characterized by vague abdominal pain that may be dull or crampy, lasts for less than 1 hour, and is poorly localized or periumbilical (Frazer & Rappaport, 1999). The pain frequently presents with nausea, vomiting, and other signs of autonomic arousal (Apley, 1975). Though the term RAP is most often used to refer to functional abdominal pain, Apley's original description is broad and does not have specific etiological implications. The majority of children with RAP do not have a specific physical disorder or organic disease. Most investigators report that only 5-10% of affected children have an organic cause for their pain (Apley, 1975; Apley & Hale, 1958).